Diagnosis and Acute Management of Adolescent Cannabinoid Hyperemesis Syndrome: A Systematic Review



      This study aimed to synthesize qualitative and quantitative data on the diagnosis and effective management of cannabinoid hyperemesis syndrome (CHS) in the adolescent population.


      Using keywords, 1,334 studies published between December 1954 and December 2019 were extracted from MEDLINE via PubMed, Embase via OVID, CINAHL via EBSCO, Web of Science, and the Cochrane Library. Studies were evaluated by two independent reviewers using predetermined inclusion and exclusion criteria.


      The search yielded 148 studies for full-text review, of which 21 were included in this systematic review. A total of 10 articles were related to the diagnosis of CHS, while 11 articles discussed the treatment and management of adolescent cases of CHS.


      CHS in the adolescent population fulfills the major and minor diagnostic criteria of CHS in the adult population; however, in adolescent patients, CHS may present more frequently in females, with the earliest reported case presenting at age 15 years. There appears to be a substantial proportion (21%) of adolescent patients diagnosed with CHS that have a history of anxiety and depression; however, higher quality studies to assess the prevalence are warranted. Although haloperidol and topical capsaicin cream may provide symptom relief in isolated cases, complete cessation of cannabis use is currently the only known effective treatment.


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        • Government of Canada
        Summary results for 2015 Canadian Tobacco, Alcohol and Drugs Survey.
        2016 (Available at:)
        • UNICEF Office of Research
        Child well-being in rich countries – a comparative overview.
        in: Innocenti report card 11. UNICEF Office of Research, Florence2013 (978-88- 6522-016-0, Available at:)
        • Patrick M.E.
        • Schulenberg J.E.
        • O'Malley P.M.
        • et al.
        Age-related changes in reasons for using alcohol and marijuana from ages 18 to 30 in a national sample.
        Psychol Addict Behav. 2011; 25: 330-339
        • Walsh D.
        • Nelson K.A.
        • Mahmoud F.A.
        Established and potential therapeutic applications of cannabinoids in oncology.
        Support Care Cancer. 2003; 11: 137-143
        • Davis M.
        • Maida V.
        • Daeninck P.
        • Pergolizzi J.
        The emerging role of cannabinoid neuromodulators in symptom management.
        Support Care Cancer. 2007; 15: 63-71
        • Hill K.P.
        Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: A clinical review.
        JAMA. 2015; 313: 2474-2483
        • Whiting P.F.
        • Wolff R.F.
        • Deshpande S.
        • et al.
        Cannabinoids for medical use: A systematic review and meta-analysis.
        JAMA. 2015; 313: 2456-2473
        • National Academies of Sciences, Engineering, and Medicine
        The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research.
        The National Academies Press, Washington, DC2017 (Available at:)
        Date accessed: December 21, 2019
        • Fergusson D.M.
        • Boden J.M.
        Cannabis use and later life outcomes.
        Addiction. 2008; 103: 969-976
        • National Institutes of Drug Abuse website
        NIDA info facts: Marijuana, National Institute on Drug Abuse.
        (Available at:)
        • Foley J.D.
        Adolescent use and misuse of marijuana.
        Adolesc Med Clin. 2006; 17: 319-334
        • Allen J.H.
        • de Moore G.M.
        • Heddle R.
        • et al.
        Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis use.
        Gut. 2004; 53: 1566-1570
        • Sontineni S.P.
        • Chaudhary S.
        • Sontineni V.
        • Lanspa S.J.
        Cannabinoid hyperemesis syndrome: Clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse.
        World J Gastroenterol. 2009; 15: 1264-1266
        • Habboushe J.
        • Sedor J.
        Cannabinoid hyperemesis acute renal failure: A common sequela of cannabinoid hyperemesis syndrome.
        Am J Emerg Med. 2014; 32: 690.e1-690.e2
        • Simonetto D.A.
        • Oxentenko A.S.
        • Herman M.L.
        • Szostek J.H.
        Cannabinoid hyperemesis: A case series of 98 patients.
        Mayo Clinic Proc. 2012; 87: 114-119
        • Bollom A.
        • Austrie J.
        • Hirsch W.
        • et al.
        Emergency department burden of nausea and vomiting associated with cannabis use disorder: US trends from 2006 to 2013.
        J Clin Gastroenterol [Internet]. 2018; 52: 778-783
        • Soriano-Co M.
