Cannabinoid Hyperemesis

Cork Emergency Departments

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What is cannabinoid hyperemesis syndrome (CHS)?

It is a rare condition caused by a regular and long-term use of marijuana. It is characterised by repeated and severe bouts of vomiting. Marijuana has several active substances which have effects on both the brain and the digestive system. These substances affect the brain and cause the drug 'high' that users feel. In the stomach it causes delayed emptying of the stomach contents. These active substances lead to relaxation of the lower oesophageal sphincter (tight muscle band in the lower food pipe) leading to reflux-like symptoms. These effects are mainly responsible for the symptoms of CHS.

What causes CHS?

One ingredient in marijuana is called THC, which has anti-sickness effects. Marijuana is prescribed in chemotherapy patients for the treatment of Nausea and Vomiting. However, if used over a long period, marijuana seems to have the opposite effect on the digestive system leading to sickness and vomiting. Research is being carried out to explain why only some long-term users of marijuana experience CHS.

What are the symptoms?

There are three stages:

Prodromal phase

• This is the first phase
• Symptoms include early morning nausea, abdominal pain, and a fear of vomiting
• Most people will keep to their normal eating patterns
• Some may still consume marijuana because they think it will help stop them with their nausea. This phase may last for weeks, months or years

Hyperemetic phase:

Symptoms may include:

Nausea, Vomiting, Abdominal pain, Reduced food intake, Weight loss.

During this phase, vomiting may often be intense and overwhelming. Many people will take a lot of hot showers during the day to ease their nausea. The hyperemetic phase will continue until you stop using marijuana.

Recovery phase:

This phase will begin once you stop using marijuana. During this phase, the symptoms will go away and you will be able to eat normally again. This phase can last days or months. If you try marijuana again, your symptoms are likely to return.

When to contact healthcare provider?

If you have had severe vomiting for a day or more.

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How is CHS diagnosed?

There are several reasons that can cause you repeated vomiting. Your healthcare provider will ask you questions about your health, perform an examination, and requests some Blood tests to rue out the other causes of Vomiting. Admitting to your healthcare provider that you use marijuana daily can speed up the diagnosis.

How is CHS treated?

If you have had severe vomiting, you may need to stay in hospital for a short time. You may need the following treatments during hyperemetic phase:

• IV (intravenous) fluid replacement
• Anti-sickness medicines
• Pain-relief medicines
• Proton-pump inhibitors (to treat stomach inflammation)
• Frequent hot showers
• Capsaicin cream (to reduce pain and nausea)

Symptoms will drop within 2 days until marijuana used again.

Complete cessation of marijuana would be required for full recovery. Support from drug rehab programmes, family therapy and cognitive behavioural therapy would be helpful.

Complications:

• Tear in the lower oesophagus (food pipe)
• Bleeding from oesophagus
• Dehydration
• Kidney failure
• Seizures

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Prevention of CHS:

STOP marijuana. Cutting down is not helpful.

Where can I get help:

1. Community Counselling and advisory service. Tel: 0214928300
   (north Cork Catchment area) Heron House, Floor 1, Blackpool Retail Centre, Cork
2. Arbour House, (South Lee catchment Area) addiction treatment centre, Douglas Road, Cork Tel: 0214968933
3. Narcotics Anonymous. PO Box137, Eglinton Street, Cork. Tel: 0214278411

Content by Dr Najam Iqbal April 2024