Cannabis hyperemesis syndrome is a result of years of high cannabis use and manifests as months of vomiting with nausea and abdominal pain. The active ingredient THC appears to be responsible for the syndrome, but the exact pathomechanism remains unclear. Therapy focuses on the emergency administration of infusions.
What is cannabis hyperemesis syndrome?
Cannabis hyperemesis syndrome is a condition that corresponds to a paradoxical reaction after years of high cannabis use. Cannabis is a genus within the hemp family and is one of the oldest useful plants ever. In use, hemp is a source of fiber and oil. In the form of hashish and marijuana, cannabis is also used as an intoxicant and medicine. Marijuana is obtained from the dried, crushed resinous flower clusters and the flower-like small leaves of female cannabis plants. Hashish, on the other hand, corresponds to the extracted resin of the plant. Within Germany, cannabis is considered the most consumed illegal drug. The intoxicating effect is due to the psychoactive cannabinoid THC. This substance shows influence THC on the central nervous system, has a central nervous depressant effect and thus has a relaxing and slightly sedating effect on the consumer. Although cannabis is already used as a remedy in Germany under certain circumstances, the plant with its psychoactive ingredients can also show highly pathological effects under certain conditions. How many people in Germany have already developed cannabis hyperemesis syndrome is relatively unclear. Presumably, there is a high number of unreported cases.
Causes
Cannabis hyperemesis syndrome is preceded by the use of cannabis. In most cases, the syndrome presents exclusively with really high consumption that has been pursued for several years. Patients often report having regularly smoked between three and up to five joints a day. Some sufferers report even higher levels of use. The exact pathomechanism of cannabis hyperemesis syndrome is as yet unknown. Presumably, habitually high doses of THC are the cause of patients’ symptoms. The mechanism of action of THC is not yet clear. At least biochemistry now agrees on its action at two different types of receptors. The CB1 and CB2 receptors are located in the central nervous system and in immune cells. C1 modulates the release of neurotransmitters in the nervous system. CB2 receptors, on the other hand, regulate cytokine release. THC presumably binds to CB1 receptors, where it affects signal transduction. Little is known about the role of the CB2 receptor. Cannabis hyperemesis syndrome, for example, may thus be related to the long-term effects of THC on C2 receptors.
Symptoms, complaints, and signs
Patients with cannabis hyperemesis syndrome undergo cyclic phases, each characterized by different conditions. In the first phase, patients suffer from nausea and vomiting. In addition, accompanying symptoms in this phase often include abdominal pain. The first phase is characteristically followed by two other phases. The first phase is also called the prodromal phase and can last for an extremely long time. In some patients, the prodromal phase comes to an end after a few months. Others suffer from the mild pain and morning vomiting for years. The second phase of the syndrome is episodic and is also called the hyperemetic phase. This phase lasts far less than the first phase. For 24 to 48 hours, patients suffer from even increased nausea and vomit up to five times an hour. Due to the high fluid and nutrient losses, dehydration or weight loss often sets in. Associated with these symptoms is mild abdominal pain. In the final phase, the symptoms subside.
Diagnosis and course
The diagnosis of cannabis hyperemesis syndrome can be made solely on the basis of the patient’s history. This can lead to problems, as many patients do not want to admit to consumption. Since differential diagnosis must be thought of many other diseases of the gastrointestinal tract, the doctor is thus sometimes lured on a false trail. The prognosis for patients with cannabis hyperemesis syndrome is relatively favorable. Although recovery may be protracted, the symptoms will at least eventually subside.
When should you go to the doctor?
Cannabis hyperemesis syndrome is a common withdrawal symptom, but it can lead to various complications and discomforts. For this reason, a doctor should definitely be consulted when cannabis is discontinued after a long period of use and the person is going through withdrawal. Especially in the case of withdrawal without medical observation, a doctor should always be consulted. The doctor should be consulted if cannabis hyperemesis syndrome causes vomiting and permanent nausea in the patient. Severe abdominal pain may also indicate the syndrome and should be investigated. Furthermore, weight loss and nutritional deficiencies are also possible. These complaints must also be examined by a doctor. Furthermore, a doctor should be consulted if there are strong psychological complaints or depression. In this case, a visit to a psychologist is advisable. The syndrome itself can usually be diagnosed and treated by a general practitioner. However, it is advisable to undergo drug withdrawal in a clinic.
Complications
Due to cannabis hyperemesis syndrome, various symptoms may occur, depending primarily on the level of cannabis use by the patient and the duration of use. Most commonly, however, there is severe vomiting and associated nausea. The symptoms are permanent and can place a heavy burden on the daily life of the person affected and reduce the quality of life. Sudden pain may also occur in different areas of the body. Due to the constant vomiting, patients suffer from a loss of fluids and nutrients, which has a negative effect on weight. Being underweight represents a very unhealthy condition for a patient and should be avoided at all costs. As a rule, only the treatment of symptoms is carried out, since a causal treatment of cannabis hyperemesis syndrome is not possible. This involves administering infusions to the patient to counteract the loss of fluids and nutrients. Likewise, the affected person must undergo withdrawal from the drug or stop taking it for a long period of time. In most cases, this results in a positive course of the disease and no further complications occur.
