Cannabinoid Hyperemesis Syndrome: What You Need to Know
January 18th, 2019
Cannabis is a hot topic nowadays. The plant has broken free from the ‘stoner stereotype’ that plagued pot’s reputation for so long. Here we are in 2019 and the plant has been legalized for medical use in 33 U.S. states, not to mention other countries around the world with varying levels of restrictions.
From Argentina, Brazil, Chile, Colombia and Uruguay, all the way to Czech Republic, Germany, Italy, Spain and the United Kingdom, cannabis has emerged as a popular medical treatment for a broad spectrum of diseases and conditions, including arthritis, AIDS, ALS, Alzheimer’s, cancer, chronic pain, depression, diabetes, epilepsy, glaucoma, multiple sclerosis (MS), Parkinson’s, PTSD, Tourette’s syndrome and much more.
With so many medical uses tied to the plant, it’s not surprising that the medical cannabis market is predicted to hit $37 billion in the United States by 2023. This is according to a report titled the “Medical Cannabis Market: Global Industry Trends, Share, Size, Growth, Opportunity and Forecast 2018-2023.
We have been hearing so much good news about the cannabis plant lately, that it’s been hard to focus on the cons. In this article, we’re going to talk about something called cannabinoid hyperemesis syndrome (CHS). While it’s not exactly common, it’s certainly a topic that remains somewhat in the dark. Let’s lift the lid on this condition caused by cannabis use to shed some light on its symptoms, diagnosis and prevention.
What is Cannabinoid Hyperemesis Syndrome?
Just a small portion of people will develop CHS; particularly those who consume cannabis in copious amounts and have done so for many years. Daily users may also be affected. Nausea and vomiting are two unpleasant symptoms associated with CHS – ironic, since one of the plant’s primary cannabinoids, cannabidiol (CBD), has been proven to provide relief for many patients when used as an antiemetic drug.
CHS is somewhat of a mystery condition, since it occurs by an unknown mechanism, according to this study. What we do know, however, is that three main cannabinoids found in the cannabis plant may trigger opposing effects on the gastrointestinal tract emesis response. They are tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabigerol (CBG).
In simple terms, nausea is the feeling of sickness that precedes emesis. When emesis occurs, the contents of the stomach may be expelled from the GI tract via the upper esophageal sphincter.
Stages & Symptoms
Repeated bouts of vomiting is a common symptom of CHS. A doctor or healthcare provider may not be up-to-date on the diagnosis of CHS, which is why it is best to visit a doctor who specializes in treating medical cannabis patients if you’re concerned.
Generally, an informed healthcare provider will diagnose CHS in one of three stages:
- Prodromal phase – Nausea in the mornings and abdominal pain may present themselves in the prodromal phase. Using more cannabis to counteract the effects may not be a good idea if the symptoms last for months or years, which is common among CHS sufferers.
- Hyperemetic phase – The longer a person goes undiagnosed with CHS and continues to use cannabis, the more severe the symptoms will become. Repeated episodes of vomiting, incessant nausea, dehydration, reduced food intake, weight loss, and abdominal pain are primary symptoms of the hyperemetic phase.
- Recovery phase – The recovery phase for someone with CHS begins with cannabis cessation. (We talk more about this in the summary.)
Cannabinoid Hyperemesis Syndrome Diagnosis
As a newly discovered unwanted side effect of cannabis consumption, CHS is not a hot topic amongst healthcare providers. This is especially true in places that have not legalized the plant for medicinal use. Symptoms may go undiagnosed for years, with many doctors confusing CHS with Cyclic vomiting syndrome (CVS).
Visiting a gastroenterologist for a diagnosis is recommended. He or she may carry out the following tests to determine a diagnosis:
- Electrolyte tests
- Blood tests (for infection and anemia)
- Pregnancy tests (if necessary)
- Pancreas and liver enzyme tests (to check organ functioning)
- Urine analysis
- Drug screening (to determine if alternative substances have caused a synergistic effect)
- Head CT scan (for nervous system testing)
- Abdominal CT scan (to ensure no underlying health problems require surgery)
- Abdominal X-ray (to rule out potential blockages)
- Upper endoscopy (to clearly analyze the stomach and esophagus)
Treatment and Prevention
Refraining from cannabis consumption completely is the first approach to tackling CHS. For frequent users, drug rehabilitation programs may come in handy. If symptoms do not subside, your healthcare provider must conduct further testing to determine a cause for vomiting and nausea.
In severe cases, patients who are in the hyperemesis phase may require the following treatments:
- IV fluid replacement to treat dehydration
- Anti-nausea and anti-vomiting medication
- Pain-relieving medicine
- Regular hot showers
Despite the cannabis plant’s well-known anti-emetic properties, there is a growing body of evidence suggesting its paradoxical implications on the gastrointestinal tract. Ongoing studies are required to ascertain precisely what the prevalence of this disease is. In addition to this, evidence is required to determine what additional treatments may be needed, aside from discontinued cannabis use.
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