Cannabinoid Hyperemesis Syndrome: A Practical Review for Clinicians

Abstract

The first clinical description of cannabinoid hyperemesis syndrome comes from an article by Allen et al. published in 2004. Since then, several publications have focused on its conceptualization and clinical approach, although it remains largely unknown among the medical community. This syndrome is characterized by the triad of chronic cannabinoid consumption, cyclic hyperemesis, and compulsive hot baths or showers for symptom relief. Abdominal pain and other symptoms may also occur. Its true prevalence is unknown, despite growing evidence that it is more frequent than previously thought. There are several hypotheses that aim to explain its pathogenesis, namely related to the cannabinoid and vanilloid receptors, the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Regarding its therapeutic approach, support measures could be justified in the acute phase (e.g. hydration), and there is evidence for the utilization of benzodiazepines (especially lorazepam), haloperidol and topical capsaicin for symptomatic relief. The only intervention that leads to the definite remission of symptoms is abstinence of cannabinoid use, with psychoeducation and adequate therapeutic guidance of the patient. Our knowledge about cannabinoid hyperemesis syndrome is still growing. The lack of awareness of the disease can lead to invasive and expensive diagnostic tests, multiple visits to the emergency department, and persistence of symptoms. This article aims to systematize the lines of clinical intervention of the disease and to promote a greater awareness of this entity among health professionals, allowing for a better identification and therapeutic approach of the condition.