humulene and Vomiting

It is known that gynecological cancers remain a worldwide problem and as shown by the statistics, there is a need for new gynecological cancer treatments. Cannabinoids, the pharmacologically active compounds of the Cannabis sativa plant, have been used for many centuries by individuals as a symptomatic treatment to alleviate pain, nausea, vomiting, and to help stimulate appetite. Research has revealed that cannabinoids also exert anti-cancer activity such as anti-proliferative and pro-apoptotic effects through a variety of mechanisms. There is significant value in the development of these compounds as anti-cancer therapies in clinical practice as they do not produce the typical toxic side effects that exist with conventional therapies and recent clinical trials have shown their great tolerability by patients at high doses. Cannabinoids can induce psychoactive effects that could limit their progression. Therefore, non-psychoactive cannabinoids are attracting pharmacological interest due to their inability to produce psychological effects. Recent studies have focussed on non-psychoactive cannabinoids in ovarian cancer and have revealed promising pre-clinical results that indicate that these compounds may have potential benefits in the treatment of these cancers. However, there are still unanswered questions and research gaps that need to be addressed. This review summarizes the current understanding of this topic and identifies the current gaps in knowledge that provide a useful direction for future work.

Topics: Cannabinoids; Cannabis; Female; Humans; Ovarian Neoplasms; Vomiting

Despite the widespread use of medical cannabis, little is known regarding the safety, efficacy, and dosing of cannabis products in children with cancer. The objective of this study was to systematically appraise the existing published literature for the use of cannabis products in children with cancer.. This systematic review, registered with the International Prospective Register of Systematic Reviews (CRD42020187433), searched four databases: MEDLINE, Embase, PsycINFO, and the Cochrane Library. Abstracts and full texts were screened in duplicate. Data on types of cannabis products, doses, formulations, frequencies, routes of administration, indications, and clinical and demographic details as well as reported efficacy outcomes were extracted. Data on cannabinoid-related adverse events were also summarized.. Out of 34,611 identified citations, 19 unique studies with a total of 1927 participants with cancer were included: eight retrospective chart reviews, seven randomized controlled trials, two open-label studies, and two case reports. The included studies reported the use of various cannabis products for the management of symptoms. Cannabinoids were commonly used for the management of chemotherapy-induced nausea and vomiting (11 of 19 [58%]). In controlled studies, somnolence, dizziness, dry mouth, and withdrawal due to adverse events were more commonly associated with the use of cannabinoids. Across all included studies, no serious cannabis-related adverse events were reported.. Although there is evidence to support the use of cannabis for symptom management, in children with cancer, there is a lack of rigorous evidence to inform the dosing, safety, and efficacy of cannabinoids. Because of the increasing interest in using cannabis, there is an urgent need for more research on medical cannabis in children with cancer.

Topics: Analgesics; Cannabinoids; Cannabis; Child; Humans; Medical Marijuana; Neoplasms; Retrospective Studies; Vomiting

Some patients diagnosed with cancer use medical cannabis to self-manage undesirable symptoms, including nausea and pain. To improve patient safety and oncological care quality, the routes of administration for use of medical cannabis, patients' reasons, and prescribed indications must be better understood.. Based on the Joanna Briggs Institute guidelines, a scoping review was conducted to map the current evidence regarding the use of medical cannabis in oncological settings based on the experiences of patients diagnosed with cancer and their healthcare providers. A search strategy was developed with a scientific librarian which included five databases (CINAHL, Web of Science, Medline, Embase, and PsycINFO) and two grey literature sources (Google Scholar and ProQuest). The inclusion criteria were: 1) population: adults aged 18 and over diagnosed with cancer; 2) phenomena of interest: reasons for cannabis use and/or the prescribed indications for medical cannabis; 3) context: oncological setting. French- or English-language primary empirical studies, knowledge syntheses, and grey literature published between 2000 and 2021 were included. Data were extracted by two independent reviewers and subjected to a thematic analysis. A narrative description approach was used to synthesize and present the findings.. We identified 5,283 publications, of which 163 met the eligibility criteria. Two main reasons for medical cannabis use emerged from the thematic analysis: limiting the impacts of cancer and its side effects; and staying connected to others. Our results also indicated that medical cannabis is mostly used for three approved indications: to manage refractory nausea and vomiting, to complement pain management, and to improve appetite and food intake. We highlighted 11 routes of administration for medical cannabis, with oils and oral solutions the most frequently reported.. Future studies should consider the multiple routes of administration for medical cannabis, such as inhalation and edibles. Our review highlights that learning opportunities would support the development of healthcare providers' knowledge and skills in assessing the needs and preferences of patients diagnosed with cancer who use medical cannabis.

Topics: Adolescent; Adult; Cannabis; Humans; Medical Marijuana; Nausea; Neoplasms; Vomiting

Palliative care aims to improve the quality of life in patients with incurable illness. Medicinal cannabis (MC) has been used in the palliative care setting to address multiple symptoms in patients.. To evaluate the full scope of available literature investigating the effects and potential harms of MC on symptom management and quality of life in palliative care.. PubMed, Embase, The Cochrane Library and clinicaltrials.gov were searched for eligible articles, published between 1960 and September 9, 2021. Quality of the evidence was assessed in accordance with Grading of Recommendations, Assessment, Development and Evaluations. Risk of bias was assessed using the RoB 2 tool for randomised controlled trials and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-randomized trials.. Fifty-two studies (20 randomised; 32 non-randomised) with 4786 participants diagnosed with cancer (n = 4491), dementia (n = 43), AIDS (n = 235), spasticity (n = 16), NORSE syndrome (n = 1) were included. The quality of evidence was 'very low' or 'low' for all studies, and low for only two randomised controlled trials. Positive treatment effects (statistical significance with P < 0.05) were seen for some MC products in pain, nausea and vomiting, appetite, sleep, fatigue, chemosensory perception and paraneoplastic night sweats in patients with cancer, appetite and agitation in patients with dementia and appetite, nausea and vomiting in patients with AIDS. Meta-analysis was unable to be performed due to the wide range of cannabis products used and the heterogeneity of the study outcomes.. While positive treatment effects have been reported for some MC products in the palliative care setting, further high quality evidence is needed to support recommendations for its use in clinical practice.

