Just left hospital: Do I have Cannabinoid Hyperemesis Syndrome?
- Thread starter Ronald MacDonald
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szuko000
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My girls got CVS, at first they thought it was the weed thing but quitting didn't help. She's had multiple tests done but there's no real way to prove it other then the intense episodes. We are also heroin addicts and it's not WDs, a good shot didn't stop it. She's turned down IV morphine in the ER for it.
I think these issues do exist. The weed one is probably becoming more common because of the high potency weed and cannabiniods. These things still activate receptor sites and still have withdrawal periods. Is it so hard to believe that years or decades even a binge on isolated compounds and cause a change in their activity? I think theres more to screwing with these receptors then a lot of us are willing to accept.
Oh and to the dude spamming the thread about CVS being worse then H withdrawal my girl would definitely agree with you. It's an odd thing, she says it's the worst pain in the world. Please dont judge something you've experienced. If you have CVS it's definitely not the H WDs your experiencing I've experienced one myself and I've seen her go through both.
I think these issues do exist. The weed one is probably becoming more common because of the high potency weed and cannabiniods. These things still activate receptor sites and still have withdrawal periods. Is it so hard to believe that years or decades even a binge on isolated compounds and cause a change in their activity? I think theres more to screwing with these receptors then a lot of us are willing to accept.
Oh and to the dude spamming the thread about CVS being worse then H withdrawal my girl would definitely agree with you. It's an odd thing, she says it's the worst pain in the world. Please dont judge something you've experienced. If you have CVS it's definitely not the H WDs your experiencing I've experienced one myself and I've seen her go through both.
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K-Dazed
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Honestly, don't listen to these idiots trying to give you a medical opinion they in no way are entitled to give. For the past two years, I have vomited every morning until I smoke, accompanied by the fact that I cannot eat or drink without vomiting, and I sweat profusely which causes extreme dehydration. I'm not saying you, or myself, have either CVS or CHS, but to listen to a bunch of idiots who aren't trained in the medical profession isn't a good idea either. I have suffered from all of the symptoms described (including weight loss and the hot showers, 4x daily), but despite that, I'm not ready to claim I have some new-found illness. I have had every blood-test under the sun, a bronchoscopy etc (you name it, I've had it - all negative). At the same time however, I'm not about to dismiss it because there haven't been many reported cases. Only a couple cases of the plague get reported each year - does that mean the plague is not a real disease? Of course not. This is supposed to be a harm-reduction website, and it is saddening to see people encouraging people to continue smoking. When I quit smoking, I saw changes ~1 week 1/2 after I quit; it could be CHS, it could just be physical withdrawals (which people on this website are much more inclined to believe, despite the lack of evidence), but whatever it is, smoking MORE weed isn't going to make it better.
Good luck. Despite all the dumbasses here, you'd be the real dumbass if you continue smoking.
Some quick questions to those who believe they suffer:
1) Do you have extreme swings of body-temperature?
2) When you vomit, is it more bile-like or like regular vomit?
3) Do you have problems eating/drinking in the morning? (specifically feeling bloated even though you know you're not?)
4) What age did you start smoking, and for how long have you been smoking?
But please, whatever you do, don't waste your time and money (or taxpayer money) continually going to the hosptial for this. Try quitting for 2 weeks, see how you feel, then if it recurs see your medical practitioner.
Quote from one of the articles on CHS:
"In all cases, including the published case, chronic cannabis abuse predated the onset of the cyclical vomiting illness. Cessation of cannabis abuse led to cessation of the cyclical vomiting illness in seven cases. Three cases, including the published case, did not abstain and continued to have recurrent episodes of vomiting. Three cases rechallenged themselves after a period of abstinence and suffered a return to illness. Two of these cases abstained again, and became and remain well. The third case did not and remains ill."
EDIT: Sorry, I only read the ignorance on the first page. The second page of this thread seems to be more helpful.
Good luck. Despite all the dumbasses here, you'd be the real dumbass if you continue smoking.
Some quick questions to those who believe they suffer:
1) Do you have extreme swings of body-temperature?
2) When you vomit, is it more bile-like or like regular vomit?
3) Do you have problems eating/drinking in the morning? (specifically feeling bloated even though you know you're not?)
