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Cannabinoid Hyperemesis Syndrome

Cannabinoid Hyperemesis Syndrome: Paradoxical Effects Of THC? Or Something Else?

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There’s one way to die from cannabis, and it’s cannabinoid hyperemesis syndrome (CHS). According to the Official Journal of the American College of Gastroenterology, there have been about 2217 reported deaths from CHS. The figure is probably higher considering that most cases are never diagnosed and hence never reported.

CHS is a rather new diagnosis that is often confused with cyclic vomiting syndrome (CVS). Both conditions are characterized by cyclic episodes of excessive vomiting (hyperemesis) that may eventually lead to death. Even though exact mechanisms are yet to be confirmed, THC has been implicated in CHS.

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On the flip side, one of the approved uses of THC is in the treatment of chemotherapy-induced nausea and vomiting (CINV). Isn’t it paradoxical that THC would trigger both CHS and be an effective cure for CINV nonetheless?

CHS was first described in a 2004 paper as cyclical hyperemesis (vomiting) as a result of chronic cannabis abuse. Apart from the vomiting, the researchers also noted that the patients were taking frequent hot baths for relief, as a learned behavior. It is hypothesized that CHS may be a result of overstimulation of endocannabinoid receptors. Genetics may also have a role to play, according to preliminary research.

RELATED: Is ‘Uncontrollable Vomiting’ Really A Serious Side Effect Of Marijuana?

CHS is often divided into three phases. The first is the prodromal phase where the patient experiences early morning nausea and slight abdominal discomfort. This phase may last for several years. The second is the hyperemetic phase that’s characterized by severe nausea and vomiting, abdominal pain and the learned behavior of taking hot baths. Left untreated, the patient can deteriorate quite fast during this stage due to electrolyte imbalance and dehydration. The final stage is the recovery phase.

Most of the patients who’ve been diagnosed with CHS are young adults with a history of chronic cannabis use (16 years on average). They reported daily use of cannabis, up to three or five times per day. Chronic cannabis use is what differentiates CHS from cyclic vomiting syndrome. In addition, the behavior of taking compulsive hot showers is only observed in CHS.

RELATED: A Brief Examination Of Cannabinoid Hyperemesis Syndrome

Treatment for CHS revolves around treating nausea and vomiting and preventing a relapse during the recovery phase. Even with the proven anti-emetic properties of cannabis, this is one case where offering it as a form of treatment may cause more harm than good.

This article originally appeared on MyCannibis.com and has been reposted with permission.



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Cannabinoid Hyperemesis Syndrome

Cannabinoid Hyperemesis Syndrome: What Causes It And How To Treat It

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Daily and long-term use of cannabis can cause a rare condition known as cannabinoid hyperemesis syndrome (CHS). Symptoms include nausea and an unsettled stomach, to name just a few.

Many researchers tried to give more details on CHS and its causes, but it requires more studies as it is a fairly new condition. The first cases were reported in 2004 in South Australia, where doctors started treating cannabis users for vomiting, stomach pain, and more. The people who experienced these issues were long-term cannabis users.

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Diagnosing the condition is often tricky, considering that many users go for treatment without mentioning using marijuana. In most cases, the symptoms disappear entirely once the user stops consuming cannabis. However, as legalization is still in progress, the number of people using marijuana is increasing, and so is the number of those with CHS.

CHS is a rare phenomenon. In most cases, it occurs in people who use marijuana for years (usually 1-5), a few times per day (3-5 times).

Main Causes of Cannabis Hyperemesis Syndrome

Some research suggests that cannabis hyperemesis syndrome is caused by the daily and long-term use of marijuana. The number of people diagnosed with CHS is increasing due to more states in the US legalizing marijuana. However, the number of regular users who develop weed sickness is not high. Some studies suggest that genetics plays a part. There is a lack of evidence that would fully support the current theories around CHS, which is why further research is necessary.

Cannabis has several active components, and since it is very complex, it affects every user differently. One of its main ingredients is THC that features anti-nausea effects. But what has been noted is that if someone uses cannabis regularly for an extended period, the results could be the opposite. Some theories suggest that THC can make cannabinoid receptors act contrary to how they should behave. As a result, the consumer may experience cramps, vomiting, stomach pain, and other issues.