Topics: Acquired Immunodeficiency Syndrome; Analgesics; Cannabis; Dementia; Humans; Medical Marijuana; Nausea; Neoplasms; Palliative Care; Quality of Life; Vomiting

Gastrointestinal symptoms are common in patients with cancer, whether related to treatment or a direct effect of the disease itself. Patients may choose to access cannabinoids outside of their formal medical prescriptions to palliate such symptoms. However, clinical guidelines are lacking in relation to the use of such medicines for gastrointestinal symptoms in patients with cancer.. A systematic review of the evidence for the use of cannabinoids for symptom control in patients with cancer was undertaken. Search strategies were developed for Medline, Embase, PsychINFO, and the Cochrane Central Register of Controlled Trials, including all publications from 1975 up to 12 November 2021. Studies were included if they were randomized controlled trials of cannabinoids compared with placebo or active comparator in adult patients with cancer, regardless of type, stage, or treatment status. Articles for inclusion were agreed by all authors, and data extracted and summarized by two authors. Each study was scored according to the Jadad scale. This review was specifically for the purpose of developing guidelines for the use of cannabis for gastrointestinal symptoms, including chemotherapy-induced nausea and vomiting (CINV), chronic nausea, anorexia-cachexia syndrome, and taste disturbance.. Thirty-six randomized controlled trials were identified that met the inclusion criteria for this review of gastrointestinal symptoms: 31 relating to CINV, one to radiotherapy-induced nausea and vomiting, and the remaining four to anorexia-cachexia and altered chemosensory disturbance. The populations for the randomized controlled trials were heterogeneous, and many studies were of poor quality, lacking clarity regarding method of randomization, blinding, and allocation concealment. For CINV, eleven RCTs showed improvement with cannabis compared to placebo, but out of 21 trials where cannabis was compared to other antiemetics for CINV, only 11 favoured cannabis.. Tetrahydrocannabinol (THC) and nabilone were more effective in preventing CINV when compared to placebo but are not more effective than other antiemetics. For refractory CINV, one study of THC:CBD demonstrated reduced nausea as an add-on treatment to guideline-consistent antiemetic therapy without olanzapine. The MASCC Guideline Committee found insufficient evidence to recommend cannabinoids for the management of CINV, nausea from advanced cancer, cancer-associated anorexia-cachexia, and taste disturbance. High-quality studies are needed to inform practice.

Topics: Adult; Anorexia; Antiemetics; Antineoplastic Agents; Cachexia; Cannabinoids; Cannabis; Consensus; Dronabinol; Expert Testimony; Humans; Nausea; Neoplasms; Randomized Controlled Trials as Topic; Vomiting

A flowering plant of variegated ingredients and psychoactive qualities, Cannabis has long been used for medicinal and recreational purposes. Regulatory approvals have been gained across a broad range of palliative and therapeutic indications, and in some cases, included in standard treatment guidelines.. The use of Cannabis and cannabinoid-based-medicines in oncology is summarized in this article. Cannabinoids are classified according to natural and synthetic subtypes and their mechanisms of action expounded. The variability of available products is discussed in the clinical context and data regarding chemotherapy-induced nausea and vomiting, cancer-related pain, anorexia, insomnia, and anxiety are presented. Moreover, immunological and antineoplastic effects in preclinical and clinical trials are addressed. Concepts such as synergism or opposition with conventional treatment modalities, the sequence of administration and dosage, molecular cross-talk and malignancy-cannabinoid congruence, are explored. Finally, side-effects, limitations in trial design and legislation barriers are related.. Sufficient evidence supports the use of Cannabis for palliative indications in oncology; however, patients should be carefully selected, guided and followed. Promising research suggests the potent antineoplastic activity, but more data must be accrued before conclusions can be drawn.

Topics: Animals; Antineoplastic Agents; Cancer Pain; Cannabinoids; Cannabis; Humans; Medical Marijuana; Nausea; Neoplasms; Palliative Care; Patient Selection; Vomiting

Cannabis products are being increasingly liberalized all over the world and there is a huge interest in cannabis-based medicine.. Presentation of current studies on the efficacy of different cannabis-based medicine for the treatment of various diseases CURRENT DATA: In German pharmaceutical legislation, nabiximols is approved for the treatment of moderate to severe therapy-resistant spasticity in multiple sclerosis and nabilone is approved for the treatment of therapy-resistant chemotherapy-associated nausea and vomiting. In case of therapy failure cannabinoids, as part of an individual therapeutic attempt, may be considered for the treatment of chronic pain (neuropathic pain, cancer pain, non-neuropathic noncancer pain), cachexia in human immunodeficiency virus as well as for Dravet and Lennox-Gastaut syndrome. From the authors' perspective there is not enough evidence for the use in chemotherapy-associated nausea and vomiting and chronic non-neuropathic pain.. Currently, a wide use of cannabinoids does not seem probable in the near future. Further studies involving more patients and evaluating long-term effects are necessary.

Topics: Cannabinoids; Cannabis; Chronic Pain; Humans; Muscle Spasticity; Nausea; Vomiting

The advent of legalized cannabis in multiple regions of the United States has rendered the drug more accessible to pediatric patients. Pediatricians and Pediatric Emergency Medicine Providers face new challenges in counseling both patients and their parents, diagnosing exploratory ingestions of cannabinoids in toddlers, and managing complications of prolonged, heavy cannabis use in adolescents. The purpose of this review article is to provide clinicians a succinct summary of recent literature regarding tetrahydrocannabinol (THC) pharmacokinetics, pharmacodynamics, impacts on development, as well as presentations of acute and chronic toxicity.. Many young children being admitted to the hospital for cannabis toxicity have been exposed to high concentration products, such as edibles, resins, or vaping fluid. These products contain extremely high concentrations of cannabinoids, and lead to sedation, respiratory depression, and other adverse effects. Chronic toxicity associated with cannabis consumption includes neurocognitive changes and cannabinoid hyperemesis syndrome.. Clinicians should provide guidance for pediatric patients and their caregivers to reduce the risk of accidental cannabis exposure, particularly with high concentration products. In addition, clinicians should consider chronic cannabis exposure when evaluating certain complaints, such as chronic vomiting or educational performance at school.

Topics: Adolescent; Cannabinoids; Cannabis; Child; Child, Preschool; Dronabinol; Humans; Pediatrics; United States; Vomiting

Despite remaining one of the most widely abused drugs worldwide, Cannabis sativa exhibits remarkable medicinal properties. The phytocannabinoids, cannabidiol and Δ-9-tetrahydrocannabinol, reduce nausea and vomiting, particularly during chemotherapy. This is attributed to their ability to reduce the release of serotonin from enterochromaffin cells in the small intestine, which would otherwise orchestrate the vomiting reflex. Although there are many preclinical and clinical studies on the effects of Δ-9-tetrahydrocannabinol during nausea and vomiting, little is known about the role that cannabidiol plays in this scenario. Since cannabidiol does not induce psychotropic effects, in contrast to other cannabinoids, its use as an anti-emetic is of great interest. This review aims to summarize the available literature on cannabinoid use, with a specific focus on the nonpsychotropic drug cannabidiol, as well as the roles that cannabinoids play in preventing several other adverse side effects of chemotherapy including organ toxicity, pain and loss of appetite.

