Oral Papers: Addiction, Pain, & Transplant II
Cannabis use is increasing due to legalization, low cost, high availability and perceptions of low risk of harm (United Nations 2018). This has lead to increased emergency room visits for the sequelae of cannabis use including Cannabinoid Hyperemesis Syndrome (CHS), a cyclical vomiting syndrome associated with chronic cannabis use (Lapoint 2018). CHS is often resistant to standard anti-emetics, and although literature exists indicating successes in treating CHS, high-quality evidence is limited and there are no established treatment strategies (Richards 2017).
We systematically reviewed existing literature for treatment strategies using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A search of the PubMed database from January 2000 to March 2019 identified case reports describing treatments of CHS. We included cases of CHS where a pharmacological treatment was applied and excluded cases where the sole recommendation was hot showers or cessation of cannabis use. Treatments were considered successful if the patient’s nausea, hyperemesis, and urge to take hot showers resolved.
We identified 41 eligible articles, consisting of 63 individual cases. Of these articles, benzodiazepines, antipsychotics, and capsaicin cream comprised most of the available literature in terms of efficacy in treating CHS in comparison to conventional anti-emetics.
Patients with CHS frequently undergo extensive work-up and have poor symptomatic relief during their hospitalization until their symptoms resolve secondary to hospitalization-induced abstinence (Bajgoric 2015). Based on this literature review of case reports, we propose a treatment algorithm for effective treatment of CHS.
A proposed treatment algorithm can allow for more efficient care while providing a foundation for further research in optimizing treatment for CHS. Future studies and case reports will allow for improvement of a treatment algorithm that is both more efficient and cost-effective.
Bajgoric, S., et al. (2015). "Cannabinoid hyperemesis syndrome: a guide for the practising clinician." BMJ Case Rep 2015.
Lapoint, J., et al. (2018). "Cannabinoid Hyperemesis Syndrome: Public Health Implications and a Novel Model Treatment Guideline." West J Emerg Med 19(2): 380-386.
Richards, J. R., et al. (2017). "Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review." Pharmacotherapy 37(6): 725-734.
World Drug Report 2018 (United Nations publication, Sales No. E.18.XI.9)