4) What age did you start smoking, and for how long have you been smoking?
But please, whatever you do, don't waste your time and money (or taxpayer money) continually going to the hosptial for this. Try quitting for 2 weeks, see how you feel, then if it recurs see your medical practitioner.
Quote from one of the articles on CHS:
"In all cases, including the published case, chronic cannabis abuse predated the onset of the cyclical vomiting illness. Cessation of cannabis abuse led to cessation of the cyclical vomiting illness in seven cases. Three cases, including the published case, did not abstain and continued to have recurrent episodes of vomiting. Three cases rechallenged themselves after a period of abstinence and suffered a return to illness. Two of these cases abstained again, and became and remain well. The third case did not and remains ill."
EDIT: Sorry, I only read the ignorance on the first page. The second page of this thread seems to be more helpful.
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haveyoufoundgod
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this, completely. the feeling of smoke, especially cigarette smoke with an empty stomach makes me gag quite often, sometimes even throw up. pot smoke only gets me when i take too fat of a hit too fast and burn my throat, or when i cough so hard i end up gagging.
also, in regards to the food, over eating before you go to bed or eating really spicy stuff can cause that to happen too. i constantly have to watch myself to make sure i don't eat after 7 or 8 pm, and not overdo it on the fire sauce. otherwise i wake up ass crack of dawn early feeling unpleasant in my tummy, usually have a pretty good shit, and then rapidly begin to feel nauseous until i get violently sick with acidic leftovers and become a sweltering desert or barely manage to fight it on and have to force a bunch of spicy, uncomfortable burps out and still feel like shit for the next few hours. the opiates definitely are not helping with any of that either, maybe try eating foods one little bite at a time when you have the munchies instead of going balls to the wall and making a ton of shit and devouring it, even though that's always fun to do stoned. you're not gonna really be able to get your 'body' back as long as you stay on the opiates, it will just keep you sickly. i can understand not wanting to go through withdrawal, but the longer you stay on, the worse it's gonna get and the harder it'll be to kick. i'd suggest just lowering your intake by a certain #mg every day until you hit 0, in as small of increments as you're comfortable with. being able to sleep in and get up and not feel sick or in pain is definitely worth kicking any habit causing it. and if you don't stop now, you're gonna get an ulcer or two, although it sounds like you may already have a few. opiods can both irritate and cause ulcers fyi.
good luck man you got this.
daaniellex
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Most likely. I'm 17, and was diagnosed with it about a month and a half ago. I was in the ER for a day then admitted to the hospital because I was lacking potassium and needed more fluids. After I got out of the hospital I was sober for about 5 days, and I recently started getting back to my normal routine of smoking everyday. Yesterday my nausea and vomiting symptoms came back; woke up at 4am super nauseous and then threw up 4 hours later. Same with this morning. I've been extremely restless and this is TORTURE- so I'm going to stop smoking even if I dont really want to. It's not worth feeling this way
PapaBearWarealge
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Do you smoke cigarettes?
Are your sinuses in decent working order?
I smoke cigarettes ( over a pack a day) I also smoke a fair amount of pot be it in blunt, joint, or water pipe form. I often wake up and within 20-45 minutes feel like death. I will eat something light and the cramping and nausea will go away more often than not. However if it does not go away I will drink a 20oz bottle of water and purge my stomach with it, my sinuses are a complete wreck all year around, I will purge with water to rid my stomach of the excessive amount of mucus I drink throughout the night. My habits may not be the healthiest, but they work. I read about the disease that evidently makes you sick from marijuana and I'm calling B.S on it. Its most certainly has to be that the people thought to have this outlandish "disease" have a condition already, they just happen to smoke pot as well.
Are your sinuses in decent working order?
I smoke cigarettes ( over a pack a day) I also smoke a fair amount of pot be it in blunt, joint, or water pipe form. I often wake up and within 20-45 minutes feel like death. I will eat something light and the cramping and nausea will go away more often than not. However if it does not go away I will drink a 20oz bottle of water and purge my stomach with it, my sinuses are a complete wreck all year around, I will purge with water to rid my stomach of the excessive amount of mucus I drink throughout the night. My habits may not be the healthiest, but they work. I read about the disease that evidently makes you sick from marijuana and I'm calling B.S on it. Its most certainly has to be that the people thought to have this outlandish "disease" have a condition already, they just happen to smoke pot as well.
