What is CHS? Maryland doctor explains an illness linked to chronic marijuana use CBS Baltimore

The hot temperature affects a part of the brain called the hypothalamus, which regulates temperature and throwing up. Initial reports describe an average of 7.1 emergency department visits, 3.1 hospitalizations, and 5.0 clinic visits prior to diagnosis 12, but as the syndrome is recognized more and cannabis availability increases, more rapid diagnosis is likely. Exclusion of what is alcoholism a major medical etiology is mandatory prior to the consideration of CHS. Other medical conditions that may present similarly to CHS include, but are not limited to, bowel perforation, cholangitis, pancreatitis, and ruptured aortic aneurysm 184.

The Effects of Cannabinoids in the Brain

• Since its symptoms are easily confused with other conditions, it can take about one to two years before people who seek medical help with CHS get an accurate diagnosis.
• While it is possible to return to feeling normal during the recovery phase, research indicates that symptoms recur if cannabis use resumes.
• It is not clear why cannabis appears to suppress emesis under certain circumstances and induces it in others.
• It’s thought that genetics may play a role because only a small number of people who regularly use cannabis develop CHS.

The articles were then segregated into diagnosis, pathophysiology, or treatment categories. When the two reviewers disagreed on article eligibility, a consensus was reached through discussion. Patients with CHS usually remain misdiagnosed for a considerable time period. In one case series the average number of emergency room visits (7.1 ± 4.3) prior to diagnosis and the delay in diagnosis (for up to 9 years) was substantial 62. Not surprisingly, the early identification of patients with CHS leads to a reduction in morbidity and costs 6.

What causes cannabis hyperemesis syndrome?

Since THC is stored in your body fat, it can take weeks to months before all the symptoms go away and you notice a difference. Smoking extra marijuana won’t help your nausea but will make it worse. People with CHS also tend to have a strong urge to take very hot showers or baths. That’s because hot water can help ease https://ecosoberhouse.com/ cannabinoid hyperemesis syndrome symptoms like nausea.

Pathophysiology of CHS

• While symptoms can be managed, the only way to stop CHS for good is to quit using cannabis in any form.
• A lack of long-term follow-up is also a major shortcoming in our knowledge of CHS.
• As a somewhat new problem, CHS is often mistaken for other problems with the same symptoms.
• As CHS is a relatively recently recognized and studied phenomenon easily confused with other diseases, there is a paucity of sizeable randomized control studies.
• Unfortunately, many of these patients relapse upon resuming cannabis 6,59,61,62.

He also warned that people with serious mental illnesses, such as schizophrenia, should be cautious about marijuana use, as studies show cannabis can exacerbate the effects of those illnesses. Neither the psychological treatments nor the pharmacological treatments seem to be that effective,” he said. Camilleri also said that cannabis use is positively correlated with anxiety and depression, and noted that doctors should treat the whole patient and not just the disorder.

• In two case reports, doctors used lorazepam (Ativan) to manage CHS-related nausea and vomiting.
• They are likely more effective than 5-HT3 antagonists (eg, ondansetron), though evidence amounts to systematic reviews of cases and 1 small RCT.
• Severe and uncontrollable vomiting increases the risk of dehydration and electrolyte imbalances, and in rare cases, patients can experience esophageal tears, Camenga said.
• These help quantify the degree of substance use to build insight and direct referrals.

What is cannabinoid hyperemesis syndrome?

Compulsive hot showering or bathing may be critical in distinguishing CHS from CVS and other conditions with similar symptoms. Studies show that between 90% to 100% of people with CHS use hot showering or bathing to relieve symptoms. Researchers have proposed that this behavior may be included in the diagnostic criteria for CHS. Δ9-tetrahydrocannabinol (THC) has several well-established effects in the central nervous system, such as alteration of psychomotor behavior, impairment in short-term memory, stimulation of appetite, and analgesia 8.

• However, with repeated use in some people, it can have the opposite effect on the digestive tract.
• Dr. Alexis Ball at Seattle Children’s was the lead author of a study that looked at more than 106,000 substance-related emergency room visits by young people between the ages of 12 and 21 at pediatric hospitals across the U.S. between 2016 and 2021.
• She wondered if her gastric distress might have been caused by the marijuana she regularly and legally smoked at her home in Toronto.
• Results from these case studies suggest that lorazepam might be an effective drug to control symptoms during the hyperemesis stage.

Cannabinoid Hyperemesis Syndrome Causes

It is important for people with CHS to stop using marijuana because this will resolve their nausea and vomiting. Preventing dehydration and stopping nausea and vomiting are the treatment goals during the hyperemesis stage of the condition. To make a diagnosis, your healthcare provider will conduct a thorough physical examination and ask you about your past health and current symptoms. It’s helpful to cannabinoid hyperemesis syndrome volunteer your history of cannabis use with your provider if you are not asked about it.

The importance of quitting cannabis with CHS

Patients are typically young adults with a long history of cannabis use. In nearly all cases there is a delay of several years in the onset of symptoms preceded by chronic marijuana abuse 6. In one study the average duration of cannabis use prior to onset of recurrent vomiting was 16.3 ± 3.4 years 62. There are at least four reported cases where the time lag was equal to or less than three years 54,59,60.

This is normally when people go see a doctor to find out what is causing these problems. They start to feel better when they stop using marijuana but can feel bad if they use it again. It is often described as a syndrome that affects only a small portion of people who are heavy, chronic cannabis users. However, research suggests that it could be far more prevalent and may continue to increase due to factors like the legalization of marijuana and the increased use of medical marijuana.