Cannabis, widely known for its anti-nausea properties in chemotherapy patients, is now linked to a puzzling condition called cannabinoid hyperemesis syndrome (CHS), characterised by recurring episodes of nausea, vomiting, and severe abdominal pain.
The condition, associated with long-term marijuana use, has been gaining attention as emergency department visits related to CHS have doubled in the U.S. and Canada from 2017 to 2021, according to recent research published in the Journal of the American Medical Association (JAMA).
First identified by doctors in Australia in 2004, CHS affects an estimated 2.75 million people annually in the US. The rise in cases could be attributed to increased cannabis use, fueled by the broader legalization of marijuana for recreational purposes. A study published in the Journal of Clinical Gastroenterology found a significant increase in hospitalisations for CHS in Massachusetts after cannabis was legalized in the state in 2012.
A Growing Concern: Factors Behind the Increase in CHS
Experts suggest that cannabis potency, which has drastically increased over the past few decades, may play a role in the rising prevalence of CHS. While the THC (tetrahydrocannabinol) concentration in marijuana was typically between 2 to 4 per cent in the 1960s, today’s cannabis products can contain THC levels of 18 to 35 percent or more.
“The cannabis available today is much more potent than what was available 30 years ago,” said Deepak Cyril D’Souza, a professor of psychiatry at Yale University and director of the Yale Center for the Science of Cannabis and Cannabinoids. However, experts are still uncertain why some individuals are more vulnerable to developing CHS than others.
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While heavy, long-term cannabis use is the most significant risk factor, researchers believe that certain individuals may have an imbalance in their endocannabinoid systems. This internal system regulates vital bodily functions and could play a role in triggering CHS. Psychological factors such as stress and lack of sleep are also believed to contribute to flare-ups.
CHS diagnosis, treatment, and potential risks
Diagnosing CHS can be challenging, as it requires several months of cannabis abstinence to confirm that the substance is causing the symptoms. Common treatments for flare-ups include intravenous fluids, anti-nausea medications, and sometimes benzodiazepines or antipsychotic drugs. A curious aspect of CHS is the compulsive bathing behavior exhibited by some sufferers, as hot water baths can temporarily alleviate symptoms.
Unfortunately, the only long-term solution for CHS is quitting cannabis use entirely. However, cessation can be difficult due to withdrawal symptoms such as anxiety, irritability, and sleep disturbances. Experts suggest tapering off use gradually or seeking professional counseling to aid in the cessation process.
Despite its growing recognition, much remains unknown about the underlying causes of CHS. Researchers continue to study the condition, hoping to develop better treatments and insights into its origins.
Experts call for further research
As cannabis use continues to rise across the globe, experts emphasize the need for further research into CHS to understand its mechanisms and improve treatment options for affected individuals. “Clearly, we need to study this more,” said D’Souza.
