Cannabis has a long history linking to many cultures; its use has been dated back many millennia. Although it was categorized as an illegal substance via the Marijuana Tax Act of 1937, marijuana today is the most used illicit drug according to the 2015 National Survey on Drug Use and Health 1. The Controlled Substances Act of 1970 classified cannabis and its cannabinoids as a schedule 1 substance, meaning cannabis has been determined to have a high potential for abuse and having no accepted medical use. There are, however, two synthesized cannabinoids that the Food and Drug Administration (FDA) has approved as medications in 1985, dronabinol (Marinol) and nabilone (Cesamet) 1.

The rising alarm about the dangers of legalized marijuana

• It’s a serious medical problem that can cause major health issues if you leave it untreated.
• Recent polls show that 88 percent of Americans favor legal medical use of cannabis, and 60 percent full legalization.
• Topical capsaicin has been advocated for use as a diagnostic tool for CHS to differentiate it from other vomiting syndromes 36.
• CHS causes you to have repeated episodes of vomiting, severe nausea, stomach pain, and dehydration.
• A case report in the literature describes Takotsubo syndrome or stress cardiomyopathy in a patient with CHS 150.
• Benzodiazepines and opioids, although sometimes prescribed, have very limited effectiveness for this condition 100.

Other known complications of forceful and uncontrolled vomiting include aspiration and subsequent pneumonitis or aspiration pneumonia as well as injury to the esophageal wall such as Boerhaave’s syndrome. One study found that 32.9% of self-reported frequent marijuana users who came to an emergency department for care met the criteria for CHS. With the widespread use, increased potency and legalization of marijuana in multiple states in the U.S., CHS may be becoming increasingly common.

Shortcomings in our knowledge of CHS and areas for future research

There is currently no FDA-approved indication for the use of haloperidol for the treatment of CHS. However, there are numerous publications citing the efficacy of intravenous haloperidol in the treatment of symptoms due to CHS 15, 16, , 19, 20•, 21, 22, 23•, 24. The efficacy of haloperidol as an antiemetic in post-surgical and chemotherapy patients has also been reported 15, 23•. Several papers indicate that haloperidol has been administered intravenously for treating CHS with a good response, though our patient received her dose intramuscularly. This difference in route of administration may account in Sobriety part for the slow response to the medication in our patient 15, 20•, 24.

What is Cannabinoid Hyperemesis Syndrome (CHS)? Part 1

In CHS, receptors that bind to the different components of marijuana can become altered. With the consumption of marijuana increasing due to the legalization of its recreational use in many states, chs symptoms and signs doctors may receive more reports of side effects from marijuana use. In this article, we describe CHS and discuss the causes, symptoms, diagnosis, and treatment of the condition. While the above results were pending, a bedside glucose reading revealed hyperglycemia (338 mg/dL) and she received 2 L of IV normal saline, ondansetron 4 mg IV, and insulin glargine 34 units subcutaneous plus regular insulin 6 units subcutaneous. She then admitted to smoking more marijuana than usual for the past several weeks and denied drinking heavily the night before.

A lack of long-term follow-up is also a major shortcoming in our knowledge of CHS. The majority of reported cases that have provided follow-up included a period of less than one year 6,52,54,56–60,62,68,71. A greater understanding of the natural course of the syndrome and response to marijuana cessation may be gained with longer lengths of follow-up. Future studies following patients longitudinally for extended periods of time are needed.

• In fact, the authors know of no reports in the literature of a CHS patient who continued to experience symptoms after marijuana was discontinued.
• There is currently no FDA-approved indication for the use of haloperidol for the treatment of CHS.
• Doctors have also noticed that people in the hyperemesis stage take frequent showers and baths, which seem to relieve nausea.
• Preclinical studies suggest that endocannabinoids and THC may evoke bradycardia, hypotension, and decreased contractility of the myocardial tissue 149.