Topics: Analgesics, Non-Narcotic; Antiemetics; Antineoplastic Agents; Appetite; Appetite Stimulants; Cancer Pain; Cannabidiol; Cannabis; Feeding and Eating Disorders; Humans; Nausea; Neoplasms; Vomiting

To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population.. There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use. The range of presentations documented in the recent literature spans gastrointestinal, psychiatric and cardiorespiratory effects, in addition to traumatic injuries and accidental ingestions by younger children. Complications of chronic cannabis use, such as 'cannabis hyperemesis syndrome', depression, psychosis or cognitive impairment, are now recognized outcomes and even more are likely to emerge.. An array of cannabis-related symptoms is possible from acute use or exposure. Common presentations include acute intoxication, hyperemesis, depression and acute physical injuries from impaired psychomotor function. Uncommon presentations include cardiorespiratory effects, and a range of symptoms in young children that include hyperkinesis and coma. Clinical vigilance is needed to suspect and clinically diagnose cannabis exposure in the emergency department.

Topics: Adolescent; Cannabis; Child; Child, Preschool; Emergencies; Emergency Service, Hospital; Humans; Substance-Related Disorders; Vomiting

Cannabis legalization has led to significant health consequences, particularly to patients in emergency departments and hospitals in Colorado. The most concerning include psychosis, suicide, and other substance abuse. Deleterious effects on the brain include decrements in complex decision-making, which may not be reversible with abstinence. Increases in fatal motor vehicle collisions, adverse effects on cardiovascular and pulmonary systems, inadvertent pediatric exposures, cannabis contaminants exposing users to infectious agents, heavy metals, and pesticides, and hash-oil burn injuries in preparation of drug concentrates have been documented. Cannabis dispensary workers ("budtenders") without medical training are giving medical advice that may be harmful to patients. Cannabis research may offer novel treatment of seizures, spasticity from multiple sclerosis, nausea and vomiting from chemotherapy, chronic pain, improvements in cardiovascular outcomes, and sleep disorders. Progress has been slow due to absent standards for chemical composition of cannabis products and limitations on research imposed by federal classification of cannabis as illegal. Given these factors and the Colorado experience, other states should carefully evaluate whether and how to decriminalize or legalize non-medical cannabis use.

Topics: Accidents, Traffic; Behavioral Symptoms; Cannabis; Colorado; Driving Under the Influence; Drug Contamination; Drug Overdose; Emergency Service, Hospital; Hospitalization; Humans; Legislation, Drug; Marijuana Use; Mental Disorders; Mental Health Services; Poisoning; Vomiting

Cannabis sativa, a subspecies of the Cannabis plant, contains aromatic hydrocarbon compounds called cannabinoids. [INCREMENT]-Tetrahydrocannabinol is the most abundant cannabinoid and is the main psychotropic constituent. Cannabinoids activate two types of G-protein-coupled cannabinoid receptors: cannabinoid type 1 receptor and cannabinoid type 2 receptor. There has been ongoing interest and development in research to explore the therapeutic potential of cannabis. [INCREMENT]-Tetrahydrocannabinol exerts biological functions on the gastrointestinal (GI) tract. Cannabis has been used for the treatment of GI disorders such as abdominal pain and diarrhea. The endocannabinoid system (i.e. endogenous circulating cannabinoids) performs protective activities in the GI tract and presents a promising therapeutic target against various GI conditions such as inflammatory bowel disease (especially Crohn's disease), irritable bowel syndrome, and secretion and motility-related disorders. The present review sheds light on the role of cannabis in the gut, liver, and pancreas and also on other GI symptoms, such as nausea and vomiting, cannabinoid hyperemesis syndrome, anorexia, weight loss, and chronic abdominal pain. Although the current literature supports the use of marijuana for the treatment of digestive disorders, the clinical efficacy of cannabis and its constituents for various GI disorders remains unclear.

Topics: Abdominal Pain; Anorexia; Cannabis; Digestive System Diseases; Dronabinol; Endocannabinoids; Gastrointestinal Diseases; Gastrointestinal Motility; Humans; Inflammatory Bowel Diseases; Irritable Bowel Syndrome; Liver Cirrhosis; Medical Marijuana; Nausea; Pancreatic Diseases; Receptors, Cannabinoid; Vomiting

Chemotherapy-induced nausea and vomiting (CINV) is a prevalent, distressing, and burdensome side effect of cancer chemotherapy. It is estimated to affect the majority of patients receiving certain anti-cancer drug regimens and can be treatment-limiting, even for life-saving medications. Despite seemingly numerous options, such as antimuscarinic anticholinergics, antihistamines, 5-HT

Topics: Antiemetics; Antineoplastic Agents; Cannabinoids; Cannabis; Dronabinol; Humans; Iatrogenic Disease; Randomized Controlled Trials as Topic; Vomiting

Cannabis sativa has long been used for medicinal purposes. To improve safety and efficacy, compounds from C. sativa were purified or synthesized and named under an umbrella group as cannabinoids. Currently, several cannabinoids may be prescribed in Canada for a variety of indications such as nausea and pain. More recently, an increasing number of reports suggest other salutary effects associated with endogenous cannabinoid signaling including cardioprotection. The therapeutic potential of cannabinoids is therefore extended; however, evidence is limited and mechanisms remain unclear. In addition, the use of cannabinoids clinically has been hindered due to pronounced psychoactive side effects. This review provides an overview on the endocannabinoid system, including known physiological roles, and conditions in which cannabinoid receptor signaling has been implicated.

Topics: Affect; Amidohydrolases; Analgesics; Animals; Appetite Regulation; Canada; Cannabinoid Receptor Agonists; Cannabinoid Receptor Antagonists; Cannabinoids; Cannabis; Cardiovascular System; Central Nervous System; Endocannabinoids; Humans; Medical Marijuana; Multiple Sclerosis; Neoplasms; Neurodegenerative Diseases; Pain; Receptors, Cannabinoid; Signal Transduction; Sleep; Vomiting

Cannabinoids (the active constituents of Cannabis sativa) and their derivatives have got intense attention during recent years because of their extensive pharmacological properties. Cannabinoids first developed as successful agents for alleviating chemotherapy associated nausea and vomiting. Recent investigations revealed that cannabinoids have a wide range of therapeutic effects such as appetite stimulation, inhibition of nausea and emesis, suppression of chemotherapy or radiotherapy-associated bone loss, chemotherapy-induced nephrotoxicity and cardiotoxicity, pain relief, mood amelioration, and last but not the least relief from insomnia. In this exploratory review, we scrutinize the potential of cannabinoids to counteract chemotherapy-induced side effects. Moreover, some novel and yet important pharmacological aspects of cannabinoids such as antitumoral effects will be discussed.

Topics: Animals; Antineoplastic Agents; Cannabinoids; Cannabis; Humans; Nausea; Neoplasms; Neuralgia; Vomiting

Cannabis is the most widely used illicit drug in the world. The medicinal value of cannabis as an antiemetic is well known by the medical fraternity. A less well-recognised entity is the potential for certain chronic users to develop hyperemesis. We describe the case of a young man who presented to us with features of cannabinoid hyperemesis syndrome. We review the current literature on this condition, its pathogenesis and management.

