Cannabinoid Hyperemesis Syndrome

Recent articles published in CNS Neuroscience and Therapeutics reflect the increasing interest of the scientific community in the therapeutic properties of cannabis[1,2]. However, an aspect that is commonly overlooked is the potential medical side effects of cannabis use, among which severe hyperemesis is an uncommon condition. Cannabinoid hyperemesis syndrome (CHS) occurs in chronic, daily cannabis users and is characterized by cyclic vomiting and compulsive bathing behavior. This clinical manifestation is paradoxical, given the previously identified therapeutic role of cannabis as an antiemetic agent. We report a recent case of CHS associated with organic and psychiatric complications that was diagnosed at our center. A 36-year-old Hispanic woman attended the emergency department of a tertiary hospital presenting with second-degree burns on 20% of her body surface. These had been caused by repeated showers in excessively hot water. She also reported a history of frequent episodes of nausea and vomiting for the previous 24 months, which after several inconclusive assessments had been attributed to anxiety. She denied any medical or surgical history, except diagnosis of gastritis in 2011, treated with omeprazole. She had visited the emergency department on several occasions during the previous 5 years referring anxiety and abdominal pain associated with vomiting and compulsive hot showers which the patient had claimed were aimed at relieving anxiety symptoms, and which were considered to be part of an obsessive–compulsive disorder (OCD). She had been treated with antidepressant and anxiolytic drugs without clear improvement. She admitted to smoking marijuana daily for at least 5 years, while she denied the use of any other illicit substances. The patient was admitted for evaluation and was administered acid-suppressive medications, antiemetics, rehydration, and topical treatment. The patient’s laboratory data at admission were normal, except for hypokalemia and a positive urinary drug screen for cannabis, while the physical examination yielded no additional information. During the length of the patient’s hospital admission, she continued to take hot showers numerous times each day. Taking into account the patient’s clinical presentation and her history of regular cannabis use, she was diagnosed with CHS. The patient was informed of the diagnosis, and of the need to cease her marijuana use. On further questioning, the patient confirmed persistent, daily marijuana use over the past 5 years. Following liaison with her psychiatrist, she was referred to a drug treatment center to address her cannabis use disorder, while her OCD diagnosis was withdrawn and her medication modified. Six months later, she had succeeded in giving up cannabis use entirely, she had not suffered any further episodes of nausea or vomiting, and she showered once daily with mild warm water.