Eligibility assessment was performed by the independent reviewers (H.S. and S.W.) and disagreements were resolved by consensus. A data extraction excel sheet was developed and used to compile and summarize the relevant studies. Inclusion criteria were established in line with the study objective, where relevant articles underwent data extraction and analysis. With the emergence of cannabis and its widespread usage in various https://ecosoberhouse.com/ settings, clinicians and users should be more aware of the long-term effects of cannabinoids. CHS is a potential side effect of prolonged cannabis use, causing major distress to consumers. While synthetic cannabinoids have been accepted as one of the main drugs to relieve N/V, their dosage and duration of administration have not been thoroughly investigated long term.
Benzodiazepines
Three retrospective studies were short-term, with small sample sizes, without a standardized reporting of outcomes and subject to the risk of bias found in Tables Tables33 and and44 24, 25, 28. Additionally, some of the statistically significant studies did not measure symptom relief, instead looked at the reduced LOS in hospitals 23, 24, 25, 28, 31. Furthermore, LOS in the ED was used to measure the stabilization of N/V symptoms; however, it was not a marker of CHS cure. In addition to the lack of controlled studies, most of the articles published on CHS were descriptive case reports 20, 23, 26, 29, 30, 31, 33, 34, 35. This anecdotal evidence is important clinically; however, CHS and its management options need to be viewed in the broader context of controlled research. Many different treatments and dosages have been reported among case studies, which may not be generalized to the wider population.
How we reviewed this article:
Helen Senderovich was responsible for the conception, design, drafting, clinical revisions, and final approval of a version to be published. Briam Jimenez Lopez was responsible for the drafting of the paper and interpretation of the data. Sarah Waicus was responsible for the drafting of the paper, interpretation of the data, and critical revisions of the paper. A recent study found that human papillomavirus vaccination when aged under 20 years, coupled with active surveillance for cervical intraepithelial neoplasia grade 2, significantly lowers the risk of cervical intraepithelial neoplasia grade 3 or cervical cancer.
Product Reviews
Our study emphasizes the importance of both acute care and long-term outpatient follow-up, as key processes in cannabis-related disorder treatment. By Rome IV criteria, the diagnosis of CHS is confirmed only when symptoms resolve upon ceasing use. Clinicians should help patients toward this goal following physiologic stabilization.
- The SAEM GRACE program addresses the best practices for the care of the most common chief complaints that can be seen on the tracking board of any emergency department in the country, based upon research and expert consensus.
- Furthermore, LOS in the ED was used to measure the stabilization of N/V symptoms; however, it was not a marker of CHS cure.
- Several treatments have been described to relieve N/V in CHS; however, there are limited controlled data to support management decisions.
- Some individuals, for instance, also admitted to smoking 2000 mg of THC per day.
- Like many EDs worldwide, the normalization of cannabis consumption has led to an increase in the number of cannabis-related consults in the ED (positive delta from 2.3 to 13.3 cases per 100,000 ED visits in the USA from 2006 to 2013) 43.
Nabilone, sold under the brand name Cesamet©, is a synthetic cannabinoid with therapeutic use as an antiemetic and as an adjunct analgesic for neuropathic pain. Nabilone mimics THC, the primary psychoactive compound found naturally occurring in cannabis. Despite the current acceptance of Nabilone as a treatment option for N/V in patients with CHS, there is a lack of data regarding the side effects of its prolonged use such as accumulation and toxicity, resulting in exacerbation of N/V rather than curing it. Brief intervention can include motivational interviewing toward reducing harm and/or use. This may include providing information about potential cognitive, psychiatric, and physical harms of cannabis use, plus clear patient-centric recommendations. Many adolescents use cannabis to manage anxiety, depression, and/or prior trauma, in which case it is crucial cannabinoid hyperemesis syndrome to offer safer options, including psychotherapy and pharmacotherapy with well-studied efficacy and AEs.
Deterrence and Patient Education
Gastric acid suppression, nasogastric tube placement, and gastroenterology consultation should be considered to mitigate sequelae, including catastrophic esophageal rupture. Most people with CHS who stop using cannabis have relief from symptoms within 10 days. Researchers are currently studying several treatment options to manage the hyperemetic phase of CHS. The only known treatment to permanently get rid of CHS is to stop cannabis use completely. You may have symptoms and side effects of CHS for a few weeks after quitting cannabis.