Topics: Adult; Antiemetics; Cannabinoids; Cannabis; Disease Management; Dronabinol; Humans; Male; Marijuana Abuse; Metoclopramide; Nausea; Receptors, Cannabinoid; Syndrome; Vomiting; Young Adult

The purpose of this review is to heighten the awareness of the increased use and risks of synthetic cannabinoids (SCs) and associated clinical manifestations among adolescents and young adults.. Reviewed case studies suggest that the use of SCs have unpredictable negative psychological and physiological effects. Predominant manifestations reported were anxiety, agitation, paranoia, hallucinations, tachycardia, nausea and vomiting, and diaphoresis.. Nurses provide the most direct and supportive care to patients who present for medical treatment after the use of SCs. Knowledge of clinical manifestations can facilitate supportive management of patients suspected of SCs use.

Topics: Adolescent; Adult; Age Factors; Anxiety; Cannabinoids; Cannabis; Female; Hallucinations; Hallucinogens; Humans; Male; Nausea; Paranoid Disorders; Pediatric Nursing; Psychomotor Agitation; Risk Factors; Substance-Related Disorders; Tachycardia; Vomiting; Young Adult

Biological activity of cannabinoids is caused by binding to two cannabinoid receptors CB1 and CB2. Psychoactive is not only tetrahydrocannabinol (THC) but also: cannabidiol, cannabigerol or cannabichromen. Formerly, the usefulness of hemp was assessed in the relation to temporary appeasement of the symptoms of some ailments as nausea or vomiting. Present discoveries indicates that cannabis-based drugs has shown ability to alleviate of autoimmunological disorders such as: Multiple sclerosis (MS), Rheumatoid arthritis (RA) or inflammatory bowel disease. Another studies indicates that cannabinoids play role in treatment of neurological disorders like Alzheimer disease or Amyotrophic lateral sclerosis (ALS) or even can reduce spreading of tumor cells. Cannabinoids stand out high safety profile considering acute toxicity, it is low possibility of deadly overdosing and side-effects are comprise in range of tolerated side-effects of other medications. In some countries marinol and nabilone are used as anti vomiting and nausea drug. First cannabis-based drug containg naturally occurring cannabinoids is Sativex. Sativex is delivered in an mucosal spray for patients suffering from spasticity in MS, pain relevant with cancer and neuropathic pain of various origin. Despite the relatively low acute toxicity of cannabinoids they should be avoid in patients with psychotic disorders, pregnant or breastfeeding woman. Cannabinoids prolong a time of reaction and decrease power of concentration that's why driving any vehicles is forbidden. Cannabis side-effects varies and depend from several factors like administrated dose, rout of administration and present state of mind. After sudden break from long-lasting use, withdrawal symptoms can appear, although they entirely disappear after a week or two.

Topics: Arthritis, Rheumatoid; Cannabidiol; Cannabinoids; Cannabis; Contraindications; Dronabinol; Drug Combinations; Humans; Inflammatory Bowel Diseases; Multiple Sclerosis; Muscle Spasticity; Nausea; Nervous System Diseases; Pain; Plant Extracts; Vomiting

Cannabis-based medications have been a topic of intense study since the endogenous cannabinoid system was discovered two decades ago. In 2011, for the first time, a cannabis extract was approved for clinical use in Germany.. Selective literature review.. Cannabis-based medications exert their effects mainly through the activation of cannabinoid receptors (CB1 and CB2). More than 100 controlled clinical trials of cannabinoids or whole-plant preparations for various indications have been conducted since 1975. The findings of these trials have led to the approval of cannabis-based medicines (dronabinol, nabilone, and a cannabis extract [THC:CBD=1:1]) in several countries. In Germany, a cannabis extract was approved in 2011 for the treatment of moderate to severe refractory spasticity in multiple sclerosis. It is commonly used off label for the treatment of anorexia, nausea, and neuropathic pain. Patients can also apply for government permission to buy medicinal cannabis flowers for self-treatment under medical supervision. The most common side effects of cannabinoids are tiredness and dizziness (in more than 10% of patients), psychological effects, and dry mouth. Tolerance to these side effects nearly always develops within a short time. Withdrawal symptoms are hardly ever a problem in the therapeutic setting.. There is now clear evidence that cannabinoids are useful for the treatment of various medical conditions.

Topics: Anorexia; Cannabinoids; Cannabis; Chronic Pain; Evidence-Based Medicine; Humans; Muscle Spasticity; Nausea; Vomiting

This paper aims to evaluate the anti-emetic efficacy of cannabinoids in cancer patients receiving chemotherapy using a systematic review of literature searched within electronic databases such as PUBMED, EMBASE, PSYCINFO, LILACS, and 'The Cochrane Collaboration Controlled Trials Register'. Studies chosen were randomized clinical trials comprising all publications of each database until December 2006. From 12 749 initially identified papers, 30 fulfilled the inclusion criteria for this review, with demonstration of superiority of the anti-emetic efficacy of cannabinoids compared with conventional drugs and placebo. The adverse effects were more intense and occurred more often among patients who used cannabinoids. Five meta-analyses were carried out: (1) dronabinol versus placebo [n=185; relative risk (RR)=0.47; confidence interval (CI)=0.19-1.16]; (2) Dronabinol versus neuroleptics [n=325; RR=0.67; CI=0.47-0.96; number needed to treat (NNT)=3.4]; (3) nabilone versus neuroleptics (n=277; RR=0.88; CI=0.72-1.08); (4) levonantradol versus neuroleptics (n=194; RR=0.94; CI=0.75-1.18); and (5) patients' preference for cannabis or other drugs (n=1138; RR=0.33; CI=0.24-0.44; NNT=1.8). The superiority of the anti-emetic efficacy of cannabinoids was demonstrated through meta-analysis.

Topics: Antiemetics; Antineoplastic Agents; Antipsychotic Agents; Cannabinoids; Cannabis; Female; Humans; Male; Nausea; Neoplasms; Treatment Outcome; Vomiting

In The Netherlands, since September 2003, a legal medicinal cannabis product, constituting the whole range of cannabinoids, is available for clinical research, drug development strategies, and on prescription for patients. To date, this policy, initiated by the Dutch Government, has not yet led to the desired outcome; the amount of initiated clinical research is less than expected and only a minority of patients resorts to the legal product. This review aims to discuss the background for the introduction of legal medicinal cannabis in The Netherlands, the past years of Dutch clinical experience in oncology practice, possible reasons underlying the current outcome, and future perspectives.

