With the changing climate of marijuana laws, it is an important condition to consider when establishing a differential. More studies will be required to evaluate the overall prevalence of this condition as well as if there are any changes following the liberalization of marijuana laws in many states. CHS tends to affect younger people; the patients reported in Table ​Table22 ranged in age from 15 to 47 years.

Cannabinoid Hyperemesis Syndrome (CHS): Causes, Symptoms, Treatment

Darmani suggested that there is growing evidence that CHS is not as rare among chronic cannabis abusers as initially estimated [6]. After stopping cannabis use, symptoms typically start to disappear within one to two days though individual results can vary. However, symptoms almost always return if you resume using marijuana. Since its symptoms are easily confused with other conditions, it can take about one to two years before people who seek medical help with CHS get an accurate diagnosis. In severe cases, not having enough fluid in your body can lead to kidney problems. Since CHS is thought to occur only with long-term marijuana use, a CHS diagnosis is often ruled out for adolescents and children.

Cannabis Cessation

Another patient in the series, a 31-year-old man, discontinued marijuana for a short time, then resumed and periodically visits the ED to manage symptoms [102]. The third patient (20-year-old man) stopped marijuana use for 2 months after CHS diagnosis, but resumed again, which resulted in another hospitalization [102]. On the second visit, CHS was diagnosed and the patients were treated with capsaicin cream 0.025% applied in a layer approximately 1 mm thick on the abdomen. In both cases, topical capsaicin provided symptomatic relief in about 30 min. Both patients reported a burning sensation where the capsaicin was applied but were satisfied with the results [97].

• In this case series, the investigators noted that this latter patient − who continued to use cannabis − had the greatest number of acute episodes of CHS [129].
• Although some clinical findings (psychiatric comorbidities, migraine, rapid gastric emptying) may make an indication towards one or the other, these features are at best of supportive nature (Table 1 (Tab. 1)).
• Symptoms of CHS typically come on several years after the start of chronic marijuana use.

Follow-up of CVS and CHS

It is not unusual for CHS patients to present frequently at the ED and to be hospitalized multiple times per year. This suggests that prompt, accurate diagnosis of CHS may save the healthcare system considerable resources and spare the patient unnecessary testing and procedures. The same factors apply to clinicians, specialists, nurses, and pharmacists, as well as other healthcare personnel, to consider the diagnosis in any chronic vomiting disorder, and to better inform themselves regarding the condition. They should also have the freedom and empowerment to speak up to other team members if they feel that this may be getting overlooked in the diagnostic picture. Since the only treatment is the removal of the offending agent, accurate diagnosis is the only portal to actual management. The ECS is actively involved in motility, secretions, emesis, satiety and inflammation [32].

Deterrence and Patient Education

Most CHS patients discover the symptomatic relief of hot showers on their own and use this method to control symptoms [1]. In a case study from Texas, a 27-year-old male patient with CHS reported he found relief in hot showers but over time, he became refractory to the hot water and ended up having to visit the ED [105]. It is not known if certain varieties of botanical marijuana are more likely to produce CHS than others. Furthermore, the role of cytochrome (CYP) P450 metabolism and genetic polymorphisms might play a role in terms of why certain individuals are susceptible to CHS. Genetic polymorphisms of the cytochrome P (CYP) 450 enzyme system, such as CYP2CP, CYP2C19, or CYP3A4 could cause an individual to accumulate excessive amounts of cannabinoid metabolite(s) which might promote vomiting. For example, THC has two main metab­olites (11-hydroxy-delta9-tetrahydrocannabinol or 11-OH- THC and 11-nor-9-carboxy-THC-delta9-tetrahydrocannabinol or THC-COOH) but it also has over 100 minor metabolites [40].

Appointments & Care

• Cutaneous problems arise typically from prolonged and excessive exposure to very hot water, heating pads, or hot water bottles.
• This is more common in men than women and usually starts around 35 years old.
• While stress response is vital to survival, prolonged stress increases the allostatic load and can have adverse effects on health [58, 59].

One treatment that’s been highly effective in treating CHS is topical capsaicin (yes, the stuff that gives hot peppers their heat). A 2015 study found that out of 13 patients admitted to the hospital with CHS, using a capsaicin cream got rid of the symptoms in all 13 patients. The human body responds to the endocannabinoids in cannabis because of the endocannabinoid receptors we have throughout the body.

Unveiling the Complexities of Cannabinoid Hyperemesis Syndrome: Mechanisms Underlying CHS

This material is intended for general information only and is provided on an «as is», «where is» basis. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use. Some people may feel better with cream (capsaicin) applied to the stomach area. If you are worried about your symptoms, see your doctor or go to the hospital.

Unlike CVS and PV, CHS is not usually relieved by antiemetic pharmacological therapy, but many patients exhibit the learned behavior of taking hot showers and baths for temporary symptomatic relief. In some cases, IV haloperidol or lorazepam (for anxiety) may provide relief for the CHS patient [14, 89]. In the literature, there is one case report of “atypical CHS” in which the patient found relief from cold showers or other ways to chill himself (use of a fan, lying on cold marble floor) but this case must be viewed as an outlier [99]. Treatment guidelines published by the San Diego Emergency Medicine Oversight Commission recommend supportive care (rehydration), patient education, and counsel to stop the use of cannabinoids [100]. Topical capsaicin can be used to provide symptomatic relief but symptoms typically resolve in a day or two without cannabinoid use regardless of treatment. Benzodiazepines and opioids, although sometimes prescribed, have very limited effectiveness for this condition [100].

What happens if I stop using cannabis?

• Ultimately, Vakharia has real concerns about the people using CHS as an excuse to demonize all cannabis use.
• Unlike CVS and PV, CHS is not usually relieved by antiemetic pharmacological therapy, but many patients exhibit the learned behavior of taking hot showers and baths for temporary symptomatic relief.

For example, the drug affects the receptors in the esophageal sphincter, the tight band of muscle that opens and closes to let food go from your throat to your stomach. If this flap doesn’t work properly, your stomach cannabinoid hyperemesis syndrome acids might flow upward and cause you to have nausea and vomiting. One study found that 32.9% of self-reported frequent marijuana users who came to an emergency department for care met the criteria for CHS.

Incidence and Prevalence

An abdominal exam revealed a nontender, nondistended abdomen with no signs of rebound or guarding. An initial workup showed a mild elevation of serum creatinine to 1.36 mg/dL (baseline is 1.10 mg/dL). Other workups, including complete blood count (CBC) with differential, complete metabolic panel, lipase, amylase, and urine analysis, were all unremarkable. The convergence of legislative efforts, increasing prevalence, and tetrahydrocannabinol toxicity make this difficult-to-diagnose condition important to consider. When you stop using cannabis completely, you will usually feel better in 10 days.