Doctor_Ew420
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I have to say, I just got back from the hospital 3 days sicker than I have ever been. Puking like mad until the point of bleeding. I am on zofran and percocets and was asked by my doctor without having hinted or have anything on my record about it "Do you smoke a lot of marijuana"
he has told me to stay away from pot for at least a day. He was reasonable. He told me that excess is the issue. This is something I have secretly been wanting to hear for a long time, I cant wait to really cut down.
I believe what he has told me and I am abstaining from pot until I am better. I was fucking shocked when he asked me that and I thanked him several times for being understanding and realizing that pot can cause problems, but used responsible (like I should be doing) it is rather benign.
God damn... the last 3 days in hospital have made me want to become a doctor or nurse so badly. I just have so much love for people who deal with 20+ very sick, sometimes paralysed, sometimes covered in their own shit or in the depths of dementia patients day after day after day. Heroes.
he has told me to stay away from pot for at least a day. He was reasonable. He told me that excess is the issue. This is something I have secretly been wanting to hear for a long time, I cant wait to really cut down.
I believe what he has told me and I am abstaining from pot until I am better. I was fucking shocked when he asked me that and I thanked him several times for being understanding and realizing that pot can cause problems, but used responsible (like I should be doing) it is rather benign.
God damn... the last 3 days in hospital have made me want to become a doctor or nurse so badly. I just have so much love for people who deal with 20+ very sick, sometimes paralysed, sometimes covered in their own shit or in the depths of dementia patients day after day after day. Heroes.
dcraver877
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have you ever considered food allergies? maybe all these people with "CHS" are eating, regulalary, foods they are allergic to. Thus, smoking pot would help relieve the negative effects. If food is still undigested 12 hours after eating then how does the body get rid of the "bad" food? You get nauseaus and throw up.
What is your diet like? Do you eat gluten or dairy every day?
What is your diet like? Do you eat gluten or dairy every day?
BananasAndOranges
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Dcraver that wouldnt make much sense as I would expecta histamine reaction if you were allergic to food....not getting sick.
dcraver877
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i am allergic to gluten and dairy and if i eat a lot of gluten my body cannot digest it so it ends up coming up as vomit.
dcraver877
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sounds more like a metabolic disorder to me which is very common these days due to our terrible diets. have you had a blood test for nutritional deficiencies? Have you been tested for heavy metals? lots of bud these days is contaminated with heavy metals and other fertilizers/chemicals. It's not all fine and dandy when you throw technology and the industrial age into the mix.
Doctor_Ew420
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Well, I have had another 3 days in the hospital being able to talk to some very helpful doctors and nurses.
I am lactose intolerant (not terribly so, i get bloated if I drink too much milk or ice cream and can vomit the next morning)
I only have an allergy to goat products (goat milk/cheese)
6 full days of vomiting, I was taking zofram every 4 hours and having hot showers every hour (Complusive, I did not read anywhere that this could help) I have been given pantoloc and it has calmed everything down. I am hoping that I am just dealing the the acid reflux issues I have had in my life and possibly my quitting meat within the last year is a contributing factor. I did get an ultrasound today and everything is normal, gall bladder, intestines, pancreas, liver etc. all good.
I had a good long talk with the doctor that just released me, he was great. He told me that he isnt sure if CHS is real. He said he has seen several young men who are heavy cannabis users who end up with this cyclical vomiting. He brought up a great point. Kurt Cobaine shot dope and smoked lots of weed to ease his life long stomach issues. He wrote many songs about it but was it the chicken or the egg? Same situation with cannabis use and mental degradation in the late 20's or early 30's. Who can really say is the person subconsciously picked up the bong to deal with slowly growing mental problems or slowly growing GI problems.
Since I was 14 I have been dealing with stomach acid problems. I did not smoke pot then, but I would wake up every morning and vomit .5-1L of stomach acid in a very painful fashion. I realized a few years later that a single bong got me on my way to school and the nausea was gone all day. I do NOT smoke as heavily as some who have posted on this page, but, I do smoke .7-1g per day. Sometimes more, and I used to hit it pretty heavy when I was younger.