Topics: Anorexia; Attitude to Health; Cannabinoids; Cannabis; Forecasting; Health Policy; Humans; Legislation, Drug; Nausea; Neoplasms; Netherlands; Pain; Phytotherapy; Vomiting

Cannabis has been known as a medicine for several thousand years across many cultures. It reached a position of prominence within Western medicine in the nineteenth century but became mired in disrepute and legal controls early in the twentieth century. Despite unremitting world-wide suppression, recreational cannabis exploded into popular culture in the 1960s and has remained easily obtainable on the black market in most countries ever since. This ready availability has allowed many thousands of patients to rediscover the apparent power of the drug to alleviate symptoms of some of the most cruel and refractory diseases known to humankind. Pioneering clinical research in the last quarter of the twentieth century has given some support to these anecdotal reports, but the methodological challenges to human research involving a pariah drug are formidable. Studies have tended to be small, imperfectly controlled, and have often incorporated unsatisfactory synthetic cannabinoid analogues or smoked herbal material of uncertain composition and irregular bioavailability. As a result, the scientific evaluation of medicinal cannabis in humans is still in its infancy. New possibilities in human research have been opened up by the discovery of the endocannabinoid system, a rapidly expanding knowledge of cannabinoid pharmacology, and a more sympathetic political environment in several countries. More and more scientists and clinicians are becoming interested in exploring the potential of cannabis-based medicines. Future targets will extend beyond symptom relief into disease modification, and already cannabinoids seem to offer particular promise in the treatment of certain inflammatory and neurodegenerative conditions. This chapter will begin with an outline of the development and current status of legal controls pertaining to cannabis, following which the existing human research will be reviewed. Some key safety issues will then be considered, and the chapter will conclude with some suggestions as to future directions for human research.

Topics: Appetite; Cannabinoids; Cannabis; Cognition; Epilepsy; Glaucoma; Humans; Marijuana Abuse; Multiple Sclerosis; Nausea; Neoplasms; Neuroprotective Agents; Pain; Phytotherapy; Spinal Cord Injuries; Vomiting

The principal constituent of cannabis, Delta(9)-tetrahydrocannabinol (THC), is moderately effective in treating nausea and vomiting, appetite loss, and acute and chronic pain. Oral THC (dronabinol) and the synthetic cannabinoid, nabilone, have been registered for medical use in the US and UK, but they have not been widely used because patients find it difficult to titrate doses of these drugs. Advocates for the medical use of cannabis argue that patients should be allowed to smoke cannabis to relieve these above-mentioned symptoms. Some US state governments have legislated to allow the medical prescription of cannabis, but the US federal government has tried to prevent patients from obtaining cannabis and threatened physicians who prescribe it with criminal prosecution or loss of their licence to practise. In the UK and Australia, committees of inquiry have recommended medical prescription (UK) and exemption from criminal prosecution (New South Wales, Australia), but governments have not accepted these recommendations. The Canadian government allows an exemption from criminal prosecution to patients with specified medical conditions. It has recently legislated to provide cannabis on medical prescription to registered patients, but this scheme so far has not been implemented. Some advocates argue that legalising cannabis is the only way to ensure that patients can use it for medical purposes. However, this would be contrary to international drug control treaties and is electorally unpopular. The best prospects for the medical use of cannabinoids lie in finding ways to deliver THC that do not involve smoking and in developing synthetic cannabinoids that produce therapeutic effects with a minimum of psychoactive effects. While awaiting these developments, patients with specified medical conditions could be given exemptions from criminal prosecution to grow cannabis for their own use, at their own risk.

Topics: Antiemetics; Cannabis; HIV Wasting Syndrome; Humans; Legislation, Drug; Nausea; Pain; Phytotherapy; Plant Preparations; Treatment Outcome; Vomiting

Topics: Anorexia; Cachexia; Cannabinoids; Cannabis; Epilepsy; Hiccup; Humans; Migraine Disorders; Muscle Spasticity; Nausea; Pain; Palliative Care; Randomized Controlled Trials as Topic; Seizures; Vomiting

In response to public pressure to allow the medical use of marijuana, the Office of National Drug Control Policy, Washington, DC, funded a study by the Institute of Medicine evaluating the scientific evidence for benefits and risks of using marijuana as a medicine. The report used scientific reviews, public hearings, and reports from other agencies, and was evaluated by knowledgeable advisors and reviewers. It called for heavier investment in research on the biology of cannabinoid systems, careful clinical studies of cannabinoids in clinical syndromes, analysis of cannabinoids' psychological effects on symptoms, and evaluations of the health consequences of heavy marijuana use; recommends against the use of smoked marijuana in medicine and for the development of a medical cannabinoid inhaler; and recommends that compassionate use of marijuana be considered under carefully reviewed protocols. Finally, the report evaluates the abuse potential, tolerance, withdrawal, and gateway risks of medical use of cannabinoid drugs.

Topics: Cannabinoids; Cannabis; Drug and Narcotic Control; Feeding and Eating Disorders; Humans; Marijuana Abuse; National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; Nausea; Pain; Phytotherapy; Practice Patterns, Physicians'; Risk Assessment; Risk Factors; United States; Vomiting; Wasting Syndrome

Topics: Anesthesia; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Mental Processes; Nausea; Pain; United Kingdom; Vomiting

Although many clinical studies suggest the medical utility of marijuana for some conditions, the scientific evidence is weak. Many patients in California are self-medicating with marijuana, and physicians need data to assess the risks and benefits. The only reasonable solution to this problem is to encourage research on the medical effects of marijuana. The current regulatory system should be modified to remove barriers to clinical research with marijuana. The NIH panel has identified several conditions for which there may be therapeutic benefit from marijuana use and that merit further research. Marijuana should be held to the same evaluation standards of safety and efficacy as other drugs (a major flaw in Proposition 215) but should not have to be proved better than current medications for its use to be adopted. The therapeutic window for marijuana and THC between desired effect and unpleasant side effects is narrow and is a major reason for discontinuing use. Although the inhaled route of administration has the benefit of allowing patients to self-titrate the dose, the smoking of crude plant material is problematic. The NIH panel recommended that a high priority be given to the development of a controlled inhaled form of THC. The presence of a naturally occurring cannabinoid-receptor system in the brain suggests that research on selective analogues of THC may be useful to enhance its therapeutic effects and minimize adverse effects.

