As CHS is a relatively recently recognized and studied phenomenon easily confused with other diseases, there is a paucity of sizeable randomized control studies. Most resources and recommendations come from case studies and expert opinions. In addition to appropriate antiemetic therapy, fluid resuscitation, and management of the patient’s symptoms, patients must recognize behaviors and exposures that place them at risk for their pathology. For supportive care, a clinician should work together with the pharmacist to see if any medications could contribute to the patient’s presentation. If administering antiemetics, the nursing staff should be familiar with the adverse event profile so they can report any concerns that may arise. Indeed, with any syndrome that results in frequent vomiting, there is a concern for a disorder of electrolytes and fluid balance in the body.

The importance of quitting cannabis with CHS

In animal studies mice lacking CB1 receptors demonstrate enhancement in circadian HPA axis activity peaks and impairment in glucocorticoid feedback [39]. The only way to stop CHS and its symptoms is to completely quit using cannabis. Most people who quit using cannabis experience no more CHS symptoms within 10 days, but sometimes it may take weeks or months for symptoms to stop. Symptoms of CHS likely won’t return if you’ve completely stopped using cannabis. One study found up to 6% of people who went to the emergency room for cyclical vomiting had CHS.

The Endogenous Cannabinoids (Endocannabinoids)

One 2018 study found that 32.9% of self-reported frequent marijuana users who’d gone to the emergency room (ER) had symptoms of CHS. And a 2022 Canadian study found that ER visits for CHS-related problems had https://ecosoberhouse.com/ increased 13-fold between 2014 and 2021. (Recreational use and sale of cannabis in Canada was legalized starting in 2018). It’s not clear what percentage of all heavy marijuana users have experienced CHS.

How we reviewed this article:

In the prodromal phase the patient has morning predominance of nausea, usually without emesis. This is followed by the hyperemesis phase, which is characterized by hyperemesis, vague abdominal pain, and learned compulsive hot bathing. With the emergence of cannabis and its widespread usage in various settings, clinicians and users should cannabinoid hyperemesis syndrome be more aware of the long-term effects of cannabinoids. CHS is a potential side effect of prolonged cannabis use, causing major distress to consumers. While synthetic cannabinoids have been accepted as one of the main drugs to relieve N/V, their dosage and duration of administration have not been thoroughly investigated long term.

As CHS is a new diagnosis, the manufacturers of these drugs did not design them for treating CHS, but a doctor may opt to prescribe them for this use. Another doctor reported using a combination of injectable lorazepam and promethazine, another antinausea medication. It should be noted that the majority of evidence found for haloperidol were case studies, which had limited generalizability [30, 31, 33]. A systematic review was conducted using PubMed, Ovid MEDLINE, Cochrane Central, EMBASE, and Google Scholar. Databases were used to search for articles on CHS published from January 2009 to June 2021, yielding 225 results of which 17 were deemed relevant and underwent review by 2 separate reviewers. All data generated or analyzed during this study are included in this article and its supplementary material files.

What are other impacts of cannabis use?

• Chronic cannabinoid usage can lead to recurrent N/V with distinct pathogenesis, known as CHS.
• Since there are so many active chemicals in cannabis, the exact cause of cannabinoid hyperemesis syndrome is unknown.
• Topical capsaicin and haloperidol are currently the only treatment with efficacy validated in RCTs [22, 32].
• Clinical guidelines for the diagnosis of CHS do not currently exist.
• The aim of this systematic review was to highlight current management options for CHS as a potential adverse effect of long-term cannabis use in adults and older populations.
• Furthermore, gastric emptying rates in patients with CVS are often accelerated rather than delayed [46,65].

People in the hyperemesis stage will experience intense and persistent nausea and vomiting. Doctors also noticed that individuals with CHS would take frequent hot showers and baths. Richards and Dutzak [34] presented a single case study that examined an extreme case of CHS in the ER who had intractable N/V, abdominal discomfort and who was unresponsive to standard antiemetics.

The metabolism of anandamide is principally carried out via fatty acid amide hydrolase (FAAH), whereas the major enzyme metabolizing 2-AG is monoacylglycerol lipase (MAGL) [18]. CHS symptoms typically present in a cyclical pattern every few weeks to months when cannabis is being used. Experts believe only a fraction of habitual cannabis users develop CHS.

What are the symptoms of cannabinoid hyperemesis syndrome?

Further, genetic polymorphisms in the metabolic P450 enzymes lead to a change in the metabolic rate of THC breakdown causing hyper or hyposensitivity [12, 13]. In-depth mechanisms for different CHS hypotheses are presented in Figure ​Figure11. To help you transition to the recovery phase, you can try a few home remedies such as regular hot baths. But too many of them may increase your risk for dehydration due to sweating. In older patients, especially those with hypertension, cardiovascular illnesses such as aortic pathology and atypical coronary artery syndromes may present as vague abdominal pain, nausea, and vomiting. Ceasing and abstaining from the use of cannabis is the only treatment that relieves and prevents symptoms of CHS, according to a systematic review on CHS management.

People who use marijuana long-term — typically for about 10 to 12 years — are at risk of developing CHS. But not every person who uses marijuana, even long-term use, develops CHS. Treatment that helps prevent dehydration and loss of electrolytes can help reduce your risk of many of these problems. If you do use cannabis, quitting can ward off future episodes of CHS.