Cannabis users may or may not struggle with cyclic vomiting. This is typically seen in long-term users and/or near-daily users. It is unknown why some individuals struggle with this and others do not.
Cannabinoid hyperemesis syndrome (CHS) will present as episodes of abdominal pain, vomiting, and nausea within 24 hours of last cannabis use. The vomiting can be up to 30 episodes per day. Typically the symptoms resolve after several days of not using cannabis; however, some individuals still have symptoms up to two weeks after not using. Patients often report their symptoms resolve while taking hot showers.
CHS has a similar presentation to other abdominal problems. When seeking medical attention for CHS, especially for the first time, it is important to rule out other causes. This can be fulfilled by thorough physical examination, laboratory testing, and CT scan of the abdomen.
CHS is diagnosed clinically. This means that it is based on the patient’s history (regular cannabis use, current symptoms, and resolution of symptoms with hot showers) and ruling out other causes for cyclic vomiting (negative labs, normal CT scan).
In the short term, droperidol and haloperidol have been proven most effective for treating the cyclic vomiting in CHS. These medications are typically used for psychiatric conditions and/or to prevent vomiting. Other medications for preventing nausea and vomiting have been proven less effective.
In the long term, it is recommended that patients who are currently suffering from CHS should abstain from cannabis use. Additional support through mental health or substance use treatment is recommended. It is unknown if merely reducing the amount of cannabis prevents recurrence.
References:
Rotella JA, Ferretti OG, Raisi E, Seet HR, Sarkar S. Cannabinoid hyperemesis syndrome: A 6-year audit of adult presentations to an urban district hospital. Emerg Med Australas. 2022 Aug;34(4):578-583. doi: 10.1111/1742-6723.13944. Epub 2022 Feb 23. PMID: 35199462; PMCID: PMC9545654.
Simonetto DA, Oxentenko AS, Herman ML, Szostek JH. Cannabinoid hyperemesis: a case series of 98 patients. Mayo Clin Proc. 2012 Feb;87(2):114-9. doi: 10.1016/j.mayocp.2011.10.005. PMID: 22305024; PMCID: PMC3538402.
Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review. J Med Toxicol. 2017 Mar;13(1):71-87. doi: 10.1007/s13181-016-0595-z. Epub 2016 Dec 20. PMID: 28000146; PMCID: PMC5330965.
Stanghellini V, Chan FK, Hasler WL, Malagelada JR, Suzuki H, Tack J, Talley NJ. Gastroduodenal Disorders. Gastroenterology. 2016 May;150(6):1380-92. doi: 10.1053/j.gastro.2016.02.011. PMID: 27147122. Assessed and Endorsed by the MedReport Medical Review Board