Topics: Analgesics; Animals; Antineoplastic Agents; Cachexia; California; Cannabis; Drug Approval; Glaucoma; Humans; Muscle Spasticity; Nausea; Phytotherapy; Self Medication; Vomiting

Topics: Amphetamine; Animals; Behavior, Animal; Biological Assay; Blood Glucose; Cannabis; Central Nervous System; Chemical Phenomena; Chemistry; Dextroamphetamine; Drug Synergism; Emotions; Humans; Hypnosis; Learning; Motor Activity; Perception; Phytotherapy; Rats; Resins, Plant; Sleep; Vomiting

This multicentre, randomised, double-blinded, placebo-controlled, phase II/III trial aimed to evaluate an oral THC:CBD (tetrahydrocannabinol:cannabidiol) cannabis extract for prevention of refractory chemotherapy-induced nausea and vomiting (CINV). Here we report the phase II component results.. Eligible patients experienced CINV during moderate-to-high emetogenic intravenous chemotherapy despite guideline-consistent antiemetic prophylaxis. Study treatment consisted of one cycle of 1-4 self-titrated capsules of oral THC 2.5 mg/CBD 2.5 mg (TN-TC11M) three times daily, from days -1 to 5, and 1 cycle of matching placebo in a crossover design, then blinded patient preference for a third cycle. The primary end point was the proportion of participants with complete response during 0-120 h from chemotherapy. A total of 80 participants provided 80% power to detect a 20% absolute improvement with a two-sided P value of 0.1.. A total of 81 participants were randomised; 72 completing two cycles were included in the efficacy analyses and 78 not withdrawing consent were included in safety analyses. Median age was 55 years (range 29-80 years); 78% were female. Complete response was improved with THC:CBD from 14% to 25% (relative risk 1.77, 90% confidence interval 1.12-2.79, P = 0.041), with similar effects on absence of emesis, use of rescue medications, absence of significant nausea, and summary scores for the Functional Living Index-Emesis (FLIE). Thirty-one percent experienced moderate or severe cannabinoid-related adverse events such as sedation, dizziness, or disorientation, but 83% of participants preferred cannabis to placebo. No serious adverse events were attributed to THC:CBD.. The addition of oral THC:CBD to standard antiemetics was associated with less nausea and vomiting but additional side-effects. Most participants preferred THC:CBD to placebo. Based on these promising results, we plan to recruit an additional 170 participants to complete accrual for the definitive, phase III, parallel group analysis.. Australian New Zealand Clinical Trials Registry ACTRN12616001036404; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370473&isReview=true.

Topics: Adult; Aged; Aged, 80 and over; Antiemetics; Antineoplastic Agents; Australia; Cannabidiol; Cannabis; Cross-Over Studies; Double-Blind Method; Dronabinol; Drug Combinations; Female; Humans; Male; Middle Aged; Nausea; Plant Extracts; Vomiting

Topics: Adult; Animals; Antiemetics; Cannabinoids; Cannabis; Clinical Trials as Topic; Dogs; Dronabinol; Humans; Vomiting

Anecdotal accounts suggested that smoking marihuana decreases the nausea and vomiting associated with cancer chemotherapeutic agents. Oral delta-9-tetrahydrocannabinol was compared with placebo in a controlled, randomized, "double-blind" experiment. All patients were receiving chemotherapeutic drugs known to cause nausea and vomiting of central origin. Each patient was to serve as his own control to determine whether tetrahydrocannabinol had an antiemetic effect. Twenty-two patients entered the study, 20 of whom were evaluable. For all patients an antiemetic effect was observed in 14 of 20 tetrahydrocannabinol courses and in none of 22 placebo courses. For patients completing the study, response occurred in 12 of 15 courses of tetrahydrocannabinol and in none of 14 courses of placebo (P less than 0.001). No patient vomited while experiencing a subjective "high". Oral tetrahydrocannabinol has antiemetic properties and is significantly better than a placebo in reducting vomiting caused by chemotherapeutic agents.

Topics: Administration, Oral; Adolescent; Adult; Aged; Antiemetics; Antineoplastic Agents; Cannabis; Clinical Trials as Topic; Dronabinol; Female; Humans; Male; Middle Aged; Neoplasms; Phytotherapy; Vomiting

Topics: Adolescent; Adult; Aged; Anesthetics; Cannabis; Color Perception; Consciousness; Cyclohexanes; Depersonalization; Diazepam; Dreams; Female; Hallucinations; Hallucinogens; Humans; Injections, Intravenous; Ketamine; Lysergic Acid Diethylamide; Male; Middle Aged; Vomiting

The medical use of Cannabis has gained popularity in Europe and Northern America in recent years. Cannabinoids are available as finished pharmaceuticals, flowers and extracts. This article focuses on supportive medicine for oncological patients. Possible indications are pain, chemotherapy-induced nausea and vomiting, loss of appetite and altered taste perception. Despite the enormous cannabis hype in medicine, the evidence for its use in oncology patients is insufficient. However, palliative patients with refractory symptoms could be candidates for a therapeutic trial. The key parameter for choosing a cannabis medicinal product is the THC/CBD ratio. Oral forms of administration are particularly suitable for cannabis-naive and older patients. Mental and cardiovascular side effects should not be underestimated.. Die medizinische Verwendung von Cannabis hat in den letzten Jahren in Europa und Nordamerika an Popularität gewonnen. Cannabinoide sind sowohl als Fertigarzneimittel als auch in Blüten- und Extraktform verfügbar. Der vorliegende Artikel legt den Fokus auf die supportive Therapie onkologischer Patienten. Mögliche Indikationen sind Schmerzen, Chemotherapie-bedingte Übelkeit und Erbrechen, Appetitlosigkeit und Geschmacksveränderungen. Trotz des enormen Hypes um Cannabis als Medizin ist die Evidenz für dessen Anwendung bei onkologischen Patienten unzureichend. Palliativpatienten mit refraktären Symptomen könnten jedoch geeignete Kandidaten für einen Therapieversuch darstellen. Der entscheidende Parameter für die Auswahl eines Cannabis-Arzneimittels ist die THC/CBD-Ratio. Orale Einnahmeformen bieten sich gerade für Cannabis-naive und ältere Patienten an. Psychische und kardiovaskuläre Nebenwirkungen sind nicht zu unterschätzen.

Topics: Analgesics; Cannabinoids; Cannabis; Humans; Nausea; Neoplasms; Vomiting

The antiemetic properties of cannabis have motivated its use in the management of chemotherapy-induced nausea and vomiting. Conversely, case reports of intractable vomiting among heavy cannabis users have increasingly appeared in the literature. Studies on cannabis and gastrointestinal tract (GIT) health are scare. Here, we use data for the National Health and Nutrition Examination Surveys (NHANES, 2005-2018) to estimate the association between cannabis use and GIT illness.. The study sample included non-pregnant adult NHANES participants (20-59 years) without history of cancer or HIV (n = 18,753). Cannabis use was categorised into never, former (0 day in the past 30 days), infrequent (1-2 days), occasional (3-19 days) and frequent (20-30 days) use. Recent GIT illness was defined as experiencing GIT illness with vomiting or diarrhoea that started in the 30 days prior to NHANES. Logistic regression was used to regress GIT illness on cannabis use, adjusting for potential confounders.. Compared to never use, frequent cannabis use was associated with higher odds of GIT illness (OR = 1.4; 95% confidence interval 1.04, 1.9). There were no associations between former, infrequent or occasional cannabis use and GIT illness.. Frequent cannabis use is associated with GIT illnesses in a large cross-sectional study of US residents. It is possible that frequent cannabis use adversely affects GIT health, consistent with clinical case reports. Alternatively, patients with GIT illness might self-medicate with cannabis given its antiemetic properties. Prospective studies are needed to understand the effects of cannabis use on GIT health.