Regardless this thread has opened my eyes and if it turns out I am just dealing with a GI/acid reflux problem, I will take the warning and cut down big time. It kind of freaks me out to think of my life without pot. I used to be a real hot head as a kid and would freak out over nothing. I have sleep paralysis and cannabis stops it in it's tracks completely.
At the same time I am scared to pick it up again, I havent smoked a cigarette in 6 days so fuck it... im done with them. I always said, to quit smoking you either have to drop me off in the woods SurvivorMan style or put me in hospital for a week. Pot just does so much for me.
I hope this isnt the case.
P.S. The last 6 days have been kind of emotional for me. I have never needed such care, I don't trust strangers and I never really trusted hospital wait staff. I thanked every beautiful nurse that helped me through these days several times, same with the fantastic and understanding doctors. No snickering, no passing judgement... I think I have figured out what I want to do with my life!!
Anyone reading this that is working on being in the health care industry or already is, I commend you absolutely! You should be very proud!
I am lactose intolerant (not terribly so, i get bloated if I drink too much milk or ice cream and can vomit the next morning)
I only have an allergy to goat products (goat milk/cheese)
6 full days of vomiting, I was taking zofram every 4 hours and having hot showers every hour (Complusive, I did not read anywhere that this could help) I have been given pantoloc and it has calmed everything down. I am hoping that I am just dealing the the acid reflux issues I have had in my life and possibly my quitting meat within the last year is a contributing factor. I did get an ultrasound today and everything is normal, gall bladder, intestines, pancreas, liver etc. all good.
I had a good long talk with the doctor that just released me, he was great. He told me that he isnt sure if CHS is real. He said he has seen several young men who are heavy cannabis users who end up with this cyclical vomiting. He brought up a great point. Kurt Cobaine shot dope and smoked lots of weed to ease his life long stomach issues. He wrote many songs about it but was it the chicken or the egg? Same situation with cannabis use and mental degradation in the late 20's or early 30's. Who can really say is the person subconsciously picked up the bong to deal with slowly growing mental problems or slowly growing GI problems.
Since I was 14 I have been dealing with stomach acid problems. I did not smoke pot then, but I would wake up every morning and vomit .5-1L of stomach acid in a very painful fashion. I realized a few years later that a single bong got me on my way to school and the nausea was gone all day. I do NOT smoke as heavily as some who have posted on this page, but, I do smoke .7-1g per day. Sometimes more, and I used to hit it pretty heavy when I was younger.
Regardless this thread has opened my eyes and if it turns out I am just dealing with a GI/acid reflux problem, I will take the warning and cut down big time. It kind of freaks me out to think of my life without pot. I used to be a real hot head as a kid and would freak out over nothing. I have sleep paralysis and cannabis stops it in it's tracks completely.
At the same time I am scared to pick it up again, I havent smoked a cigarette in 6 days so fuck it... im done with them. I always said, to quit smoking you either have to drop me off in the woods SurvivorMan style or put me in hospital for a week. Pot just does so much for me.
I hope this isnt the case.P.S. The last 6 days have been kind of emotional for me. I have never needed such care, I don't trust strangers and I never really trusted hospital wait staff. I thanked every beautiful nurse that helped me through these days several times, same with the fantastic and understanding doctors. No snickering, no passing judgement... I think I have figured out what I want to do with my life!!
Anyone reading this that is working on being in the health care industry or already is, I commend you absolutely! You should be very proud!
cvssufferer
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Sorry to hear what you have been going through Dr EW420...it really is awful whatever it is! It would be great if we could speak more though about symptoms etc. Would you mind if I PM'd you? Have you ever been on the cyclic vomiting message board with your symptoms?
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I dont think I really need to post much on here. If you are also researching the non proven, poorly researched and poorly documented Cannabis Hyperemesis you will probably have seen me before looking for answers.
