The severe nausea and vomiting associated with CHS is one of the most interesting paradoxical effects of cannabis in patients with CHS. Very interesting indeed.... Written By Health Laslo The purpose of this article is to educate you on the signs and symptoms of a syndrome associated with the chronic stimulation of endocannabinoid system receptors (CB1 and CB2) via the chronic and heavy use of cannabis. The syndrome is referred to as Cannabinoid Hyperemesis Syndrome or CHS. Al- though CHS is thought to be relatively rare, it is also thought to be underreported since the symptoms look very similar to Cyclic Vomit- ing Syndrome (CVS). Interestingly enough, 50 percent of patients with CVS report daily cannabis use reinforcing the premise that this syndrome is grossly under- recognized and underreported. The primary difference between CHS and CVS is the compulsive hot bathing/showering to elevate nausea and vomiting, which we will discuss in detail below. CHS has been documented in a number of case reports in medical journals for 10 years now, yet it continues to be under- recognized and misdiagnosed. CHS is characterized by years of daily cannabis use that causes recurrent “flare ups” of severe nausea, vomiting/abdominal pain, compulsive bathing for symptom relief and symptom resolution with cessation of use. These flare ups occur on average every two months and can last for days resulting in multiple ER visits and hospitalizations. This can place a large financial burden on patients and their families due to the misdiagnosis, ineffective treatments and length of time it takes to get a correct diagnosis. When I first read about CHS in the scientific journals, I filed it away in my brain as “good to know,” but not prevalent enough for me to consider writing an educational piece on it. This changed after a friend of mine with multiple sclerosis who has been using cannabis for three years for spasticity and pain relief started experiencing episodes of severe nausea followed by numerous bouts of vomiting throughout the day and night. Subsequently, my friend’s CHS symptoms would last on average seven to 14 days. In the beginning she thought it was the flu and would ride it out as long as possible. However, inevitably she would end up in the ER and hospital for a few days as doctors re- hydrated her with IV fluids and tried to figure out what was going on. As mentioned above in the description of CHS, one of the unique and frankly strange components of the syndrome is the compulsive bathing in really hot water. Taking these baths provided her symptomatic relief, but it was relatively short-lived with the symptoms returning 30 to 45 minutes later. Hence, she found herself taking anywhere be- tween six to 10 hot baths a day. In addition to the bathing ritual for temporary relief of her nausea, she naturally consumed cannabis for its well-known antiemetic (anti-nausea) ef- fects. Unfortunately, unbeknownst to both of us at the time, the cannabis she was consuming was the cause of the problem and not the cure. The severe nausea and vomiting associated with CHS is one of the most interesting paradoxical effects of cannabis in patients with CHS. It is well-known and accepted within the medical community that cannabis can markedly improve nausea associated with chemotherapy and hence is thought to be an excellent antiemetic medication. The cause of the paradoxical hyper- emetic symptoms of CHS remains unclear, but several mechanisms have been proposed. The principal active cannabinoid in canna- bis is the highly lipophilic compound THC, which binds to cannabinoid type one (CB1) and type two (CB2) receptors in the CNS and other tissues. It is thought that the antiemetic and appetite-stimulating effects of cannabis are mediated by CB1 receptor activation in the hypothalamus. Nausea and vomiting are thought to be mediated by the CB1 receptor’s activation in the enteric nervous system (nervous system of the gastrointestinal tract), which causes slowed peristalsis and delayed gastric emptying. In sensitive people, chronic heavy cannabis use can cause THC to accumulate to a toxic level in fatty tissues, causing enteric receptor-binding effects to override the CNS receptor-binding effects. This is supported by case studies describing severe vomiting with IV injection of crude marijuana extract. Basically, after years of cannabis expo- sure, my friend had developed a form of cannabinoid toxicity. Logically this makes sense. As mentioned before, the treatment for CHS is complete cessation. In my friend’s case, after spending a few days in the hospital away from her vaporizer and dab rig, we slowly saw improvements daily in her condition after taking an imposed tolerance break. Yeah we might live in WA, one of the two great states in this country that has legalized cannabis consumption, but they haven’t set up any dab rigs at Swedish or Virginia Mason Hospital… yet. So if there is anything you take away from this review, remember CHS specifically responds to hot baths, which alleviate the nausea and vomiting. Second, if you do think that you or a loved one has CHS, stop using cannabis for a few days and see if your symp- toms start to subside. This is a good thing to know about; it may save you or a loved one from going through all the tests and procedures and save you a lot in medical bills. Better living through education folks.
Posted on: Sat, 08 Nov 2014 02:48:43 +0000
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