Cannabinoid Hyperemesis Syndrome CHS: Causes, Symptoms & Treatment

It has been observed that CBD is antiemetic at low doses but proemetic at high doses 37. Furthermore, CBG may be able to reverse the antiemetic properties of CBD 38. This would mean that the proemetic effects observed in CHS involve an interplay of processes, possibly including high levels of CBD reversed by CBG 39. Cameron Nicole Beard, 19, of East Moline, Ill., said she struggled to believe her doctors about the link between pot and severe vomiting. But in California and Colorado, which have loosened marijuana laws in recent years, emergency physicians say they’re seeing it more often. Even Mecca Irby, who believed six months ago she was dying from CHS, has cut back but not completely stopped smoking marijuana.

What are the symptoms of cannabinoid hyperemesis syndrome?

• What most people don’t realize, researchers say, is that the THC young people are vaping and dabbing today has little resemblance to the marijuana of decades past.
• Daily marijuana smokers are at risk of developing cannabinoid hyperemesis syndrome (CHS), which researchers warn could become more common as marijuana becomes increasingly legal.
• Nausea, vomiting, and abdominal pain are diffuse symptoms that may derive from any of several diverse etiologies.
• Researchers are currently studying several treatment options to manage the hyperemetic phase of CHS.
• They agreed with the CHS diagnosis and ordered monitoring of his levels, which improved with the rehydration again.

A thin layer of topical capsaicin cream was applied to the abdominal region, chest, or back. Only one CHS patient returned to the ED within 3 days after receiving topical capsaicin; capsaicin was administered again, and the patient reported rapid relief and was discharged without further treatment 96. In a study of the treatment of neuropathic pain with topical capsaicin, the most common adverse effect was a burning sensation upon application, localized erythema, and nonproductive cough 106. It is likely that topical capsaicin used for CHS treatment would have similar adverse effects. The onset of symptoms was reported in 13 of those cases at a median of 9 years (range 3–25 years).

• Once they are activated, anandamide and 2-AG have different pathways for biosynthesis and subsequent degradation, in that anandamide is metabolized mainly by FAAH while 2-AG is metabolized via monoacylglycerol lipase 30.
• For CHS patients, these tests typically offer normal-range results, but they are expensive, time-consuming, and place a hardship on the patient as well as the healthcare system.
• A thorough history, physical examination and directed testing of differential diagnoses may assist in ruling out these diagnoses.
• Brian was also experiencing symptoms even after he had quit smoking, which caused us to doubt the diagnosis further.

General Health

All presented to the emergency department with nausea and vomiting in the days preceding death and were treated symptomatically. Toxicological analysis revealed tetrahydrocannabinol in postmortem blood. These three cases demonstrate the importance of recognizing CHS as a potential cause or contributing factor to death in cannabinoid user. Oncology patients may be advised to use cannabinoids to relieve chemotherapy-induced nausea and vomiting, only to develop CHS over time.

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

Gastric motility and gastroparesis must be discussed in the context of CHS. The enteric nervous system contains CB1 receptors, which, when activated, can inhibit GI motility by inhibiting the release of those transmitters that cause stomach contractions 47. This effect causes delayed gastric emptying and continues to inhibit transit through the small intestine. The effects are similar to gastroparesis and, thus, CHS may be caused by a functional gastroparesis. The GI effects of cannabinoids are mediated mainly via the CB1 receptor, which can inhibit gastric acid secretion, lower esophageal sphincter relaxation, and alter intestinal motility, cause visceral pain, and produce inflammation 27, 48.

However, in the digestive tract, marijuana has the opposite effect and makes nausea and vomiting more likely to occur. Daily marijuana smokers are at risk of developing cannabinoid hyperemesis syndrome (CHS), which researchers warn could become more common as marijuana becomes increasingly legal. Rates of cannabis use disorder have spiked in the past 40 to 50 years, D’Souza said, with some studies suggesting between 20 and 30 percent of marijuana users meeting the criteria for the disorder.

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• On the second visit, CHS was diagnosed and the patients were treated with capsaicin cream 0.025% applied in a layer approximately 1 mm thick on the abdomen.
• If you think you have CHS or cannabis use disorder, talk to a healthcare provider.
• Every once in a while she wishes she could indulge in a joint, but she knows there are healthier diversions.
• The Drug Abuse Warning Network (DAWN) states that marijuana mentions (the number of times “marijuana” is mentioned in a medical record) have increased 21% from 2009 to 2011 3.
• It is likely that topical capsaicin used for CHS treatment would have similar adverse effects.
• Other symptoms may include sweating, flushing, thirst, weight loss, and changes in body temperature.

When I arrived, there were three nurses and a what is chs doctor in the room already. Brian had an oxygen mask on, they were putting an IV in each arm, and they had already taken blood to send to the lab. My first introduction to CHS was in April 2018, when my 17-year-old son Brian was diagnosed at an emergency room (ER) in Indianapolis. In America, cannabis samples seized by the DEA showed that potency tripled from 4 percent THC in 1995 to 12 percent in 2014. One woman from Boston, who deemed herself an ‘Olympic smoker’, spent more than two weeks in the hospital. Every once in a while she wishes she could indulge in a joint, but she knows there are healthier diversions.

Hot baths may relieve the nausea for a while, but they don’t cure CHS. The only known treatment to permanently get rid of CHS is to stop cannabis use completely. You marijuana addiction may have symptoms and side effects of CHS for a few weeks after quitting cannabis. Many people with CHS will compulsively shower or bathe — often for hours every day — to relieve CHS symptoms. The literature contains a wealth of case studies and case reports on patients suffering from CHS; these case reports come from around the world but have striking similarities. The mechanism of action of topical capsaicin likely involves TRPV1 receptors.