Cannabinoid Hyperemisis Syndrome: Real or Not Real?

woman-in-showerIn researching cannabis, I run across some pretty weird studies once in awhile. I thought I’d share with you these studies related to a new “syndrome” that’s being linked to long-term marijuana use. This condition has pretty unusual symptoms of severe vomiting and long showers. It sounds pretty uncomfortable for the people experiencing it. What’s going on here? And is this something to be concerned about? I’ll let you be the judge after you read the excerpts below.

Severe Vomiting Sickness With Chronic Cannabis Abuse

Date: March 23, 2009
Source: World Journal of Gastroenterology

Marijuana, a commonly abused drug among high school and college students, is linked to a severe form of vomiting syndrome and compulsive bathing behavior. This form of severe vomiting sickness is increasingly recognized with widespread abuse of marijuana. The syndrome usually subsides with strict abstinence from marijuana abuse.

According to Dr. Sontineni, doctors and health care workers currently under recognize the syndrome leading to delayed diagnosis and expensive diagnostic investigations. Increasing consistent use of marijuana among United States populations, particularly young people, over several years will see a steady rise in the number of cases diagnosed each year.

The syndrome was first recognized in Australia around the Adelaide hills. The exact mechanism leading to generation of these symptoms, why it appears only after several years of marijuana abuse and why compulsive hot showering behavior relieves the symptoms is still under scientific investigation.

The recognition of this novel syndrome and increasing physician awareness is supported by the Department of Medicine at Creighton University Medical Center. Similarly, scientists and doctors at other institutions worldwide are beginning to identify more cases with this new syndrome as a result of chronic marijuana abuse among populations.

Cannabinoid Hyperemesis Relieved by Compulsive Bathing

Date: January 2009
Source: Mayo Clin Proc.

Cannabinoid hyperemesis is a clinical syndrome characterized by repeated vomiting and associated learned compulsive hot water bathing behavior due to long-term marijuana use. Research has indentified type 1 cannabinoid receptors in the intestinal nerve plexus that have an inhibitory effect on gastrointestinal motility. This inhibitory effect may lead to hyperemesis in marijuana users. The thermoregulatory role of endocannabinoids may be responsible for the patient’s need to take hot showers. We report 2 cases of cannabinoid hyperemesis that demonstrate this unusual adverse effect of marijuana use.

Case 1 An obese 25-year-old woman who was a long-term cannabinoid user presented to the emergency department with nausea, vomiting, and abdominal pain that worsened for several days. During the previous 5 years, the patient had noted intermittent episodes of similar symptoms, each lasting about a week and often requiring hospitalization for dehydration. Her symptoms were refractory to all types of antiemetic medications and only responded to prolonged hot showers, some lasting 6 hours or more. Her medical history included bipolar disorder, reflux esophagitis, polycystic ovarian disease, and mild cerebral palsy with chronic mild left facial droop. She had no history of surgery or known drug allergies and reported that she took only lamotrigine. She had begun smoking marijuana 6 to 7 years earlier and used the substance almost daily. Her last marijuana use was 1 day before admission to the hospital. She denied alcohol, tobacco, or other illicit drug use.

The patient was admitted for supportive care because she could not tolerate food. Many antiemetic medications, including ondansetron, promethazine, metoclopramide, lorazepam, and esomeprazole, were given with minimal symptomatic relief. Morphine sulfate was given for abdominal pain. Erythromycin was ordered to help increase gastric motility, but its administration was unsuccessful because the patient refused to leave the hot shower in her room. Indeed, she spent much of her hospitalization in the shower, noting that this was the only thing that controlled her symptoms. She showered as much as 4 hours at a time and even left her room to use a neighbor’s shower when her shower stall broke. Her symptoms resolved in 48 hours without any other intervention, and she was discharged from the hospital.

Case 2 A 23-year-old man presented with 1 day of nausea, vomiting, and abdominal pain in the epigastric and right upper quadrant. His symptoms were worsened by food and improved with a prolonged hot shower. He noted having similar symptoms several times during the past 2 years; on these occasions, he would come to the emergency department only after exhausting all the hot water in his shower at home. He reported no fevers, chills, indigestion, travel history, or sick contacts. He had experienced chronic abdominal pain for 9 years and had been tested for human immunodeficiency virus and, more recently, for tuberculosis, with negative findings on both. He had no known drug allergies and was not taking any medications. He reported using marijuana 2 to 3 times a day for the past 9 years but denied alcohol or other illicit drug use.

The patient noted feeling better soon after coming to the emergency department. He stated that he had come to the hospital because he was afraid his symptoms would not improve and because he had used all the hot water in his house by showering for 4 hours. He was treated symptomatically with ondansetron and phenergan for nausea, dilaudid for pain control, and normal saline for hydration. After a few hours, his symptoms resolved, and he was discharged from the hospital.

Conclusion: The toxicity and adverse consequences of long-term marijuana use are still under investigation. Marijuana may either cause or control nausea and vomiting, but the mechanism is unknown. Given the prevalence of illicit marijuana use and the increased popularity of marijuana use for medicinal purposes, these paradoxical effects require further investigation. This case report aims to raise awareness of the potential adverse effects of marijuana use and the importance of obtaining a thorough patient history, which should include consideration of the potential for substance abuse. A thorough history is particularly important when a patient presents with intractable nausea and vomiting that are refractory to antiemetic medication but that are relieved by a hot shower. When confronted with these unusual symptoms, the physician should consider not only organic disease but also illicit marijuana use as a possible cause.

I encourage you to read the studies in full. You’ll find plenty of other research about this at the NIH web site. And there’s always google. So you tell me. Give me your best opinion. Real or not real?



Categories: Mental Health, Research

Tags: , , , ,

2 replies

  1. Hard to say. As a general rule, the symptoms of withdrawal from a substance of abuse are the opposite of the symptoms of intoxication. That is generally true of addictions across the board. So if cannabis treats nausea (and many would say it does) then if you are dependent on it and go into withdrawals, it is plausible that severe nausea could occur. I’ve never heard of it defined as a syndrome, though.

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