For equality purposes and anyone else reading who doesnt suffer these symptoms and are unsure...........there are other adult sufferers of this terrible vomiting syndrome that do not smoke cannabis aswell!! Make that of what you will! Infact a doctor who specialises in the field of the known syndrome of "Cyclic Vomiting" state that only 40% of her adult CVS sufferers smoke cannabis. So what exactly are the causes of vomiting for the others? Even the published studies say that abstaining cannabis doesnt work in every case!!!! In those same poorly done CHS studies, they only pick out and study CVS patients who smoke cannabis and ignore the patients who dont. What sort of study is that? A study that certainly wasnt funded by the CVSA that is for certain!
Here is a paper which was written by a CVSA specialist in which cannabis, although not condoned, it is quoted "The possible role of cannabis in causing CVS has been examined, although it remains controversial
http://emedicine.medscape.com/article/933135-overview
That means a specialist who specialises in the area of cyclic vomiting has examined the possible role of cannabis in the illness and even she doesnt believe it!!!!! It doesnt take a genius to see that various doctors are not doing their research thoroughly enough and I invite anyone who believes they have cannabis hyperemesis to come over to the CVSA forum for a friendly discussion about it. I think doctors check that forum and would be very interested to hear from you. You will see the thread I have started, it would be great to hear your stories, more particularly your recovery after abstaining etc.
All that being said, I am NOT a doctor and maybe abstaining cannabis will help with your vomiting, some people report it does. However even more report it makes no difference. I think, like the CVS doctors think, it is a correllation rather than a causation. Infact in some states in USA in is prescribed for cyclic vomiting.....go figure?!
Thanks for listening and reading. Every side has 2 stories and this one there are people who claim abstaining cannabis worked, and others claiming it doesnt. As I said, 50-60% of CVS patients dont smoke cannabis so IMHO it cant be a cause.....does it make symptoms worse? Maybe in some, maybe not on others but I doubt it is solely to blame
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I will finally add aswell, if anyone is interested in the actual illness Cyclic Vomiting (what some doctors are claiming is caused by cannabis abuse)...........please watch Greys Anatomy this week 15th November 2012. It is based around a male patient who keeps ending up at the ER with this mysterious vomiting episodes and is finally diagnosed with cyclic vomiting. Lets see if he smokes cannabis eh? Incidentally, it is being directed by one of the actresses Dr Bailey (in the show). Her daughter suffers from cyclic vomiting and she is doing it to raise awareness of the illness. She doesnt smoke cannabis either!
----------------------------------------------------------------
I dont think I really need to post much on here. If you are also researching the non proven, poorly researched and poorly documented Cannabis Hyperemesis you will probably have seen me before looking for answers.
For equality purposes and anyone else reading who doesnt suffer these symptoms and are unsure...........there are other adult sufferers of this terrible vomiting syndrome that do not smoke cannabis aswell!! Make that of what you will! Infact a doctor who specialises in the field of the known syndrome of "Cyclic Vomiting" state that only 40% of her adult CVS sufferers smoke cannabis. So what exactly are the causes of vomiting for the others? Even the published studies say that abstaining cannabis doesnt work in every case!!!! In those same poorly done CHS studies, they only pick out and study CVS patients who smoke cannabis and ignore the patients who dont. What sort of study is that? A study that certainly wasnt funded by the CVSA that is for certain!
Here is a paper which was written by a CVSA specialist in which cannabis, although not condoned, it is quoted "The possible role of cannabis in causing CVS has been examined, although it remains controversial
http://emedicine.medscape.com/article/933135-overview
That means a specialist who specialises in the area of cyclic vomiting has examined the possible role of cannabis in the illness and even she doesnt believe it!!!!! It doesnt take a genius to see that various doctors are not doing their research thoroughly enough and I invite anyone who believes they have cannabis hyperemesis to come over to the CVSA forum for a friendly discussion about it. I think doctors check that forum and would be very interested to hear from you. You will see the thread I have started, it would be great to hear your stories, more particularly your recovery after abstaining etc.
All that being said, I am NOT a doctor and maybe abstaining cannabis will help with your vomiting, some people report it does. However even more report it makes no difference. I think, like the CVS doctors think, it is a correllation rather than a causation. Infact in some states in USA in is prescribed for cyclic vomiting.....go figure?!
