Current recommendations in the diagnosis and management of cannabinoid hyperemesis syndrome

Purpose of review

Legalization and decriminalization of marijuana over recent years has led to a significant increase in the prevalence of cannabinoid hyperemesis syndrome (CHS). CHS can be a debilitating syndrome that provides unique challenges to healthcare providers in the both the inpatient and outpatient setting. Recent evidence has provided some insight into the pathogenesis of this syndrome and potential treatments in both the acute and chronic phases.

Recent findings

Since identification of the syndrome in 2004, the only known treatment has been complete cessation of all delta-9-tetrahydrocannabinol (THC)-containing products. Recent evidence suggests that dopamine antagonists may be useful in the acute phase and outpatient treatment of underlying disorders like anxiety, depression and substance use disorder is critical to treatment success.

Summary

While the epidemiology and pathogenesis of CHS remains largely unknown, recent evidence suggests that treatment of CHS must not only include management of acute episodes with IV fluid repletion, dopamine antagonists, capsaicin cream, and other, more traditional antiemetics, but also treatment of underlying conditions that may be contributing to chronic THC use such as anxiety, depression and substance use disorder.