Cannabis Hyperemesis Syndrome in Palliative Care: A Case Study and Narrative Review

Abstract

Background: Cannabis is increasingly used by persons at end of life to ameliorate symptoms such as pain, spasticity, anorexia, or anxiety. Cannabis hyperemesis is a distressing adverse effect of chronic use and may cause significant morbidity. Unfortunately, the clinical presentation of this syndrome may be subtle in a person with complex medical issues or disability. Providers must remain vigilant for possible variations in presentation in these populations. Aim: To assess literature on cannabis hyperemesis and present unique considerations for clinical assessment and treatment for patients at end of life. Design: Initial literature scoping yielded limited evidence on the subject in the setting of chronic disease and disability. A case of cannabis hyperemesis in a person with advanced amyotrophic lateral sclerosis is presented to illustrate challenges in diagnosis and management in this setting. A narrative synthesis of current literature on assessment and management and special considerations for evaluation and treatment for patients under palliative care was performed. Results: Several unique considerations for the diagnosis and management of cannabis hyperemesis in palliative care patients are highlighted in the case presented, including: (1) Symptoms may possibly be abolished through decrease rather than complete abstinence from cannabis, (2) Frequent hot baths may not be present in patients with physical impairments in activities of daily living, and (3) Management of primary symptoms (pain, spasticity, nausea, and anxiety) in the end-of-life care patient must be considered to maximize comfort. Conclusion: The presentation of cannabis hyperemesis may be atypical in palliative care patients due to disability. More work is needed to improve risk stratification for patients using cannabis for palliative care.

Therapeutic Potential of Cannabis, Cannabidiol, and Cannabinoid-Based Pharmaceuticals

“…This is especially worrying as emerging evidence indicates serious contraindications for heavy cannabis use by adolescents [186]. Moreover, there is growing concern for the emergence of cannabis-induced hyperemesis syndrome, or uncontrolled vomiting, observed in both adolescents and adults [187,188]. A further complication is the fact that there seems to have been a marketplace race (in jurisdictions with legalized recreational cannabis) to provide products with higher and higher Δ 9 -THC levels and with lower and lower CBD [189,190].…”

Cannabis and End-of-Life Care: A Snapshot of Hospice Planning and Experiences Among Illinois Medical Cannabis Patients With A Terminal Diagnosis

“…Hospice providers have overwhelmingly expressed attitudes in favor or allowing the application of cannabis as a therapeutic for their patients. 9,45,46 However, few of the providers were certifying patients with any frequency. 47 In this sample few respondents obtained certification from a hospice doctor, illustrating this phenomenon occurring even in settings where state policy allows providers to certify patients for access to cannabis as a therapeutic.…”

Review of the Use of Medicinal Cannabis Products in Palliative Care

“…The final phase is the recovery phase, in which your body begins to return to normal. Frequent hot baths are usually the most effective treatment to reduce the symptoms of hyperemesis syndrome, and cessation of cannabis is the only definitive treatment [96][97][98].…”