Thanks for listening and reading. Every side has 2 stories and this one there are people who claim abstaining cannabis worked, and others claiming it doesnt. As I said, 50-60% of CVS patients dont smoke cannabis so IMHO it cant be a cause.....does it make symptoms worse? Maybe in some, maybe not on others but I doubt it is solely to blame
----------------------------------------------
I will finally add aswell, if anyone is interested in the actual illness Cyclic Vomiting (what some doctors are claiming is caused by cannabis abuse)...........please watch Greys Anatomy this week 15th November 2012. It is based around a male patient who keeps ending up at the ER with this mysterious vomiting episodes and is finally diagnosed with cyclic vomiting. Lets see if he smokes cannabis eh? Incidentally, it is being directed by one of the actresses Dr Bailey (in the show). Her daughter suffers from cyclic vomiting and she is doing it to raise awareness of the illness. She doesnt smoke cannabis either!
Doctor_Ew420
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Yes, please PM me, I can't think of a better person to bounce my symptoms off of, Thank you so much. (all of bluelight, thank you!)
This thread looks dead, but want to chime in regarding cannabis hyperemesis syndrome:
Firstly, I am a staunch medical cannabis ADVOCATE. I am a physician who is quite well read on the subject and STRONGLY in support of its use (as long as the patient doesn't have a developing/teenage brain or some co-existing psych or medical condition that would be negatively effected by THC)
Secondly, from what I've read, I believe Cannabis Hyperemesis Syndrome is real. Moreover, I think the question of its existence is diverting attention away from the more important question: HOW DO WE TREAT IT!!!???? In the eyes of most doctors, this question would seem idiotic. "Duh, by not smoking weed dumb*ss." This attitude will change. As cannabinoid pharmacologic research progresses, the medical field will begin to appreciate that cannabinoids are potent DMARDs (tx autoimmune dz) and anti-neoplastic drugs (tx Cancer) with a far better side-effect profile than current therapies. In that setting, it will become a priority for clinicians to devise a strategy for treatment of CHS that will allow continued use of cannabis. (As opposed to the current perspective: "you shouldn't be using this anyway").
WHY CANNABIS HYPEREMESIS SYNDROME IS REAL (for those of you who haven't experienced it and may be skeptical)
(A) There are a limited number of case reports, but they all have the same unique presentation:
- the patient is a chronic cannabis user who suddenly develops a paradoxical cyclical vomiting syndrome whenever s/he uses cannabis
- (importantly) the only thing that seems to alleviate the emesis is a scalding HOT bath
- Upon cessation of cannabis, the syndrome goes away. Once cannabis use is resumed, the cyclical vomiting returns
(B) TRPV1 - A biochemical explanation of why SCALDING HOT baths slow/stop vomiting in ALL case reports of CHS
- Unbeknownst to the authors of earlier case reports, THC and CBD are potent "desensitizers" of the heat activated selective cation channel "Transient Receptor Potential Vanilloid 1" (TRPV1), a channel which has been shown to have anti-emetic effects when activated.
***In other words, TRPV1 is anti-emetic AND is de-activated by THC/CBD, AND is activated by an increase in body temperature.
-Thus, a potential biochemical mechanism which may underlie CHS is now emerging from the ever growing body of research on cannabinoids and the endocannabinoid/endovanilloid system, though this potential role of TRPV1 dysregulation in the pathogenesis of CHS does not seem to have been addressed at all in the literature (that I can find).
- Regardless, there is no way the earliest "discoverers" of CHS could have foreseen the existence of an anti-emetic ion channel that's activated by heat and de-activated by cannabis. If this were all just a lie it's incredibly serendipitous that the "hot bath part" was included and that now there is a biochemical explanation for it. These facts combined with the homogenous nature of the case reports on CHS is highly suggestive that this is a REAL syndrome.
After confirming the TRPV1 link and further elucidating the mechanisms underlying CHS, diagnostic and treatment modalities will hopefully be developed. Quantification of TRPV1 expression/activity may play a role in diagnosis, or dx based on clinical presentation may be enough.