        • Batke M.
        • Cappell M.S.
        The cannabis hyperemesis syndrome characterized by persistent nausea and vomiting, abdominal pain, and compulsive bathing associated with chronic marijuana use: A report of eight cases in the United States.
        Dig Dis Sci. 2010; 55: 3113-3119
        • Singh E.
        • Coyle W.
        Cannabinoid hyperemesis.
        Am J Gastroenterol. 2008; 103: 1048-1049
        • Sannarangappa V.
        • Tan C.
        Cannabinoid hyperemesis.
        Intern Med J. 2009; 39: 777-778
        • Galli J.A.
        • Sawaya R.A.
        • Friedenberg F.K.
        Cannabinoid hyperemesis syndrome.
        Curr Drug abuse Rev. 2011; 4: 241-249
        • Simonetto D.A.
        • Oxentenko A.S.
        • Herman M.L.
        • Szostek J.H.
        Cannabinoid hyperemesis: A case series of 98 patients.
        Mayo Clin Proc. 2012; 87: 114-119
        • Venkatesan T.
        • Levinthal D.J.
        • Li B.U.K.
        • et al.
        Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome.
        Neurogastroenterol Motil. 2019; 31: e13606
        • Atkins D.
        Grading quality of evidence and strength of recommendations.
        Br Med Jou. 2004; 328: 1490
        • Miller J.B.
        • Walsh M.
        • Patel P.A.
        • et al.
        Pediatric cannabinoid hyperemesis: Two cases.
        Pediatr Emerg Care. 2010; 26: 919-920
        • Desjardins N.
        • Jamoulle O.
        • Taddeo D.
        • Stheneur C.
        Cannabinoid hyperemesis syndrome in a 17-year-old adolescent.
        J Adolesc Health. 2015; 57: 565-567
        • Couchman D.
        • Harrison M.E.
        A 15-year-old girl with intractable vomiting.
        Paediatr Child Health. 2018; 23: 306-307
        • Heise L.
        Cannabinoid hyperemesis syndrome.
        Adv Emerg Nurs J. 2015; 37: 95-101
        • Sawni A.
        • Vaniawala V.P.
        • Good M.
        • et al.
        Recurrent cyclic vomiting in adolescents: Can it be cannabinoid hyperemesis syndrome?.
        Clin Pediatr. 2016; 55: 560-563
        • Pélissier F.
        • Claudet I.
        • Gandia-Mailly P.
        • et al.
        Cannabis hyperemesis syndrome in the emergency department: how can a specialized addiction team be useful? A pilot study.
        J Emerg Med. 2016; 51: 544-551
        • Jones J.L.
        • Abernathy K.E.
        Successful treatment of suspected cannabinoid hyperemesis syndrome using haloperidol in the outpatient setting.
        Case Rep Psychiatry [Internet]. 2016; 2016: 3614053
        • Graham J.
        • Barberio M.
        • Wang G.S.
        Cap- saicin cream for treatment of cannabinoid hyper- emesis syndrome in adolescents: a case series.
        Pediatrics. 2017; 140e20163795
        • Solis-Garcia G.
        • Gonzalez-Martinez F.
        • Urbiola E.
        • et al.
        Cannabinoid hyperemesis syndrome in adolescents: A poorly diagnosed syndrome.
        J Paediatr Child Health. 2019; 55: 1264-1266
        • Wilson L.
        Case 3: Recurrent vomiting and 60-lb weight loss in a 17-year-old girl.
        Pediatr Rev. 2016; 37: 264-266
        • McConachie S.M.
        • Caputo R.A.
        • Wilhelm S.M.
        • Kale-Pradhan P.B.
        Efficacy of capsaicin for the treatment of cannabinoid hyperemesis syndrome: A systematic review.
        Ann Pharmacother. 2019; 53: 1145-1152
        • Sorenson C.J.
        • DeSanto K.
        • Borgelt L.
        • et al.
        Cannabinoid hyperemesis syndrome: Diagnosis, pathophysiology and treatment - a systematic review.
        J Med Toxicol. 2017; 13: 71-87

      Linked Article

      • The Coming Storm: Cannabis Hyperemesis Syndrome in Adolescents
        Journal of Adolescent HealthVol. 68Issue 2
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          Acceptance of cannabis (Cannabis sativa, Cannabis indica, pot, grass, or marijuana) use is a growing phenomenon across the United States. The plant is dried, cured or oil extracted, then products smoked or vaporized to absorb its psychoactive compound tetrahydrocannabinol. As of this publication, there are 11 states where Cannabis use is legal in the United States and widespread efforts are underway to expand this further. Although the American Academy of Pediatrics policy regarding marijuana use states that “cannabis use can lead to impaired judgment concentration and coordination that increases risk of accidents,” it is the neuromodulator effects associated with cannabis use that are important to us as its effect on the developing nervous system are unclear [1,2].
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