Cannabinoid Hyperemesis Syndrome: Insights from Recent Research
Introduction:
Dr. David Danish is a certified prescriber of Medical Marijuana, but he is also very open about the many downsides sometimes associated with marijuana use. Cannabinoid Hyperemesis Syndrome (CHS) is a condition that has been gaining attention in both the medical and psychiatric fields due to its increasing prevalence alongside the widespread legalization and use of cannabis. In the December 2016 issue of the Journal of Medical Toxicology, Cecilia J. Sorensen and her colleagues published a comprehensive systematic review titled "Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment." This research provides valuable insights into the diagnosis, underlying mechanisms, and potential treatment options for CHS, which is crucial for settings like Philadelphia Integrative Psychiatry where a holistic approach to patient care is emphasized.
The study meticulously analyzed data from various sources to identify the key characteristics and effective treatments of CHS. CHS is associated with chronic cannabis use and is often accompanied by compulsive hot baths/showers for symptom relief. The syndrome is under-recognized due to factors like the paradoxical use of cannabis for nausea treatment, stigma, and under-reporting of cannabis use due to its illegal status in many regions.
Diagnosis of CHS:
The study identified 14 diagnostic characteristics of CHS, with the most common being regular cannabis use (100% of cases), cyclic nausea and vomiting (100%), symptom resolution after stopping cannabis (96.8%), compulsive hot baths with symptom relief (92.3%), male predominance (72.9%), abdominal pain (85.1%), and at least weekly cannabis use (97.4%).
Pathophysiology of CHS:
The pathophysiology remains unclear, with limited research dedicated to its underlying mechanism. Theories suggest dysregulation of the endocannabinoid system, genetic variations in metabolic enzymes, and direct interaction of cannabinoids with CB-1 receptors in the gastrointestinal tract. The evidence for each proposed mechanism is very low, indicating a need for further research.
Treatment of CHS:
Cannabis cessation is the best treatment, with a high rate of symptom resolution upon stopping cannabis use. Supportive care with intravenous fluids, dopamine antagonists, and topical capsaicin cream has shown some benefit. Avoidance of narcotic medications is recommended due to potential worsening of symptoms and risk of dependence.
Limitations:
The study is limited by the heterogeneity of case reports and the absence of controlled studies. There is a publication bias, as clinicians are more likely to report cases consistent with the initially reported index case. The internal validity is limited by the possibility of missing articles and the exclusion of non-English language articles.
Discussion:
CHS is characterized by severe cyclic vomiting, usually accompanied by abdominal pain, and is associated with early age of cannabis use. The syndrome commonly develops in the third decade of life, with symptom onset preceded by daily to weekly cannabis use. Patients report temporary relief of symptoms with hot baths/showers and experience resolution of symptoms with cannabis cessation. The pathophysiology underlying CHS is unclear, but cannabis cessation appears to be the best treatment. The study calls for greater education among clinicians to limit repeated diagnostic workups and for public health messages to warn cannabis users about the potential development of CHS.
Conclusion:
CHS is a condition associated with medical marijuana use , characterized by cyclic vomiting and abdominal pain. The definitive treatment for CHS is cannabis cessation, which leads to symptom resolution in the majority of cases. Further research is needed to understand the pathophysiology of CHS and to establish effective treatments for acute exacerbations.
This research is instrumental for the practitioners at Philadelphia Integrative Psychiatry, as it equips our healthcare providers with evidence-based knowledge to better diagnose and treat CHS. Understanding the link between cannabis use and certain psychiatric and physical symptoms allows our team to offer more targeted and effective care.
Source:
https://www.researchgate.net/publication/311784718_Cannabinoid_Hyperemesis_Syndrome_Diagnosis_Pathophysiology_and_Treatment-a_Systematic_Review
