For CHS, cardinal symptoms are cyclic vomiting accompanied by abdominal pain following cannabis consumption. These symptoms can be alleviated by hot showers, and complete resolution of the syndrome requires complete abstinence 15. For CWS, patients should at least have three DSM-5 symptoms, within 1 week of complete cessation or reduction in cannabis use; this should occur following a heavy or prolonged use. Symptoms include loss of appetite, hypothymia, irritability, restlessness, anxiety, and sleep disturbance. While no consensus exists pertaining to the minimal duration of exposure, one study demonstrated that smoking ≥ 6 marijuana joints/day over 12 months triples the odds of CWS (in comparison to smoking 1 joint/day over the same period) 13, 21. It is of interest to note that abdominal pain and vomiting are cannabinoid hyperemesis syndrome not included in the diagnostic criteria for the DSM-5; this further reflects the importance of a thorough medical history in establishing a diagnosis.
Pathophysiology of abdominal pain and emesis
Proponents of marijuana use and legalization might think that reports of CHS by medical professionals are suspicious or are an attempt to discourage marijuana use. One cannabis consultant stated that many people in the cannabis industry believe CHS is a made-up illness, or at the very least, a condition that is very misunderstood. The incidence of CHS seems to be increasing as cannabis consumption increases. Although, as medical professionals become more aware of CHS and its consequences, more research will likely be conducted. There are multiple hypotheses regarding the pathophysiology of CHS; however, because of the multitude of active chemicals in cannabis and the existence of various sites of action, the definitive pathophysiological process is unknown. Additionally, not all cannabis users develop CHS, causing further difficulty in describing the syndrome.
2. Epidiolex dosing for seizures associated with LGS, DS, and TSC
With the expanding acceptance and legalization of cannabis worldwide, healthcare providers face a crucial imperative to accurately identify CHS amidst a sea of similar clinical presentations. The ramifications of misdiagnosing CHS can extend far beyond financial burdens, potentially obstructing the timely recognition of life-threatening conditions and compromising the quality of care and life for affected individuals. Although often presenting with similar symptoms such as abdominal pain and vomiting, cannabinoid hyperemesis syndrome (CHS) and cannabis withdrawal syndrome (CWS) are the result of two differing pathophysiological processes. Distinguishing between these two syndromes is essential to provide appropriate symptomatic options.
1. Overcoming barriers to initiation of Epidiolex
- After a 90-day break from cannabis, it may be possible to reintroduce cannabis slowly and carefully.
- Symptoms are most common in early middle-aged adults who have used cannabis regularly since adolescence.
- Ironically, one of the potential complications of long-term cannabis use is a condition called cannabis hyperemesis syndrome (CHS).
- More research is still needed to understand the impact of cannabinoids on hypothalamic endocannabinoid and endocannabinoid-related enzymes.
You may have symptoms and side effects of CHS for a few weeks after quitting cannabis. It’s a condition that can lead to serious health complications if you don’t get treatment for it. In one small study of eight patients hospitalized with CHS, four of the five who stopped using weed recovered from CHS. One of the 4 who recovered went back to using marijuana and the vomiting resumed. If you have CHS and don’t stop using, your symptoms like nausea and vomiting are likely to come back.
A patient-centered approach aimed to avoid attribution and anchoring errors is vital to provide proper treatment in a timely manner for medical conditions resulting from prolonged marijuana use. One suggested reason is via the stimulation of the dopaminergic system by cannabinoids in the nucleus accumbens. While understimulation of this system leads to vomiting and abdominal pain, this reward pathway can also cause paradoxical effects when overstimulated, such as anhedonia and lower positive and higher negative emotionality scores 10, all symptoms regularly seen in chronic users. Sudden abstinence or drop in intake in patients whose dopaminergic pathway has been upregulated in response to high doses of cannabinoids could therefore theoretically cause symptoms of withdrawal. This has been well demonstrated in regularly THC-exposed animals and humans, whom, when administered Rimonabant© (a CB1 receptor blocker, used to treat obesity) 11, 12, rapidly develop abdominal pain and hyperemesis.
If you need help quitting cannabis, the Substance Abuse and Mental Health Services Administration offers https://ecosoberhouse.com/ a 24/7 helpline in English and Spanish. A representative can refer you to local treatment facilities, support groups, and community-based organizations. Keep in mind none of these treatments will be effective if you continue using cannabis products. It’s thought that genetics may play a role because only a small number of people who regularly use cannabis develop CHS.
Cannabis hyperemesis syndrome: 5 scientific answers to “scromiting” questions
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