SPECIFIC THOUGHTS/THEORIES ON THE PATHOGENESIS OF CANNABIS HYPEREMESIS SYNDROME:
- In most cannabis users, any possible pro-emetic effects of THC/CBD-induced TRPV1 desensitization would be negated by the more potent anti-emetic effects of concomitant CB1 receptor activation. BUT....CB1 receptor and TRPV1 ion channel expression are likely BOTH pathologically low in chronic cannabis users
(1) CB1 receptor expression is downregulated in the face of increased THC and decreased degradation of endocannabinoids (effect of CBD)
(2) TRPV1 channels are directly desensitized by THC/CBD which ultimately leads to internalization and degradation of these receptors.
-It follows that this dysregulation of both the cannabinoid and vanilloid receptor systems may lead to a paradoxical syndrome in which :
(A) Repeated use causes progressive downregulation of CB1 and TRPV1 until finally a "tipping point" is reached in which CB1 expression
is so low that activation of this receptor no longer overcomes the theoretical "pro-emetic" effects of TRPV1 desensitization (because THC
both activates CB1 and desensitizes TRPV1 simultaneously, remember?).
(B) Once this tipping point is reached, any future exposure to cannabis would be expected to have a pro-emetic effect owing to complete
inactivation of TRPV1 by THC/CBD combined with inadequate activation of CB1 mediated "anti-emetic pathways." Moreover, this
effect would be expected to persist for a while after cannabis exposure since it takes time for TRPV1 to regain "sensitivity."
- Onward to Treatment:
These effects could be overcome by doing things that activate TRPV1 (i.e. hot baths) and reversed by re-sensitizing/upregulating TRPV1
*Due to the fact that TRPV1 is "desensitized", heat-induced activation would likely take a large stimulus (i.e. SCALDING hot baths).
*PGE2 analogues (dinoprost) also activate TRPV1 and may have therapeutic benefit in CHS, but NO ONE has looked at this.
*PGI2 analogues may work too, but worse side effect profile than PGE2/dinoprost
*Additionally, agents that restore sensitivity of TRPV1 may actually reverse the condition and allow patients to continue using cannabis. Unfortunately, the rather dangerous general anesthetic "propofol" is the only pharmacologic agent that has been shown to restore TRPV1
sensitivity to date (according to the literature I've reviewed). Likely that there are other yet-to-be-discovered agents which can do this, as well as
old/known drugs whose effects on TRPV channels just hasn't been examined yet. TRPV pharmacology is a new, burgeoning field of study
after all.
Regardless of the validity of my rants and speculations, I'm certain that hot baths help curb the nausea and vomiting in these patients via heat-triggered activation of TRPV1. And this mechanism needs to be further explored, along with methods of restoring TRPV1 sensitivity, so the patients w/ CHS who actually need Cannabis for treatment of cancer, autoimmune disease, HIV/AIDS, etc can continue using it.
Firstly, I am a staunch medical cannabis ADVOCATE. I am a physician who is quite well read on the subject and STRONGLY in support of its use (as long as the patient doesn't have a developing/teenage brain or some co-existing psych or medical condition that would be negatively effected by THC)
Secondly, from what I've read, I believe Cannabis Hyperemesis Syndrome is real. Moreover, I think the question of its existence is diverting attention away from the more important question: HOW DO WE TREAT IT!!!???? In the eyes of most doctors, this question would seem idiotic. "Duh, by not smoking weed dumb*ss." This attitude will change. As cannabinoid pharmacologic research progresses, the medical field will begin to appreciate that cannabinoids are potent DMARDs (tx autoimmune dz) and anti-neoplastic drugs (tx Cancer) with a far better side-effect profile than current therapies. In that setting, it will become a priority for clinicians to devise a strategy for treatment of CHS that will allow continued use of cannabis. (As opposed to the current perspective: "you shouldn't be using this anyway").
WHY CANNABIS HYPEREMESIS SYNDROME IS REAL (for those of you who haven't experienced it and may be skeptical)
(A) There are a limited number of case reports, but they all have the same unique presentation:
- the patient is a chronic cannabis user who suddenly develops a paradoxical cyclical vomiting syndrome whenever s/he uses cannabis
- (importantly) the only thing that seems to alleviate the emesis is a scalding HOT bath
- Upon cessation of cannabis, the syndrome goes away. Once cannabis use is resumed, the cyclical vomiting returns
(B) TRPV1 - A biochemical explanation of why SCALDING HOT baths slow/stop vomiting in ALL case reports of CHS
- Unbeknownst to the authors of earlier case reports, THC and CBD are potent "desensitizers" of the heat activated selective cation channel "Transient Receptor Potential Vanilloid 1" (TRPV1), a channel which has been shown to have anti-emetic effects when activated.
