Adolescent Cannabis Hyperemesis Syndrome During the COVID-19 Pandemic

Lonsdale, Hannah; Brown, Jerry M.; Wilsey, Michael

doi:10.1097/pec.0000000000002603

Cited by 3 publications

(6 citation statements)

References 4 publications

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“…The limited number of investigations using waste-water (Löve et al 2022), post-mortem (Mariottini et al 2020) or sales-activity epidemiology (Groshkova et al 2020;Schauer et al 2021), however, cast some doubt on whether there was not more hidden cannabis use as admitted within self-report questionnaires usually used throughout the pandemic research on addictive substance use (e.g., Table 1). Increasing cases of the cannabis hyperemesis syndrome (Lonsdale et al 2022) which might also be considered as an indirect indicator of an increased cannabis use supports these concerns. If cannabis use would have increased during the pandemic, would this trend impact the health and the COVID-19 outcomes of the users?…”

Section: Discussionmentioning

confidence: 97%

“…An increase of suspected cannabis hyperemesis syndrome (CHS; Bonnet 2022) in adolescents during the first SARS-COV-2 wave in Baltimore and St. Petersburg, USA was constituted (Lonsdale et al 2022). In Theran, a 26-year-old cannabis-dependent male was diagnosed with CHS, which was initially confused with gastrointestinal COVID-19 (Pirnia et al 2020).…”

Section: Cannabis Use Disorder Cannabis Abuse and Dependencementioning

confidence: 99%

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Cannabis use, abuse and dependence during the COVID-19 pandemic: a scoping review

et al. 2022

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The interaction between cannabis use or addiction and SARS-COV-2 infection rates and COVID-19 outcomes is obscure. As of 08/01/2022 among 57 evaluated epidemiological/clinical studies found in Pubmed-database, most evidence for how cannabis use patterns were influenced by the pandemic was given by two systematic reviews and 17 prospective studies, mostly involving adolescents. In this age group, cannabis use patterns have not changed markedly. For adults, several cross-sectional studies reported mixed results with cannabis use having increased, decreased or remained unchanged. Two cross-sectional studies demonstrated that the severity of adults´ cannabis dependence was either increased as a consequence of increasing cannabis use during the pandemic or not changed. Regarding the effect of cannabis use on COVID-19 outcomes, we found only five retrospective/cross-sectional studies. Accordingly, (i) cannabis use did not impact mild COVID-19 symptoms; (ii) cannabis using individuals experienced more COVID-19-related hospitalizations; (iii) cannabis using veterans were associated with reduced SARS-COV-2 infection rates; (iv) frequent cannabis use was significantly associated with COVID-19 mortality, and (v) cannabis dependents were at higher risk of COVID-19 breakthrough after vaccination. It should be outlined that the validity of these retrospective/cross-sectional studies (all self-reports or register/e-health-records) is rather low. Future prospective studies on the effects of cannabis use on SARS-COV-2 infection rates and COVID-19 outcomes are clearly required for conclusive risk–benefit assessments of the role of cannabis on users’ health during the pandemic. Moreover, substance dependence (including cannabis) is associated with (often untreated) somatic comorbidity, which severity is a proven key risk factor for worse COVID-19 outcomes.

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Section: Discussionmentioning

confidence: 97%

Section: Cannabis Use Disorder Cannabis Abuse and Dependencementioning

confidence: 99%

Cannabis use, abuse and dependence during the COVID-19 pandemic: a scoping review

et al. 2022

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“…16 These treatments may be useful for the control of the acute symptoms of CHS, but the only known definitive method for long-term relief is sustained cessation of cannabis; therefore, clinicians must both treat the acute symptoms of CHS and support patients to permanently cease use of cannabis through referral to specialist substance-use counseling. 5,17 Follow-up information for the patients in this case series was not available.…”

