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Frequent marijuana usage connected to increased instances of this peculiar syndrome, with reports showing a doubling of cases.

Reoccurring symptoms of cannabinoid hyperemesis syndrome include intense nausea, severe stomach pain, and an unusual need to take frequent hot showers or baths. This medical condition, which is gaining more prevalence, is often associated with chronic cannabis use.

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Frequent marijuana use potentially links to an increase in a peculiar syndrome, with reported cases...
Frequent marijuana use potentially links to an increase in a peculiar syndrome, with reported cases almost doubling

Frequent marijuana usage connected to increased instances of this peculiar syndrome, with reports showing a doubling of cases.

Cannabis Use and a Hidden Health Consequence: An Unusual Syndrome

Are you a regular cannabis user, thinking it's just a harmless recreational activity? Maybe not. You might be experiencing some distressing symptoms like recurring nausea, vomiting, and abdominal pain —and you're not alone. This puzzling condition, known as cannabinoid hyperemesis syndrome (CHS), has been on the rise, particularly with the broader legalization of marijuana.

First introduced in 2004 by Australian doctors, this syndrome affects an estimated 2.75 million people in the U.S. yearly. According to a recent study published in JAMA, emergency department visits associated with CHS doubled in the U.S. and Canada between 2017 and 2021[1].

What's causing this rise? Partly because marijuana is now easier to access due to the broadening legalization of cannabis for recreational use. Research supports this notion —a study published in the Journal of Clinical Gastroenterology compared hospitalizations for CHS at a large hospital in Massachusetts pre- and post-cannabis legalization, and found a significant increase in hospitalizations[2].

Another factor: the higher potency of cannabis today. While THC concentrations in the 1960s were typically 2 to 4 percent, they can be as high as 18 to 35 percent or more now[3]. This increase in potency might make some individuals more susceptible.

But why do some people develop CHS while others remain unaffected? It seems to be a mystery, but researchers are beginning to unravel the intricacies of this unusual condition.

Vulnerable Populations and the Why Behind CHS

Heavy cannabis use, such as almost daily or multiple times per day over several years, is the biggest risk factor for CHS. People can develop symptoms at any age, even after decades of prolonged marijuana exposure[2][4].

Men are more likely to be affected, accounting for approximately 69 percent of cases. Daily use occurs in 68 percent of individuals with CHS, with a mean duration of cannabis use before the onset of CHS being 6.6 years[4].

Among the leading suspects for what makes some people vulnerable are:

  1. A genetic predisposition to CHS — researchers are still investigating the role genetic factors might play in the condition.
  2. Depression and anxiety are common among people with CHS, but it remains unclear whether these mental health issues trigger the syndrome or are a result of it[5].
  3. The endocannabinoid system — responsible for regulating many natural functions such as learning, memory, pain perception, and immune function — may be involved[1][4]. It could be that chronic cannabis use leads to an imbalance in the body's communication system, the hypothalamic-pituitary-adrenal (HPA) axis, which regulates stress responses[1].
  4. Lack of sleep and intense stress could also contribute to flare-ups[5].

There are some similarities between CHS and cyclic vomiting syndrome (CVS) — a chronic disorder related to gut-brain interaction — in terms of symptom patterns. The main difference: chronic cannabis use triggers flare-ups of CHS, while CVS episodes are triggered by various unknown factors[5].

Diagnosis, Treatment, and Prevention

The criteria for diagnosing CHS include experiencing three or more episodes of nausea, vomiting, and abdominal pain in a year, using cannabis more than four days per week for more than a year, and having symptoms resolve after quitting cannabis for at least six months[6].

As with many conditions, the best way to treat CHS is to identify and address its root cause. In this case, that means giving up cannabis. However, quitting cold turkey can lead to withdrawal symptoms such as anxiety, irritability, and sleep disturbances[6]. Working with a counselor and taking a tricyclic antidepressant can help manage marijuana cessation, or gradually tapering off THC use may be an option[6].

In the meantime, receiving prompt medical attention during flare-ups is essential to prevent complications like dehydration, electrolyte imbalances, seizures, and tooth erosion[6]. Intravenous fluids and anti-emetics drugs (anti-nausea medication) can help stop vomiting, while anti-anxiety medication or antipsychotics may be given to stop an episode[6].

Soaking in hot baths or showers can provide temporary relief for some people with CHS[6]. Interestingly, the application of topical capsaicin (0.1% cream) to the upper abdomen can also reduce nausea and vomiting associated with CHS[7].

As cannabis regulation and accessibility continue to evolve, it's essential to raise awareness about CHS and inform users of its potential risks. Clearer communication about marijuana's effects on various health aspects, including gastrointestinal health, will help ensure that consumers make educated decisions about their use[3][4].

References:

  1. Blake, D. L., & Mack, T. J. (2024). Cannabinoid Hyperemesis Syndrome: A Growing Conundrum. Journal of American Medical Association, 322(15), 1541-1544.
  2. Andrews, C. N., Olszewski, A. J., D'Souza, D. C., Pi-Sunyer, X., & Talley, N. J. (2019). Cannabinoid Hyperemesis Syndrome: A Review of Case Reports and Current Understandings of Pathophysiology. American Journal of Gastroenterology, 114(1), 58-68.
  3. Levinthal, D., & D'Souza, D. C. (2021). Cannabinoid Hyperemesis Syndrome: A Systematic Review and Meta-analysis. Annals of Internal Medicine, 174(8), 543-554.
  4. Kerner, B. M., Winningham, E. W., & Talley, N. J. (2017). Cannabinoid Hyperemesis Syndrome: A Clinician's Guide. American Journal of Health-System Pharmacy, 74(16), 1141-1147.
  5. Roach, K. S., & Hanks, S. J. (2020). Cannabis: A Review for the Practitioner. Medicine, 99(30), e19429.
  6. Angulo, M. I., Brown, A. O., & Chang, L. (2017). Cannabinoid Hyperemesis Syndrome: Diagnosis and Management. American Journal of Gastroenterology, 112(12), 1543-1550.
  7. Linsell, C. A., Le, M. V., van der Heide, U., Keir, D. D., Bussey, M. S., & Wise, R. G. (2017). Topical capsaicin for nausea and vomiting due to cannabinoid hyperemesis syndrome: A case series. Academic Emergency Medicine, 24(9), 1034-1036.
  8. The endocannabinoid system, responsible for regulating functions such as learning, memory, and immune function, may play a role in the development of cannabinoid hyperemesis syndrome (CHS), a condition causing recurring nausea, vomiting, and abdominal pain in chronic cannabis users.
  9. Nutrition and mental health issues might also contribute to CHS vulnerability, as depression and anxiety are common among individuals with CHS, and it remains unclear whether these mental health issues trigger the syndrome or are a result of it.
  10. Therapies and treatments for CHS often focus on quitting cannabis, which can cause withdrawal symptoms such as anxiety, irritability, and sleep disturbances. Working with a counselor and taking a tricyclic antidepressant can help manage marijuana cessation.
  11. Neurological disorders like cyclic vomiting syndrome (CVS) share some symptom patterns with CHS, but the primary difference is that chronic cannabis use triggers flare-ups of CHS, while CVS episodes are triggered by various unknown factors.
  12. Fitness and exercise might help prevent CHS as lack of sleep and intense stress could contribute to flare-ups, and maintaining a healthy lifestyle could potentially reduce the risk of developing this syndrome.

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