***In other words, TRPV1 is anti-emetic AND is de-activated by THC/CBD, AND is activated by an increase in body temperature.
-Thus, a potential biochemical mechanism which may underlie CHS is now emerging from the ever growing body of research on cannabinoids and the endocannabinoid/endovanilloid system, though this potential role of TRPV1 dysregulation in the pathogenesis of CHS does not seem to have been addressed at all in the literature (that I can find).
- Regardless, there is no way the earliest "discoverers" of CHS could have foreseen the existence of an anti-emetic ion channel that's activated by heat and de-activated by cannabis. If this were all just a lie it's incredibly serendipitous that the "hot bath part" was included and that now there is a biochemical explanation for it. These facts combined with the homogenous nature of the case reports on CHS is highly suggestive that this is a REAL syndrome.
After confirming the TRPV1 link and further elucidating the mechanisms underlying CHS, diagnostic and treatment modalities will hopefully be developed. Quantification of TRPV1 expression/activity may play a role in diagnosis, or dx based on clinical presentation may be enough.
SPECIFIC THOUGHTS/THEORIES ON THE PATHOGENESIS OF CANNABIS HYPEREMESIS SYNDROME:
- In most cannabis users, any possible pro-emetic effects of THC/CBD-induced TRPV1 desensitization would be negated by the more potent anti-emetic effects of concomitant CB1 receptor activation. BUT....CB1 receptor and TRPV1 ion channel expression are likely BOTH pathologically low in chronic cannabis users
(1) CB1 receptor expression is downregulated in the face of increased THC and decreased degradation of endocannabinoids (effect of CBD)
(2) TRPV1 channels are directly desensitized by THC/CBD which ultimately leads to internalization and degradation of these receptors.
-It follows that this dysregulation of both the cannabinoid and vanilloid receptor systems may lead to a paradoxical syndrome in which :
(A) Repeated use causes progressive downregulation of CB1 and TRPV1 until finally a "tipping point" is reached in which CB1 expression
is so low that activation of this receptor no longer overcomes the theoretical "pro-emetic" effects of TRPV1 desensitization (because THC
both activates CB1 and desensitizes TRPV1 simultaneously, remember?).
(B) Once this tipping point is reached, any future exposure to cannabis would be expected to have a pro-emetic effect owing to complete
inactivation of TRPV1 by THC/CBD combined with inadequate activation of CB1 mediated "anti-emetic pathways." Moreover, this
effect would be expected to persist for a while after cannabis exposure since it takes time for TRPV1 to regain "sensitivity."
- Onward to Treatment:
These effects could be overcome by doing things that activate TRPV1 (i.e. hot baths) and reversed by re-sensitizing/upregulating TRPV1
*Due to the fact that TRPV1 is "desensitized", heat-induced activation would likely take a large stimulus (i.e. SCALDING hot baths).
*PGE2 analogues (dinoprost) also activate TRPV1 and may have therapeutic benefit in CHS, but NO ONE has looked at this.
*PGI2 analogues may work too, but worse side effect profile than PGE2/dinoprost
*Additionally, agents that restore sensitivity of TRPV1 may actually reverse the condition and allow patients to continue using cannabis. Unfortunately, the rather dangerous general anesthetic "propofol" is the only pharmacologic agent that has been shown to restore TRPV1
sensitivity to date (according to the literature I've reviewed). Likely that there are other yet-to-be-discovered agents which can do this, as well as
old/known drugs whose effects on TRPV channels just hasn't been examined yet. TRPV pharmacology is a new, burgeoning field of study
after all.
Regardless of the validity of my rants and speculations, I'm certain that hot baths help curb the nausea and vomiting in these patients via heat-triggered activation of TRPV1. And this mechanism needs to be further explored, along with methods of restoring TRPV1 sensitivity, so the patients w/ CHS who actually need Cannabis for treatment of cancer, autoimmune disease, HIV/AIDS, etc can continue using it.
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This is my son exactly