Read Also: What Are the Possible Side Effects of THC or Cannabis Use?


CHS Symptoms and Phases

The symptoms of CHS are divided into three main phases. The first is called the prodromal phase, the second is hyperemetic, and the third is the recovery phase.

CHS Phases

Prodromal Phase

The prodromal phase is the first one, and the symptoms in this stage are usually abdominal pain, morning nausea, and urge to vomit. Other symptoms can be skin flushing, body temperature changes, and sweating. While this phase is on, most people will continue to eat normally. In addition, most users will continue to consume cannabis, thinking it will help them stop nausea and vomiting. The prodromal stage can last for a long time, in some cases for a couple of weeks, months, and even years.

Hyperemetic Phase

The second stage is called the hyperemetic phase, and during it, the vomiting is often pretty intense. To ease nausea, people will mostly use hot showers throughout the day. Some people take marijuana to ease nausea, but it only makes the situation worse.

The symptoms in this phase include feeling sick and nauseous, throwing up after smoking weed, dehydration, stomach pain, disturbance of eating patterns, reduced food intake, and weight loss. The syndrome represents a real medical issue. Extreme vomiting and intense tummy pain can plausibly lead to scromiting (the combination of screaming and vomiting). The phase lasts until the consumer stops with marijuana usage.


Read Also: Medical Marijuana — What You Should Know


Recovery Stage

The last of three phases is the recovery stage. It starts the moment the user stops consuming cannabis. During this phase, all the symptoms will go away, and the person will go back to the standard eating patterns. In addition, people in the recovery phase generally feel better. The need for several hot showers or baths throughout the day will disappear as well. The stage can last from a couple of days to a few months. If an individual decides to turn back to marijuana by any chance, the symptoms will most likely return.

Diagnosis of the Sickness

Various health issues can cause repeated vomiting, and what needs to be pointed out is that CHS is a rare condition. The healthcare provider will ask the patient about the symptoms, and it will also ask about past health and issues if there were any. Then, a physical exam is necessary, including a stomach exam.

CHS Diagnostic Criteria

One of the things that can make the diagnosis faster and a lot simpler is admitting the consumption of marijuana to the doctor. For many health care providers, diagnosing the syndrome can be pretty challenging and can take a lot of time and effort. The main reason for that is that the patient does not report and mention their use of cannabis.

There are specific criteria to diagnose the syndrome. The first one is the patient has been consuming marijuana regularly for over a year. Some other things that can play a significant role are weekly cannabis usage, tummy pain, relief after taking a hot bath or shower, nausea, vomiting, etc. Other things that are considered are morning nausea, age (if the person is younger than 50), weight loss, and disturbed eating patterns.


Read Also: 7 Best Marijuana Strains for Overall Good Health and Disease Prevention


Cannabinoid Hyperemesis Syndrome Treatment

If the health care provider diagnoses the CHS, it will be explained to the patient what is cannabinoid hyperemesis syndrome, and then it is the treatment time.

One of the first steps doctors suggest is to stop consuming marijuana. If a person experiences extreme vomiting and nausea, hospitalization that may last a few days could be necessary.

CHS Treatment

During the second phase, known as the hyperemesis phase, the patient might need treatment, such as:

  • Medicines for pain relief and anti-sickness
  • Constant hot showers or baths
  • Intravenous fluid replacement
  • Anti-nausea drugs

All of the above are short-term treatments. The only option to treat the condition long-term is to stop using marijuana.

In most cases, the symptoms of the syndrome will disappear pretty fast. The patient may feel much better in general within a few days, usually one or two. However, the symptoms can come back if the person starts consuming cannabis again.


Read Also: Long Term Effects of Daily Marijuana Use


Prevention and Consequences If Untreated

The only way to prevent cannabinoid hyperemesis syndrome is the complete absence of marijuana consumption. Unfortunately, people tend to consume cannabis for years and become chronic users before the CHS develops. That’s because the development of the syndrome takes a lot of time.

