Med/Psych Update

Cannabinoid hyperemesis syndrome: A result of chronic, heavy Cannabis use

Current Psychiatry. 2013 October;12(10):48-54

References

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Acute, hyperemetic episodes are ideal teachable moments because of the acuity of symptoms and clear association with Cannabis use. However, some patients may be skeptical about CHS because of the better-known antiemetic effects of Cannabis. For such patients, provide informational materials describing CHS and take time to address their concerns or doubts.

Motivational interviewing can help provoke behavior change by exploring patient ambivalence in a directive, patient-focused manner. Randomized controlled trials have documented significant reductions in Cannabis use with single-session motivational interviewing, with greater effect among heavy users.¹⁷ Single-session motivational interviewing showed results comparable to providing drug information and advice, suggesting that education and information are useful interventions.¹⁸ Although these single-session studies appear promising, they focus on younger users who have not been using Cannabis as long as typical CHS patients. Multi-session interventions may be needed to address longstanding, heavy Cannabis use in adult CHS patients.

Cognitive-behavioral therapy. In a series of randomized controlled trials,
motivational enhancement training and cognitive-behavioral therapy (CBT) were effective for Cannabis use cessation and maintenance of abstinence.¹⁹

Although these interventions take more time—six to 14 sessions for CBT and one to four sessions for motivational enhancement training—they should be considered for CHS patients with persistent use.

Bottom Line

Cannabinoid hyperemesis syndrome (CHS) is characterized by years of daily, heavy Cannabis use, cyclic nausea and vomiting, and compulsive bathing. Symptoms resolve with Cannabis cessation. Workup of suspected CHS should rule out life- threatening causes of nausea and vomiting. Acute hyperemetic episodes should be managed supportively. Motivational enhancement therapy or cognitive-behavioral therapy should be considered for persistent Cannibis use.

Related Resources

Motivational interviewing for substance use disorders. www.motivationalinterview.org.
Danovitch I, Gorelick DA. State of the art treatments for cannabis dependence. Psychiatr Clin North Am. 2012;35(2):309-326.

Drug Brand Names

Alprazolam • Xanax Haloperidol • Haldol Lorazepam • Ativan

Ondansetron • Zofran Prochlorperazine • Compazine

Disclosure

The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.