Section: Discussionmentioning

confidence: 99%

“…19 We recognize that obtaining such a history can be challenging when many adolescent patients are reluctant to provide details to health care providers, particularly in the presence of family members or guardians. 17,20 Physicians must take steps to create an environment that facilitates accurate reporting, for example, by using established interviewing tools, such as the HEEADSSS assessment 21 and requesting that adults involved with the patient's care leave the room while these questions are being asked. The HEEADSSS is a psychosocial interview that covers Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicidal ideation, and Safety to give clinicians a better understanding of an adolescent's situation, needs, risk-taking behaviors, and concerns.…”

Section: Discussionmentioning

confidence: 99%

Acute Treatment of Adolescent Cannabinoid Hyperemesis Syndrome With Haloperidol, Lorazepam, and/or Capsaicin: A Single Institution Case Series

Brown,

Wilsey,

Dhana

et al. 2023

Journal of Psychiatric Practice

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Cannabinoid hyperemesis syndrome (CHS), an under-recognized and seemingly paradoxical condition, arises in some adolescents and adults who chronically use cannabis. It presents acutely with intractable nausea, vomiting, and abdominal pain but standard antiemetic therapy leads to improvement for only a minority of patients. Randomized controlled trial evidence in adults indicates the superiority of haloperidol over ondansetron in alleviating the acute symptoms of CHS, but safe and effective treatment for adolescents with the disorder is currently unknown. The successful use of topical capsaicin has also been reported. We report a case series of 6 adolescent patients with CHS who presented to Johns Hopkins All Children’s Hospital and were treated with haloperidol, lorazepam, and/or capsaicin. Four patients given 5 mg intravenous (IV) haloperidol and 2 mg IV lorazepam and 1 patient treated with 5 mg IV haloperidol and peri-umbilical topical capsaicin (0.025%) experienced full acute symptomatic relief. One patient, treated only with topical capsaicin, reported improvement of symptoms with some persistent nausea. Haloperidol/lorazepam, haloperidol/capsaicin, and topical capsaicin alone appear safe and effective in adolescents, but larger studies are required to confirm our findings.

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“…However, the average content of Delta-9-tetrahydrocannabinol (THC) (delta-9-tetrahydrocannabinol), the major active component of cannabis products has risen from around 3% in the 1960 s to over 20% by the early twenty-first century [5]. This, as well as an increase in consumption amongst adolescent users during the COVID-19 pandemic indicate that today's adolescents consume a higher amount of THC than their predecessors [6,7].…”

Section: Introductionmentioning

confidence: 99%

Paediatric cannabinoid hyperemesis

Lonsdale

Wilsey

2022

Current Opinion in Pediatrics

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Purpose of reviewThe prevalence of adolescent cannabinoid hyperemesis syndrome (CHS) continues to grow, as clinicians increasingly recognize the presenting features of cyclical nausea, emesis, abdominal pain and relief of symptoms with hot showers, in the setting of chronic cannabinoid use.Recent findingsOur understanding of the contributory mechanisms continues to grow, but high-quality evidence of effective treatment in adolescents remains lacking. Current best evidence in the treatment of acute paediatric CHS suggests intravenous rehydration and electrolyte correction, followed by 0.05 mg/kg haloperidol with or without a benzodiazepine. The only long-term treatment remains complete cessation of cannabinoid use.SummaryThis article reviews our growing knowledge of adolescent CHS and provides practical guidance for diagnosis, treatment and understanding the underlying mechanisms of the condition.

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Adolescent Cannabis Hyperemesis Syndrome During the COVID-19 Pandemic

Cited by 3 publications

References 4 publications

Cannabis use, abuse and dependence during the COVID-19 pandemic: a scoping review

Cannabis use, abuse and dependence during the COVID-19 pandemic: a scoping review

Acute Treatment of Adolescent Cannabinoid Hyperemesis Syndrome With Haloperidol, Lorazepam, and/or Capsaicin: A Single Institution Case Series

Paediatric cannabinoid hyperemesis

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