Topics: Adult; Antiemetics; Cannabis; Cross-Sectional Studies; Gastrointestinal Tract; Hallucinogens; Humans; Nutrition Surveys; Vomiting

BACKGROUND Patients with type 1 diabetes mellitus may experience gastrointestinal symptoms, including those suggestive of diabetic gastroparesis. Cannabinoid hyperemesis syndrome (CHS) includes nausea, vomiting, and abdominal pain in the setting of chronic cannabinoid use. This report presents a case of CHS in a 23-year-old woman with uncontrolled type 1 diabetes mellitus. CASE REPORT A 23-year-old woman with chronically uncontrolled type 1 diabetes mellitus had been presenting monthly at the emergency department for the last 2 years, for acute bouts of intractable nausea and vomiting, occasionally with abdominal pain. Given her history of uncontrolled diabetes, she had been managed for diabetic gastroparesis with prokinetics. A gastric emptying study 6 months prior to admission was normal, and the patient had had multiple unremarkable abdominal computed tomography imaging scans. On this admission, she benefitted from supportive management with only temporary improvement of symptoms. On further questioning, she reported consistent use of cannabis for the last few years, and regression of acute vomiting with hot baths at home. With counseling, she ceased cannabis for 2 months and was symptom-free during this period. CONCLUSIONS This report has shown the importance of taking a comprehensive drug history in all patients, including in patients with type 1 diabetes, and is a reminder that cannabinoid use can cause severe nausea, vomiting, and abdominal pain in this patient group.

Topics: Abdominal Pain; Adult; Cannabinoids; Cannabis; Diabetes Mellitus, Type 1; Female; Gastroparesis; Humans; Nausea; Vomiting; Young Adult

Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction (DGBI) characterized by recurrent episodes of nausea and vomiting. Most children outgrow their CVS symptoms and develop migraine headaches, but there are limited data in adults. We thus sought to determine the natural history of CVS in adults.. We conducted a retrospective analysis of patients at a specialized tertiary care clinic. Frequency of CVS episodes, emergency department (ED) visits, and hospitalizations were recorded at the index visit and at follow-up.. Of 455 CVS patients with complete data, mean age was 33 ± 13 years, 294 (65%) were female, and 392 (86%) were Caucasian. Mean duration of follow-up was 47.4 ± 37.2 months. There was a significant reduction in frequency of CVS episodes/year (18 to 6.8), ED visits (6.1 to 2), and hospitalizations (2.3 to 0.7) (all p-values < 0.001) but only 88 (19%) of patients had complete resolution of episodes at follow-up. On multivariable regression analysis, non-white race [0.33 (0.11-0.98) p = 0.01], comorbidity count [0.77 (0.62-0.95) p = 0.01], cannabis use [0.36 (0.2-0.65) p = 0.0007], and aprepitant use [0.2 (0.08-0.005) p < 0.001] were associated with a reduced odds of complete resolution of CVS episodes. Of note, 19 patients (4%) died.. While most adults with CVS improved with specialized care, in contrast to children, only a small subset (~1 in 5) had complete resolution of symptoms. Reasons for the effects of race, cannabis use, and comorbidity burden on outcomes in CVS are unclear and warrant further investigation.

Topics: Adult; Cannabis; Child; Female; Humans; Male; Middle Aged; Migraine Disorders; Retrospective Studies; Tertiary Care Centers; Vomiting; Young Adult

Cannabis is the most widely used psychoactive substance in the United States (US), with reported use patterns increasing among adults in recent years. Cannabinoid hyperemesis syndrome (CHS) has been one concern related to increased cannabis use patterns. US emergency departments have reported an increase of CHS cases over the last decade, yet little is known about CHS. This study explores the experiences of people with chronic cannabis use and cyclic vomiting and their perceptions of CHS.. Semi-structured interviews were conducted with 24 people recruited from a prospective cohort of patients presenting to Rhode Island emergency departments with symptomatic cyclic vomiting and chronic cannabis use. Data were analyzed thematically using NVivo.. Participants characterized their cyclic vomiting as related to food and alcohol consumption patterns, stress, and existing gastrointestinal issues. Despite recurrent episodes of cyclic vomiting, nausea, and abdominal pain, many participants remained uncertain whether their symptoms were driven by cannabis. Many participants relied on at-home research to assess their symptoms and seek out management approaches. Clinical treatment recommendations focused on cannabis cessation. However, most participants felt clinical recommendations failed to consider the complexity and challenge of stopping cannabis use given the chronicity of use and therapeutic benefits some perceived cannabis to have.. Although cannabis cessation is the only reported CHS cure to date, additional clinical and non-clinical treatment approaches are needed to better support people with chronic cannabis use and cyclic vomiting to meet their ongoing needs.

Topics: Adult; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Prospective Studies; Syndrome; Vomiting

The legalization of recreational and medical cannabis has increased the availability and potency of cannabis products in homes and communities. Although state laws regarding legalization and commercial sale often encompass adult use only, pediatric toxicity from unintentional exposures to cannabis edibles and adolescent harm from chronic use are increasing in states and countries that have relaxed laws on use. Unintentional edible ingestions are shown to increase in regions that legalize and commercialize cannabis products at the retail level. Long-term effects on teenagers regarding psychiatric changes as well as acute gastrointestinal effects from hyperemesis syndrome are well documented in the medical literature. This article provides clinical information on the presentation, evaluation, and management of adverse effects from pediatric and adolescent teen exposures to cannabis seen in acute care and emergent settings.

Topics: Adolescent; Adult; Cannabis; Child; Critical Care; Drug-Related Side Effects and Adverse Reactions; Humans; Syndrome; Vomiting

Little is known about the risks and benefits of cannabis use in the context of cancer care. This study characterized the prevalence, reasons for use, and perceived benefits of cannabis and compared symptoms and perceived risks between those who reported past 30-day cannabis use and those who did not.. Adults undergoing cancer treatment at a National Cancer Institute-designated cancer center completed measures of sociodemographic characteristics, cannabis use, use modalities, reasons for use, perceived harms/benefits of use, physical and psychological symptoms, and other substance/medication use. Analyses compared patients who used or did not use cannabis in the past 30 days.. Participants (N = 267) were 58 years old on average, primarily female (70%), and predominantly White (88%). Over a quarter of respondents (26%) reported past 30-day cannabis use, and among those, 4.5% screened positive for cannabis use disorder. Participants who used cannabis most often used edibles (65%) or smoked cannabis (51%), and they were younger and more likely to be male, Black, and disabled, and to have lower income and Medicaid insurance than participants who did not use cannabis. Those who used cannabis reported more severe symptoms and perceived cannabis as less harmful than those who did not use cannabis. The most common medical reasons for cannabis use were pain, cancer, sleep problems, anxiety, nausea/vomiting, and poor appetite. Participants reported the greatest cannabis-related symptom relief from sleep problems, nausea/vomiting, headaches, pain, muscle spasms, and anxiety.. Patients with cancer who used cannabis perceived benefits for many symptoms, although they showed worse overall symptomatology.. Among adults undergoing cancer treatment, 26% reported cannabis use in the past 30 days. Those who used cannabis were more likely to be male and disabled and to have lower income and Medicaid insurance than those who did not use cannabis. Participants most commonly reported using cannabis for pain, cancer, sleep, anxiety, and nausea/vomiting and reported the greatest perceived benefits for sleep, nausea/vomiting, headaches, pain, muscle spasms, and anxiety, yet participants who used cannabis also reported feeling worse physically and psychologically compared to those who did not use cannabis. Participants who used cannabis were more likely to report that cannabis was less risky to their health than alcohol, smoking, and opioids than those who did not use cannabis.

