The use of medical cannabis for the effective treatment of nausea has been well documented for quite some time. However a novel set of characteristic symptoms that lead to an apparent increase in nausea has recently (2004) been coined. This paradoxical condition is known as Cannabinoid Hyperemesis Syndrome (CHS).
Cannabinoid Hyperemesis is exactly what you might think it is: exaggerated emesis (vomiting) with cannabis use. The recognition of this condition arose from clinicians recognizing a common cluster of symptoms in a relatively small population of chronic, heavy, and regular cannabis users.
The typical patient profile tends to be a regular user (i.e. daily consumption over an extended period of time such as one year or more). The nausea and vomiting was predominantly in the morning, lasted hours to days, and might recur cyclically over weeks to months. Many had 7 or more episodes a year. Yuck!
The typical patient profile presenting to their provider might offer the following story: “I had to come into the ER because I ran out of hot water at home, and I was afraid my nausea and vomiting would not stop. A long hot shower or bath was the only thing that helped.” Hmmm…?? A hot shower was all that it took to relieve their symptoms? Patients may also have experienced some abdominal pain, and typically had nothing else in their history or on their exam that indicated another specific cause to explain their symptoms. Patients seemed to find out on their own, that long hot showers or baths relieved their symptoms.
When a loved one has nausea and vomiting, often the helpful thing we would want to provide would be a cold compress to the forehead, right? So does a hot shower seem counterintuitive?
Why would a hot bath or shower make these patients feel better?
Brain receptors that likely relieve nausea are probably the same culprits in producing a “paradoxical effect” (meaning that it has the opposite effect as the one intended) in this group of patients. A paradoxical effect with respect to a medically prescribed chemical is that it has the opposite effect as the one intended. For example, maybe you are aware that a common over the counter medication, such as Benadryl, can sometimes be taken at night for its sedative effects to help one sleep. Well, paradoxically, in some patients, it actually keeps them awake.
If someone were to have an adverse effect to a substance, often we would imagine or anticipate that it would show up early on when using it. However, just like some food allergies, it may take repeated exposures before the body has an acquired hypersensitive response. With CHS in particular, it is important to consider it even after long term regular use without these symptoms, which makes its recognition tricky.
What’s more, the typical medications used to treat nausea and vomiting don’t seem to help these patients. Are you confused about this condition yet?
What to do?
Initially, supportive therapy is provided, meaning intravenous fluids are given to correct dehydration caused by the vomiting. Other creative treatments are documented in the literature. So, it is important for patients to know the signs of dehydration as an indication of the need to seek medical treatment. These may include: dry mouth, thirst, reduction in urination frequency and the appearance of concentrated or dark urine, dizziness, lack of energy, confusion, and a faster than normal heart rate.
So…..are you wondering what the long term treatment is? It seems to be cessation of the use of cannabis. Just like other medically prescribed pharmaceuticals, sometimes patients just develop side effects that are intolerable.
Why should this article demand our attention? Cannabis is a widely used drug of choice throughout the world. More and more, its use as a medically prescribed agent is becoming more accessible and acceptable. In 2008, the World Health Organization estimated the lifetime prevalence of the use of cannabis in the US was about 44%. Given the relatively new recognition of this condition, there remains a lack of information and awareness about CHS – among medical professionals as well as patients. It is likely that if chronic, regular cannabis use increases, the number of people experiencing this may increase too.
There is no current clinical test or other method to clearly diagnose this condition. History is key!
Sometimes patients are reluctant to or don’t think it is important to tell their health care providers about their use of cannabis or other herbal remedies or supplements. It is imperative that health care providers help their patients understand why supplying that specific information is important. For example, anything the patient takes in on their own, whether that be cannabis or any other type of substances, may interact with medications that are prescribed.
Both patients that use cannabis, and clinicians that treat patients that use cannabis must be aware of this condition. The down side to not recognizing CHS is ongoing symptoms, emergency room visits, and potentially unnecessary diagnostic tests, and even exploratory surgeries.
The exact frequency of this side effect of chronic cannabis use is difficult to know. Perhaps with more recognition of the condition and reporting of it, this information will become better well known.
It is our wish at UPG that our blogging is a reliable, timely, consistent, and informative way for you to stay abreast of current issues related to cannabis use. We would love to hear your thoughts. Have you had any experience (or think you may have) with CHS? Leave us your comments below, or on our Facebook, Twitter or other social media pages!