Cannabinoid Hyperemesis Syndrome: A Systematic Review

Abstract

Introduction: Marijuana is the most widely used illicit drug worldwide. Twenty five states legalized the Marijuna use as medical purpose in the Unites States. More states are expected to allow the Marijuana use as medical purpose as well as recreational use. Cannabinoid hyperemesis syndrome (CHS) was initially reported in 2004 and still remains an under-recognized clinical entity. We conducted a systemic review to analyze CHS case series. Methods: A systemic literature reviews used the search engines of PubMed, ISI Web of Science, Medline/Ovid, Google Scholar, and CINAHL and the following search terms “cannabinoid hyperemesis syndrome” or “ cannabis” or “marijuana” and “vomiting” or “emesis” or “vomiting” through June 2016 identified CHS cases written in English. Results: A total of 64 stuies and 213 cases were reported. Mean age was 28.63 (range 14-51), more than two-thirds were male (71.83%, 153/213) and reported from United States (78.40%, 167/213). One study of reporting 98 CHS cases (Simonetto et al. Mayo Clin Proc 2012) did not differ from other remaining 63 studies (n = 115) in terms of age or gender (all P > .05). Twenty four CHS cases were tested with conventional urine drug screen, and 17 cases were reported positive for tetrahydrocannabinol (sensitivity 70.83%). Three CHS cases resulted from synthetic Marijuana use were reported, and all of them was negative for tetrahyrocannabinol. Intoxication and organ damage from synthetic Marijuana were reported more severe than natural Marijuana use (Mills et al. Am J Med Sci 2015). Three CHS cases were reported during pregnancy. Five CHS were reported from mental health professionals. Conclusion: Two hundred thirteen CHS cases were reported worldwide as of June 2016. CHS cases were predominantly young age and male. Only three CHS cases were reported from synthetic Marijuana use, but, these were false negative for conventional urine drug screen. Urine drug screen's senstitivity of diagnosing CHS cases was limited. Liasion approach across physian specialties could be valuable to detect more CHS cases from natural and synthetic Marijuana use and to save unnecessary healthcare costs from unrecognizing CHS cases.