When a person has the symptoms, especially vomiting, it may cause additional issues such as dehydration. In addition, if the condition is not treated, some other complications may arise, such as weakness, muscle spasms, shock, to name a few. In the most severe cases, cannabinoid hyperemesis syndrome can lead to kidney failure that can cause death.

Conclusions

CHS is caused by regular marijuana consumption. When the syndrome develops, which takes a few years, the consumer will experience various problems such as nausea, vomiting, weight loss, disturbed eating patterns, etc. The symptoms take three phases, and they can be extremely severe, especially in phase two.

The diagnosis of the syndrome is one of the trickiest parts of the story because people often fail to report using marijuana to their health care providers. Once the syndrome is finally diagnosed, the patient gets familiar with the condition, learns what CHS is, and begins treatment. The most important part of the recovery process is the stopping of weed consumption. If the patient continues to consume, the symptoms will come back.

The condition is a rare phenomenon and it does not affect all smokers. Every marijuana user should know the right dose. When the marijuana consumer experiences extreme vomiting for one whole day or more, contacting a health care provider is the best possible option.

Disclaimer: The information in this article is for educational purposes only and should not be used as a substitute for any prescribed medication. See your doctor first!

This article originally appeared on AskGrowers.com and has been reposted with permission.



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Cannabinoid Hyperemesis Syndrome

Is ‘Uncontrollable Vomiting’ Really A Serious Side Effect Of Marijuana?

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There is reportedly a rise of an unusual illness happening across the United States, and it is prevalent in spots that have legalized marijuana. It seems that droves of people are going to the emergency room for stomach problems, including “uncontrollable vomiting,” resulting from pot use.

“They are writhing, holding their stomach, complaining of really bad abdominal pain and nausea,” Dr. Sam Wang, a pediatric emergency medicine specialist and toxicologist at Children’s Hospital Colorado, told CNN.


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Once the nausea turns to full-blown vomiting, Wang says the diagnosis is quickly established. “They vomit and then just continue to vomit whatever they have in their stomach, which can go on for hours,” he said. “They often say they took a scalding hot shower before they came to the ER, but it didn’t help. “That’s when we know we may have a case of cannabis hyperemesis syndrome.”

There indeed exists a condition known as cannabinoid hyperemesis syndrome (CHS). The symptoms range from morning nausea to stomach pain in the early stage and persistent vomiting as a patient gets worse. However, medical experts admit they aren’t exactly sure what causes CHS. They only have theories. Some claim genetics are to blame, while others believe it results from brain changes following longtime pot use. They just can’t pinpoint which is closest to the truth.

Although the condition was once considered rare, doctors agree that it can still be dangerous. It can even prove fatal in severe cases.

Joseph Habboushe, MD, MBA, assistant professor of emergency medicine at New York University School of Medicine/Bellevue, spoke to Healio Gastroenterology and Liver Disease about the condition back in 2018. He said people who experience CHS often find that hot showers DO relieve the symptoms. It’s dangerous, as “this increases their chances of dehydration and acute renal failure due to a combination of sweating in the shower and vomiting.”

RELATED: Do You Need To Worry About Your Cannabis Use? Study Reports New Details On CHS

Although CHS is an actual medical condition, not all doctors are willing to accept marijuana as the cause. Why? Because “the diagnosis code is new [October 2020] and cases are being lost in the total number of Nausea/Vomiting coded cases,” Dr. Adrian Elliot, head of the Emergency Department at Fairview Hospital, told The Berkshireedge. “Additionally,” he continued, “it is difficult to get to the diagnosis of cannabinoid hyperemesis syndrome, as getting all of the history needed to make the definitive link between marijuana use and the nausea/vomiting patient complaint is difficult in the emergency department setting.” It usually takes several ER visits to solidify a diagnosis.

Endocannabinoid Deficiency
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A school of thought suggests marijuana potency is to blame for the purported uprising in CHS cases. But the truth is, modern medicine doesn’t have any idea. There is only speculation surrounding potency, predisposition, specific products, etc. But there isn’t any data to support these claims. The best researchers can do is examine ER vomiting cases and look for a correlation.

