Cannabis health risks: What science is starting to say

Miriam was vomiting uncontrollably on a summer morning in 2022 when she arrived at a Utah hospital. As the laws regarding the possession and use of marijuana change, CHS may become more prevalent because more people will have legal access to the drug. Doctors have a lack of knowledge of CHS, and this makes it hard to identify people with the condition. However, doctors exercise caution when prescribing lorazepam because it is a controlled substance with the potential for abuse and addiction. The use of lorazepam for CHS is also off-label, so a person’s doctor would need to make them aware of this fact. Researchers have identified two receptors called CB1 and CB2 to which marijuana molecules attach.

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A flood of THC appears to slow internal cannabinoid production and attenuate receptor networks, Piomelli said. More THC is then required for a similar effect, a key marker of addiction. Those system disruptions can also lead to severe inflammation and immune and digestive problems, such as Miriam experienced with CHS. At the federal level, marijuana remains a Schedule 1 illegal drug, alongside heroin, LSD and a few others. But at the state level, the race chs symptoms and signs to legalization in recent years has been dizzying.

What is Cannabinoid Hyperemesis Syndrome (CHS)? Part 1

Although it was considered to be rare, the number of cases has increased with the legalization of marijuana in many places and the opening of retail stores to easily get it. This has increased both the number of people using the drug and the “high” in the available weed. It’s a serious medical problem that can cause major health issues if you leave it untreated. If you have any symptoms of severe dehydration, like dizziness, confusion and a rapid heartbeat, call 911 right away. The diagnostic criteria for CHS were ill-defined prior to the establishment of the Rome IV criteria of 2016.2223 Per the Rome IV criteria, all 3 of the following must be met to be diagnosed with CHS.

Patient Education

Although there were very few case studies involving CHS patients with eating disorders, bulimia might present in such a way that it could be confused with CHS. About 35% of individuals with some form of substance use disorder have an eating disorder (which typically precedes the substance use disorder) versus 5% of the general population 174. The serum levels of psychiatric drugs may be reduced in patients suffering from CHS or other vomiting syndrome. A vicious cycle can occur in which CHS patients taking psychiatric medications suffer nausea and vomiting, increase their use of marijuana to manage marijuana addiction those symptoms, and exacerbate their mental health condition. For patients on psychiatric pharmacological regimens, CHS can have a destabilizing effect on the patient 126.

In all 4 cases, CHS was diagnosed, and patients were counseled to avoid cannabis in the future. Three out of 4 patients resumed marijuana use and presented at the hospital again. One of the patients, a 27-year-old man, said he understood the cause of his symptoms but was “unable” to stop smoking marijuana. Another patient in the series, a 31-year-old man, discontinued marijuana for a short time, then resumed and periodically visits the ED to manage symptoms 102.

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In the brain, CB1 receptors are localized to the cerebral cortex, hypothalamus, anterior cingulate gyrus, hippocampus, cerebellum, and basal ganglia 8. In the gastrointestinal system, CB1 receptors are found on both intrinsic and extrinsic neurons, with the enteric nervous system serving as the major site of action 9. Other organs where CB1 receptors have been identified are the spleen, heart, liver, uterus, bladder, and vas deferens 10. In the gastrointestinal system, CB2 receptors are expressed by lamina propria plasma cells and activated macrophages, as well as by the myenteric and submucosal plexus ganglia in human ileum 9,12,13. CB2 receptors are likely involved in the inhibition of inflammation, visceral pain, and intestinal motility in the inflamed gut 9,14. According to the outlet, Krumholtz developed a rare condition called cannabinoid hyperemesis syndrome (CHS) after he returned to using marijuana after “a long break.”

• According to the Cleveland Clinic, CHS “can affect people who use cannabis (marijuana) long-term,” and can cause “frequent, severe nausea and vomiting.”
• Cutaneous problems arise typically from prolonged and excessive exposure to very hot water, heating pads, or hot water bottles.
• The only known treatment to permanently get rid of CHS is to stop cannabis use completely.
• CB1 receptors are mostly present in the brain, but they also occur in other organs.
• Over time, the symptoms will go away completely unless you start to use again.
• Conventional antiemetics are not contraindicated but are generally ineffective likely because of the atypical mechanisms behind CHS.

THC accumulates largely within body fat which serves as a long-term storage site for the drug 20,22. This characteristic partially explains its prolonged elimination half-life. A large reservoir of stored THC in fat tissue may produce a “reintoxication effect” secondary to increased lipolysis during times of increased stress or food deprivation 23. The same factors apply to clinicians, specialists, nurses, and pharmacists, as well as other healthcare personnel, to consider the diagnosis in any chronic vomiting disorder, and to better inform themselves regarding the condition. They should also have the freedom and empowerment to speak up to other team members if they feel that this may be getting overlooked in the diagnostic picture.

• It is important for people with CHS to stop using marijuana because this will resolve their nausea and vomiting.
• Cannabidiol, in contrast to THC, is non-psychotropic, has a low affinity for CB1 and CB2 receptors 27, and acts as a partial agonist at the 5-HT1A receptor 28.
• In fact patients with CHS are often mislabeled as having CVS and vice versa.
• In some cases, lorazepam may be helpful to counteract the anxiety suffered by the patient, but lorazepam as treatment for CHS is generally not effective 116.
• Our mission is to inform, assist, and support people affected by gastrointestinal disorders.Our original content is authored specifically for IFFGD readers, in response to your questions and concerns.
• It has been suggested that chronic stimulation of primarily the CB1 receptor contributes to CHS.

• Overall, the grade of evidence of any of these theories is very low and, in some ways, helps to explain why multiple interventions may help with CHS management.
• The delay in gastric emptying seems as if it would be promote emesis 53, yet this delay often occurs with the antiemetic benefits of THC, possibly because those antiemetic effects override the effects of delayed intestinal motility 13.
• Once they are activated, anandamide and 2-AG have different pathways for biosynthesis and subsequent degradation, in that anandamide is metabolized mainly by FAAH while 2-AG is metabolized via monoacylglycerol lipase 30.
• He consented to IV haloperidol 1 mg which relieved his symptoms and produced no adverse effects; he subsequently received two more IV doses of 2 mg before he was discharged 114.
• But why is CHS an episodic condition with sometimes very long asymptomatic periods between attacks?

In a report on a 16-year-old CHS patient, she reported that she used marijuana herself but had been exposed prior to that to secondhand smoke for many years, as her family used marijuana 125. The mechanism of action of topical capsaicin likely involves TRPV1 receptors. In other words, topical capsaicin opens the TRPV1 channels, which has an antiemetic effect. Chronic or excessive use of cannabinoids may also stimulate the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system in addition to disrupting the endocannabinoid system. The endocannabinoid system plays a role in allostasis of the autonomic nervous system following episodes of stress 55. The HPA axis is the main neuroendocrine system activated by the body when confronting stress 56.

How soon after cannabis hyperemesis syndrome treatment will I feel better?

In the acute setting, volume resuscitation is urgently required for many CHS patients who may arrive dehydrated and hypovolemic. Electrolyte replacement is appropriate to correct any electrolyte imbalances that may have occurred with prolonged vomiting. While patients benefit from rehydration and other forms of supportive care, the only effective treatment for CHS is marijuana cessation.