Articles that were clearly not relevant based on title and abstract were excluded. The articles were then segregated into diagnosis, pathophysiology, or treatment categories. When the two reviewers disagreed on article eligibility, a consensus was reached through discussion.

Treatment / Management

There is very limited evidence to suggest that agents such as dopamine antagonists and capsaicin cream and avoidance of opiate pain medications may be of benefit. While many providers utilize these agents in practice and find them effective, prospective case-control studies are needed before recommendations can be made based upon effectiveness. The authors of this study acknowledge the potential difficulties of such cannabinoid hyperemesis syndrome studies, owing to the fact that CHS is a heterogeneous clinical entity, and thus, selecting a comparable group of patients may prove difficult. Additionally, agents such as topical capsaicin cream are not commonly stocked in hospitals and emergency departments but could be made available in the outpatient setting. There is moderate evidence to support that the definitive treatment for CHS is cannabis cessation.

How common is cannabis hyperemesis syndrome?

However, researchers have yet to determine the cause of CHS since it does not affect all users of marijuana. CHS is also underdiagnosed because people sometimes use marijuana to suppress nausea and vomiting. Doctors currently lack knowledge of the condition, and there are no clinical guidelines for its treatment and management. Our review revealed that CHS patients may often have poor follow-up. Multidisciplinary care may be necessary for management and diagnosis. Patients may deny cannabis use as a cause of their symptoms and fail to follow-up or seek medical care at other facilities resulting in repeated testing and resource utilization [8].

Deterrence and Patient Education

With cannabis use increasing throughout the world as the threshold for legalization becomes lower, its user numbers are expected to rise over time. Despite this trend, a strict criterion for the diagnosis of CHS is lacking. Early recognition of CHS is essential to prevent complications related to severe volume depletion. The recent body of research recognizes that patients with CHS impose a burden on the healthcare systems.

Along with the discovery of the CB1 and CB2 receptors has been the identification of endogenous arachidonic acid derivatives that bind to these receptors (Figure 1). These compounds are referred to as endogenous cannabinoids, or endocannabinoids. The best characterized endocannabinoids are anandamide and 2-arachidonylglycerol (2-AG) [9]. The endocannabinoids are present in both the central nervous system [8] and enteric nervous system [15].

• As more states legalize cannabis, more people are learning whether cannabis is right for them.
• These supportive treatments can help people during the hyperemesis stage of the condition, but recovery depends on the person stopping their use of marijuana.
• The pro-emetic properties of CBD (at higher doses) and CBG may play a role in the severe nausea and vomiting observed in patients with Cannabinoid Hyperemesis Syndrome (Figure 2).

CHS is a condition caused by chronic and repeated cannabis use that leads to severe nausea and vomiting. The only proven way to prevent cannabis hyperemesis syndrome is to avoid cannabis (marijuana). If you have cannabis use disorder and need help quitting, professional treatment is available. CHS is a very rare syndrome and is easily cured by stopping the consumption of cannabis. This should not, by any means, hurt marijuana’s reputation for being the safest recreational drug around, but people need to be aware of the syndrome’s existence. If you know anyone with these symptoms tell him or her go to a doctor and stop smoking.

Pathophysiology

With the continued use of cannabis and a lack of treatment, symptoms become more intense. The only treatment known to cure CHS is to stop using cannabis and not resume its use. One study found up to 6% of people who went to the emergency room for cyclical vomiting had CHS. CHS is a newly identified condition, so doctors currently know little about it.

What happens if cannabis hyperemesis syndrome is left untreated?

• Two distinct cannabinoid receptors, CB1 and CB2, have been identified in human and animal models.
• This hypothesis is supported by the demonstration of delayed gastric emptying on gastric emptying scintigraphy in some cases [6,55,62].
• This could result in excessive levels of pro-emetic cannabinoids or emetogenic metabolites.
• Doctors have also noticed that people in the hyperemesis stage take frequent showers and baths, which seem to relieve nausea.
• Patients are typically young adults with a long history of cannabis use.

What is cannabinoid hyperemesis syndrome? Here’s what to know, and why experts say it’s on the rise