RELATED: A Brief Examination Of Cannabinoid Hyperemesis Syndrome

Wang’s study, published last week in the journal JAMA Network Open, claims to have found that correlation. His teams noticed a near 30% increase in vomiting cases (800,000 total) since marijuana was made legal in Colorado. But there doesn’t appear to be any cut-and-dry proof that the cases were pot-related. As Dr. Elliot stated, it’s almost impossible to link CHS cases to cannabis consumption.

There is undoubtedly a lot we do not understand about marijuana. Let’s get that straight. We don’t have much concrete evidence (outside the anecdotal) that it comes with any of its many reported health benefits. At the same time, there isn’t much evidence surrounding the adverse effects either.

This lack of research is the federal government’s fault. For decades, the powers-that-be have made it difficult for researchers to examine the herb. President Biden said during his campaign he would change the course of cannabis — downgrading its Schedule I classification on the Controlled Substances Act — but he has yet to make good.

So, it could be years before medical professionals better understand CHS and its relationship to cannabis. In the meantime, cannabis users experiencing persistent vomiting should seek medical attention and ultimately take a break from bud. The condition improves once a person stops using cannabis.



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Cannabinoid Hyperemesis Syndrome

Do You Need To Worry About Your Cannabis Use? Study Reports New Details On CHS

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By Andrew Ward

Cannabinoid hyperemesis syndrome (CHS) is a rare condition that is believed to lead to intractable nausea, vomiting and abdominal pain in cannabis consumers. The condition can last days or weeks, returning for months. CHS’s origins remain uncertain.

Awareness of the condition has grown in recent years, first mentioned in a lab study in 2004. Still, some continue to push back on CHS as a condition, questioning its severity or sometimes considering it a misdiagnosis. Advocates for the legitimacy of the condition cite support from leading hospitals, including Cedars Sinai and studies from The Mayo Clinic.

Should Chronic Pain Patients Use Metered Doses For Most Effective Treatment?
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An Austin, Texas-based study released on Tuesdayanalyzes underlying genetic mutations in heavy cannabis flower and concentrates consumers in an attempt to better understand and identify the genetic markers of the condition.

Using “the largest contemporaneous database,” the study compared CHS diagnoses and symptoms of heavy-cannabis consumers.

RELATED: A Brief Examination Of Cannabinoid Hyperemesis Syndrome

The analysis adds to an incrementally growing pool of studies. “CHS is remarkably stereotyped in its presentation,” the study notes, pointing out that nearly 75% of CHS patients are consumers for at least one year and all suffer from recurring severe nausea, vomiting and other possible adverse effects over several months.

Key Findings And Breakthroughs

Analysts concluded that their research is the first “to note associated mutations in genes affecting neurotransmitters, the endocannabinoid system, and the cytochrome P450 complex associated with cannabinoid metabolism.”

RELATED: Federal Health Experts Express Concerns Over Strong Marijuana

In a press release, CReDO Science CEO and study co-lead, Dr. Ethan Russo, stated that “These important preliminary findings contribute to the growing body of knowledge, stimulate additional investigation, help elucidate the pathophysiology of CHS and, ultimately, direct future treatment.”

Difficult Menstruation
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Len May, CEO of Endocanna Health, also co-led the study.

The results came from a pool of 585 heavy cannabis-consuming respondents through an online survey. Of the subjects, 28 patients and 12 controls finished genomic testing.

RELATED: Let’s Talk About The ‘New’ Syndrome In Which Weed Users Can’t Stop Puking

While the final pool was smaller than anticipated, researchers believe more results will come through ongoing questionnaire submissions and testing, said CReDO ScienceCOO Nishi Whiteley.

Next Steps: CHS Treatment

Whiteley added that the company is assessing its next steps, with the current high priority focused on “coming up with treatments that are affordable and sensible for the patient that will help provide them immediate relief.”

Relief options arose from the study but did not appear consistent at this time.

Whiteley added that the results revealed that one consistent remedy did not work in the study. Instead, various options showed promise depending on the individual and the side effects they experienced.

This article originally appeared on Benzinga and has been reposted with permission.



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