History and Physical
In women, a pregnancy test is necessary to assess for any pregnancies, especially ectopic pregnancies. Imaging is up to the discretion of the clinician, depending on various specific factors of history or physical exam, which may be concerning for surgical processes. Lorazepam has no studies assessing its utility in CHS, but a summary of case reports suggests an efficacy of 58.3% in 19 patients 3. Despite the lack of evidence, clinical experience has led to lorazepam being recommended as an adjunct in recent cyclic vomiting syndrome guidelines for patients who have an anxiety component to their presentation 8. Since 40-50% of traditional cyclic vomiting syndrome patients were chronic cannabis users, it is reasonable to extrapolate these guidelines to CHS until more specific literature is published. Withdrawal symptoms seem to respond well to oral THC substitution 30, the concept being that these will interact with CB1 receptors, in a bid to counter severe symptoms due to rapid downregulation from withdrawal.
For CWS, patients should at least have three DSM-5 symptoms, within 1 week of complete cessation or reduction in cannabis use; this should occur following a heavy or prolonged use. Symptoms include loss of appetite, hypothymia, irritability, restlessness, anxiety, and sleep disturbance. While no consensus exists pertaining to the minimal duration of exposure, one study demonstrated that smoking ≥ 6 marijuana joints/day over 12 months triples the odds of CWS (in comparison to smoking 1 joint/day over the same period) 13, 21. It is of interest to note that abdominal pain and vomiting are not included in the diagnostic criteria for the DSM-5; this further reflects the importance of a thorough medical history in establishing a diagnosis. The duration of cannabis administration ranged between 6 months to 11 years may precipitate symptoms of CHS. The Rome IV diagnostic criteria of CHS require cannabinoid use and persistence of N/V symptoms for at least the past 6 months.
A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options
Importantly, for the definition of cyclic vomiting syndrome, these episodes of vomiting cannot be attributed to other disorders. This factor is a key distinguishing feature from cannabis hyperemesis syndrome, where the toxicokinetics of cannabis itself influence the course of the disease. With a high potential for relapse (54% of patients achieving 2-week abstinence, and 71% relapse within 6 months 39), follow-up of patients should be initiated, if possible, from acute care 39, 44. This can be done through healthcare liaison officers, dedicated community outreach nurses, and/or group counseling sessions such as Marijuana Anonymous which works in a similar fashion to Alcoholics Anonymous, with sponsors and group discussions.
- With the only known treatment being abstinence and the high risk of relapse, it is important to rely not solely on acute care but also on long-term follow-up strategies.
- Careful consideration is imperative in older individuals where comorbidities and pharmacological interacts can mask or exacerbate CHS.
- Drugs with an anticholinergic effect may likewise block medullary mediated vomiting, though they may have minimal impact on visceral stimulation, including the crippling abdominal cramping pain that patients with CHS experience.
- MR and EPH conceptualized the article, reviewed the literature, and drafted the first version.
- The excessive self-administration of hot showers, a feature well-described in the literature 5, is thought to reverse this by inducing peripheral vasodilatation of the peripheries and redistributing blood flow away from the gastrointestinal tract 4.
The GRACE-4 multidisciplinary panel applied the Grading of Recommendations Assessment, Development, and Evaluation (GRACE) approach to assess the certainty of evidence and strength of recommendations regarding three questions for adult ED patients coming to the ED with AWS, AUD, or CHS. Since the early 2000s, both CHS and CWS have been recognized by the ICD-10 (F12.241 and F12.30 of the 10th edition of the International Classification of Diseases, respectively). CHS is also included in the Rome IV definition as a functional gastrointestinal disorder, while CWS is encompassed in the DSM-5 (5th edition of the Diagnostic and Statistical Manual of Mental Disorders) 19, 20. The use of cannabis as a recreational substance has increased worldwide in the past 20 years, as its use becomes more socially accepted. Now regularly consumed by a large spectrum of the population, this trend has resulted in an increase in the number of cannabis-related medical consultations 1, making its consumption a non-negligible public health issue. In Switzerland, nearly 1/3 of the population over the age of 15 years has already tried cannabis for reasons other than medical purposes 2.