Cannabis is the most commonly used illicit drug in the United States with over 16.7 million users in 2009 1. The 18–25 year old age group has the highest prevalence of marijuana use 1. The majority of these individuals are less than nineteen years of age 2. Similarly in Europe, cannabis use is prominent among young adults, with a prevalence that has increased from 5% in 1990 to 15% in 2005 3. While the overall prevalence of marijuana use has remained stable in the United States at 4%, the prevalence of cannabis use disorders (i.e. cannabis dependence, cannabis abuse) has continued to rise 4.
A paradoxical condition
Symptoms of CHS typically come on several years after the start of chronic marijuana use. Not everyone with the Oxford House condition seeks medical help or tells their provider that they use marijuana. Another doctor reported using a combination of injectable lorazepam and promethazine, another antinausea medication. In CHS, receptors that bind to the different components of marijuana can become altered.
A Guide to Cannabis Hyperemesis Syndrome (CHS)
Δ9-tetrahydrocannabinol (THC) is the principle active compound in cannabis (Figure 1). The metabolism of THC occurs mainly in the liver via oxidation and hydroxylation reactions. In humans this is carried out largely by the CYP2C isoenzyme subfamily of the cytochrome P450 complex 19.
What Is Cannabinoid Hyperemesis Syndrome?
Abdominal X-rays and head CT scans may also be needed to confirm a CHS diagnosis. Normally, when the gastrointestinal system detects that a toxin or other pathogen has entered the stomach, it “tells” the brain to release neurotransmitters into the gastrointestinal tract. Cannabis seems to stop the release of chemicals that cause nausea and, sometimes, vomiting. The condition is a rare phenomenon and it does not affect all smokers. When the marijuana consumer experiences extreme vomiting for one whole day or more, contacting the health care provider is the best possible option. One of the first steps doctors suggest is to stop consuming marijuana.
MNGI Digestive Health: A Commitment to Quality Care and Exceptional Patient Outcomes
Cannabidiol, in contrast to THC, is non-psychotropic, has a low affinity for CB1 and CB2 receptors 27, and acts as a partial agonist at the 5-HT1A receptor 28. CBD enhances the expression of CB1 receptors in the hypothalamus and amplifies the hypothermic effects caused by THC 29. In animals the effect of CBD on toxin-induced vomiting displays a biphasic response with low doses producing an anti-emetic effect whereas higher doses enhance vomiting 30,31. The diagnosis of the syndrome is one of the trickiest parts of the story because people often fail to report using marijuana to their health care providers. Once the syndrome is finally diagnosed, the patient gets familiar with the condition, learns what CHS is, and begins treatment. The most important part of the recovery process is the stopping of weed consumption.
- Prevalence cannot accurately be determined until accurate diagnosis and classification are agreed upon.
- That’s because the development of the syndrome takes a lot of time.
CHS Symptoms
Preventing dehydration and stopping nausea and vomiting are the treatment goals during the hyperemesis stage of the condition. One doctor reported using injectable lorazepam to help control what are the 3 stages of chs nausea and vomiting symptoms in an adult. Within 10 minutes, nausea and vomiting stopped, and the person no longer felt abdominal pain. Cannabinoid hyperemesis syndrome (CHS) is a condition that sometimes develops due to the long term use of marijuana. Treatment for cannabinoid hyperemesis syndrome often involves supportive therapy with intravenous fluids and anti-emetic medications. During the hyperemetic phase, IV fluids might include lorazepam, proton pump inhibitors, and sodium chloride solution.
More research is still needed to understand the impact of cannabinoids on hypothalamic endocannabinoid and endocannabinoid-related enzymes. When researchers started investigating CHS several years ago, they found that people in the hyperemic stage were taking numerous hot showers during the day to relieve nausea and vomiting. At first, researchers thought the compulsion to take hot showers was a psychological side effect of CHS. They later learned this was a type https://ecosoberhouse.com/ of “learned” behavior due to the ability of hot water to lessen the severity of nausea, vomiting, and stomach pain. Nausea remains ongoing during the hyperemic phase and is no longer confined to the morning hours.
THC-COOH, in contrast, is a non-psychotropic metabolite that possesses anti-inflammatory and analgesic properties 26. I am currently on day 23 of sobriety, and will continue to update this as I progress through recovery. The first of these goals is to provide some sort of general timeline as to recovery from CHS, so that those who are new here can get some sort of general idea of when they can expect to be feeling better. The second goal is to be able to plot these points on graphs, in order to look for specific trends both overall, and within particular categories. Experts say that you must avoid cannabis in order to prevent CHS. The symptoms typically last a few weeks, though the throwing up should ease up in a day or two.
- Substances like THC (tetrahydrocannabinol) and other chemicals in cannabis bind to molecules in your brain to trigger the “high” that can occur when using cannabis products.
- CHS symptoms often subside within two days, although some effects persist for several weeks.
- Nausea remains ongoing during the hyperemic phase and is no longer confined to the morning hours.
- At first, researchers thought the compulsion to take hot showers was a psychological side effect of CHS.
- 11-OH-COOH is a psychotropic metabolite that is equipotent to THC in terms of producing psychic effects and lowering intraocular pressure 25.
Another proposed explanation is that in susceptible individuals the pro-emetic effect of cannabis on the gut (e.g. delayed gastric emptying) overrides its anti-emetic CNS properties 62. This hypothesis is supported by the demonstration of delayed gastric emptying on gastric emptying scintigraphy in some cases 6,55,62. Further research is required to investigate the gastrointestinal physiology in these patients during both the acute attacks of hyperemesis and between episodes. Cannabis Hyperemesis Syndrome (CHS) is a rare but important condition that can affect long-term, frequent cannabis users. It manifests through recurrent episodes of severe nausea, vomiting, and abdominal pain.
ABOUT THE AUTHOR
Mohit Khera, MD, MBA, MPH, is the Professor of Urology and Director of the Laboratory for Andrology Research at the McNair Medical Institute at Baylor College of Medicine. He is also the Medical Director of the Executive Health Program at Baylor. Dr. Khera earned his undergraduate degree at Vanderbilt University. He subsequently earned his Masters in Business Administration and his Masters in Public Health from Boston University. He received his MD from The University of Texas Medical School at San Antonio and completed his residency training in the Scott Department of Urology at Baylor College of Medicine. He then went on to complete a one-year Fellowship in Male Reproductive Medicine and Surgery with Dr. Larry I. Lipshultz, also at Baylor.
Dr. Khera specializes in male infertility, male and female sexual dysfunction, and declining testosterone levels in aging men. Dr. Khera’s research focuses on the efficacy of botulinum toxin type A in treating Peyronie’s disease, as well as genetic and epigenetic studies on post-finasteride syndrome patients and testosterone replacement therapy.
Dr. Khera is a widely published writer. He has co-authored numerous book chapters, including those for the acclaimed Campbell-Walsh Urology textbook, for Clinical Gynecology, and for the fourth edition of Infertility in the Male. He also co-edited the third edition of the popular book Urology and the Primary Care Practitioner. In 2014, he published his second book Recoupling: A Couple’s 4 Step Guide to Greater Intimacy and Better Sex. Dr. Khera has published over 90 articles in scientific journals and has given numerous lectures throughout the world on testosterone replacement therapy and sexual dysfunction. He is a member of the Sexual Medicine Society of North America, the American Urological Association, and the American Medical Association, among others.