Treatment and therapy
The treatment of cannabis hyperemesis syndrome is rather difficult because the pathomechanism is unknown so far. Thus, therapy cannot address the actual cause, but is purely symptomatic. The focus is on avoiding dehydration and high weight loss. If necessary, patients are given intravenous fusions that bypass the gastrointestinal tract in acute conditions. Interestingly, many patients with cannabis hyperemesis syndrome report the soothing effect that a hot bath or shower has on their symptoms. As a result, this approach is recommended by physicians to sufferers in the acute phase. However, the water should not be too hot to rule out scalding. In the hyperemetic phase, patients are given antiemetics. This conservative drug therapy is directed against the nausea and is intended to suppress the nausea. No other therapeutic steps are available. Patients are generally recommended absolute abstinence in order to avoid further stress on the detoxification organs and to exclude a recurrence of the disease. As a rule, those affected regain their subjective sense of well-being during the recovery phase.
Outlook and prognosis
Because very little is known about cannabis hyperemesis syndrome in medicine to date, usually only symptomatic treatment can be given to alleviate the symptoms. A causal treatment is not possible in this case. However, the symptoms can be completely alleviated if the affected person undergoes withdrawal or otherwise stops taking cannabis. The treatment itself is carried out with the help of medication and infusions to supply the body with important nutrients. With successful withdrawal, the symptoms of cannabis hyperemesis syndrome no longer occur in most cases. However, no prediction can be made about the duration of withdrawal, as it depends greatly on the patient’s condition. The symptoms of the syndrome can vary in severity, and the severity also depends on the duration of use.The longer the consumption lasts, the more difficult withdrawal often is. If cannabis hyperemesis syndrome occurs only after very prolonged use of cannabis, the symptoms may also be relieved by reducing the amount consumed.
Prevention
Cannabis hyperemesis syndrome can be prevented by abstinence from cannabis. Since the syndrome is only expected to occur with extremely heavy use and years of use, absolute abstinence need not be required for prevention. Moderate use of cannabis can also prevent the syndrome.
Aftercare
The aftercare situation in the still relatively unexplored cannabis hyperemesis syndrome is not particularly good. Withdrawal alone often only helps in the medium term, as the symptoms of long-term cannabis use may not be completely over until three months later. Many sufferers see hot baths as a palliative during the acute phase of vomiting, stomach pain, and inability to eat. After successful cannabis withdrawal, whether or not the patient will be permanently symptom-free depends very much on the quantity and quality of cannabis consumed over the years. It is also problematic to distinguish the present symptoms from other diseases or cyclic vomiting. Therefore, in individual cases it may take several years until the described problems are even recognized as cannabis hyperemesis syndrome. The ignorance among orthodox physicians is still great. Without knowledge about the chronic cannabis use of his patient, the treating physician has hardly a chance to find the right diagnosis, a suitable form of therapy or follow-up measures. In the case of the regularly occurring cannabis hyperemesis syndrome, aftercare only makes sense if the user abstains from cannabis use in the future. What is also difficult is that medical professionals do not yet know what triggers cannabis hyperemesis syndrome. If it is poisoning symptoms from neem oil, which is often used as an organic pesticide by cannabis cultivators, follow-up care would have to be different than for other causes.
Here’s what you can do yourself
Cannabis hyperemesis syndrome is preceded by years of regular and very high cannabis use. People who use the drug regularly should therefore consider starting therapy in good time, also with regard to possible late effects. Professional help is needed at the latest when the first signs of addiction appear. There are free state drug counseling centers in every state. In addition, the churches and secular charitable associations offer help. Those affected can also find help and information on the Internet. If cannabis hyperemesis syndrome is suspected, the attending physician must be informed about the use. Doctors in Germany are subject to a strict duty of confidentiality. Even if criminal offenses should have occurred in connection with cannabis use, the physician is obligated to maintain silence and may not inform the police or the public prosecutor’s office or testify against a patient as part of an investigation. Patient records are also off-limits. Therefore, there is no reason to hide drug abuse from the treating physician. The therapy of a cannabis hyperemesis syndrome is best supported by the patient himself by completely stopping further use of the drug. For this purpose, therapy is usually necessary. The attending physician, drug counseling centers or the health insurance company will provide information about appropriate offers. If the patient belongs to a milieu in which cannabis use is considered normal, he should take measures to break away from these circles. For this purpose, the help of therapists and social workers can be sought.
