In Response to: Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment a Systematic Review

how long does cannabinoid hyperemesis syndrome last

The dose can be gradually increased in 10 mg increments every 1–2 weeks until the G.I. Cardiac arrhythmias have not been observed with gradual dose titration. Amitriptyline is initially started at a low dose of 10 mg at night and gradually increased to 10 mg every 1–2 weeks until the therapeutic effect is achieved 96. Slow up-titration helps to adapt and minimize anticholinergic side effects, including dry mouth, sedation, constipation, postural hypotension, palpitations, chronic fatigue, blurred vision, nightmares, and mild hallucinations.

  • This leads to high THC concentrations, particularly after consuming potent cannabis, which explains its pro-emetic effects 51.
  • The patient had CVS, not CHS, despite a false-positive for marijuana.
  • Researchers are trying to understand why some people develop it and others don’t.
  • Or hospital, and dosage titration can be made during closer outpatient care.

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Patients who fail to respond to antiemetic therapy are at high risk for dehydration and resulting in nutritional deficiencies. Other known complications of forceful and uncontrolled vomiting include aspiration and subsequent pneumonitis or aspiration pneumonia as well as injury to the esophageal wall such as Boerhaave’s syndrome. Serotonin antagonism in the gastrointestinal tract from medications such as ondansetron, dolasetron, and granisetron likewise have varying levels of efficacy. Drugs with an anticholinergic effect may likewise block medullary mediated vomiting, though they may have minimal impact on visceral stimulation, including the crippling abdominal cramping pain that patients with CHS experience. Opioids, while often prescribed for the patient’s debilitating abdominal pain, are not appropriate for CHS, as they may, in fact, worsen nausea and vomiting.

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Cannabinoid hyperemesis syndrome (CHS) is a very unpleasant — and potentially dangerous — complication of long-term marijuana use. Because of this possible complication, it’s important to use caution with marijuana and other cannabis products. If you think you have CHS or cannabis use disorder, talk to a healthcare provider. Like many people who develop CHS, Brandon Danielson was initially misdiagnosed. Doctors thought he had cyclical vomiting syndrome, a condition what is alcoholism with similar symptoms — extreme abdominal pain, severe bouts of vomiting, and nausea. According to his death certificate, Brandon Danielson died of cannabinoid hyperemesis syndrome, or CHS, a condition that results from daily use of cannabis, especially high-THC concentrates.

how long does cannabinoid hyperemesis syndrome last

Cannabinoid Hyperemesis Syndrome Treatment Guidelines

The cause of death in both people was found to be hyponatremic dehydration, also known as low sodium levels. Stopping cannabis use is the only known way to permanently get rid of CHS. Researchers are continuing to examine potential treatment options for CHS. The researchers found that 32.9 percent of the participants reported having experienced symptoms of CHS in the past.

how long does cannabinoid hyperemesis syndrome last

  • A sympathetic overactivity during this phase results in symptoms such as tachycardia, hypertension, hot flashes, sweating, and trembling 42.
  • It tends to affect people who use cannabis at least once a week and happens more often in adults who’ve been using cannabis since their adolescent years.
  • The HPA axis is the main neuroendocrine system activated by the body when confronting stress 56.
  • It should be noted that in the case of CHS, compulsive showering in hot water is not an anxiety disorder but rather a learned behavior that the patient develops to relieve symptoms 94.
  • It blocks NK1 and inhibits the binding of substance P, thereby preventing receptor activation and reducing nausea sensation in the brainstem 85.
  • After about years of chronic marijuana use, patients begin to have a strong feeling of sickness, throwing up, and belly pain.
  • Once cannabis use is stopped, the symptoms of CHS will gradually start to subside.

The enteric nervous system contains CB1 receptors, which, when activated, can inhibit GI motility by inhibiting the release of those transmitters that cause stomach contractions 47. This effect causes delayed gastric emptying and continues to inhibit transit through the small intestine. The effects are similar to gastroparesis and, thus, CHS may be caused by a functional gastroparesis. Activating CB1 receptors reduces gastric motility, resulting in delayed gastric emptying in murine 49, 50 and human studies 51, 52. This applies not just to botanical marijuana; dronabinol (delta-9-tetrahydrocannabinol) slows gastric emptying and decreases colonic tone as well 54. A combination of prescribed pharmaceuticals and OTC pain relievers used as recommended can manage symptoms.1 With continued abstinence and symptom management, full recovery can follow.

Even Mecca Irby, who believed six months ago she was dying from CHS, has cut back but not completely stopped smoking marijuana. Upon her return to the hospital in 2020, Kerby found that teenagers were self-diagnosing CHS. Irby had a hard time connecting the high-potency weed she considered a miracle cure for her depression to what is chs the disabling sickness that occurred a few years later. On several occasions, she got so ill that even the smell of food made her throw up. During her initial six years at Children’s, almost no one knew about CHS. “Illegal production of these products in garages and elsewhere continues to be a significant safety concern,” the association said.

how long does cannabinoid hyperemesis syndrome last

How is cannabis hyperemesis syndrome treated?

It leads to severe nausea, vomiting, and abdominal pain due to overstimulated cannabinoid receptors. Lots of patients with CHS find relief from heat therapy such as hot showers & baths, a heating pad also works! Although there’s no official reason for why this provides relief for CHS patients, scientists believe that warm temperatures correct the cannabis-induced disequilibrium at the thermoregulatory centers. Heat/hot showers also activates TRPV1 which helps with inhibiting pain signals, resulting in analgesic and antiemetic effects.

how long does cannabinoid hyperemesis syndrome last

Oncology patients may be advised to use cannabinoids to relieve chemotherapy-induced nausea and vomiting, only to develop CHS over time. In some case reports in the literature, a few patients rejected the notion that marijuana might in some way be the cause of their symptoms and refused to give it up even to see if it might relieve their symptoms 1. The literature reports on global clinical experience with CHS to date in the form of case studies, case reports, and case series. While case reports are not the strongest form of evidence, the range of case reports in the literature over the past years presents a coherent picture of the condition, its diagnosis, and treatment.

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