Topics: Adult; Cancer Pain; Cannabis; Female; Headache; Humans; Male; Medical Marijuana; Middle Aged; Nausea; Neoplasms; Pain; Sleep Wake Disorders; Spasm; Vomiting

The objectives of this study were to characterize the detailed cannabis use patterns (eg, frequency, mode, and product) and determine the differences in the whole-blood cannabinoid profiles during symptomatic versus asymptomatic periods of participants with suspected cannabinoid hyperemesis syndrome recruited from the emergency department (ED) during a symptomatic episode.. This is a prospective observational cohort study of participants with symptomatic cyclic vomiting onset after chronic cannabis use. Standardized assessments were conducted to evaluate for lifetime and recent cannabis use, cannabis use disorder, and cannabis withdrawal symptoms. Quantitative whole-blood cannabinoid testing was performed at 2 times, first when symptomatic (ie, baseline) and at least 2 weeks after the ED visit when asymptomatic. The differences in cannabinoid concentrations were compared between symptomatic and asymptomatic testing. The study was conducted from September 2021 to August 2022.. There was a difference observed between delta-9-tetrahydrocannabinol metabolites, but not the parent compound during symptomatic episodes and asymptomatic periods. Most participants (84%) reported using cannabis > once per day (median 3 times per day on weekdays, 4 times per day on weekends). Hazardous cannabis use was universal among participants; the mean cannabis withdrawal discomfort score was 13, indicating clinically significant rates of cannabis withdrawal symptoms with cessation of use. Most participants (79%) previously tried to stop cannabis use, but a few (13%) of them had sought treatment.. Patients presenting to the ED with cannabinoid hyperemesis syndrome have high cannabis use disorder scores. Further studies are needed to better understand the influence of THC metabolism and concentrations on symptomatic cyclic vomiting.

Topics: Cannabinoids; Cannabis; Cohort Studies; Emergency Service, Hospital; Humans; Marijuana Abuse; Substance Withdrawal Syndrome; Vomiting

Nausea and vomiting of pregnancy, also referred to as morning sickness, affects more than 70% of all pregnancies. Symptoms range from mild to severe and, in some cases, can be debilitating, resulting in a reduced quality of life. Moreover, prenatal cannabis use prevalence has doubled in the United States, and cannabis potency, measured by the concentration of delta-9-tetrahydrocannabiniol, has increased from 10% in 2009 to 14% in 2019. State-level recreational legalization of cannabis may contribute to the liberalization of its use and reduced risk perception. Furthermore, the relatively recent discovery of cannabinoid hyperemesis syndrome may contribute to the mischaracterization of morning sickness in individuals who use cannabis during pregnancy. Although cannabis has well-documented antiemetic properties, there is insufficient research on the topic. Therefore, it is essential to establish a tangible understanding of the association between nausea and vomiting of pregnancy and prenatal cannabis use.. This study aimed to estimate the degree to which nausea and vomiting of pregnancy might be associated with prenatal cannabis use in a sample of pregnant people in Michigan, a state where recreational cannabis use became legal in December 2018.. This was a prospective study of participants from the Michigan Archive for Research on Child Health, a population-based pregnancy cohort that was recruited using a probability-based sampling approach. Participants were recruited from 22 prenatal clinics located throughout Michigan's lower peninsula. Cross-sectional analyses were performed for data available between October 2017 and January 2022.. Among this sample of Michigan pregnant people, 14% (95% confidence interval, 11%-16%) reported cannabis use. Participants who experienced increasing morning sickness severity had higher odds of using cannabis (adjust odds ratio, 1.2; 95% confidence interval, 1.1-1.2). When the sample was restricted to first-trimester morning sickness and cannabis use, the results remained statistically robust. When the direction of the association was reversed, an increase in morning sickness severity was detected among participants who used cannabis during pregnancy (ß. Study findings indicated a link between nausea and vomiting of pregnancy and prenatal cannabis use. Moreover, this study revealed that using cannabis in the 3 months before pregnancy is associated with first-trimester morning sickness severity. The strengths of our study contribute to the scant epidemiologic evidence in this area of research. More fine-grained, time-specific data on nausea and vomiting of pregnancy and prenatal cannabis use are necessary to draw inferences about cause-effect relationships. Our study might provide a basis to discourage cannabis use during pregnancy until more evidence is collected.

Topics: Cannabis; Child; Cross-Sectional Studies; Female; Humans; Michigan; Morning Sickness; Nausea; Pregnancy; Prospective Studies; Quality of Life; United States; Vomiting

There are few studies in Spain on cannabinoid hyperemesis syndrome (CHS), as well as on the use of topical capsaicin as a treatment.. Retrospective study of patients over 14 years of age seen in a hospital emergency department during 2018 and 2019 with a diagnosis of CHS based on the following criteria: compatible clinical picture, cannabis use less than 48h and positive urine cannabis test. Epidemiological and clinical variables, attendance times and treatment (including use of topical capsaicin 0.075%) were collected.. Fifty-nine attendances were studied, from 29 patients (4.4 cases/10,000 visits, 95% CI 2.8-4.7). Fifty per cent returned for CHS, differing only in more tobacco (P=.01) and cocaine (P=.031) use. Capsaicin was used in 74.6% of visits. The mean time to resolution of vomiting after application was 17.87min.. Although probably underdiagnosed, CHS has a low incidence in the emergency department in Spain, with high patient recurrence. The use of capsaicin ointment is efficient and safe.

Topics: Cannabinoids; Cannabis; Capsaicin; Humans; Incidence; Marijuana Abuse; Retrospective Studies; Syndrome; Vomiting

Topics: Adolescent; Cannabis; COVID-19; Humans; Marijuana Abuse; Pandemics; SARS-CoV-2; Vomiting

Research on cannabis-related health outcomes in diverse older adults is limited. The current study utilized a matched cohort study design to compare older adults in Hawai'i with identified cannabis diagnoses and matched controls on chronic health conditions, acute health events, and healthcare utilization from 2016 to 2020.. Patients age 50 + were identified using ICD-10 diagnostic codes for cannabis use, abuse, and dependence using electronic health record data from an integrated health system (Kaiser Permanente Hawai'i). Those with cannabis diagnoses (n = 275) were compared to matched non-using controls (n = 275; based on age, sex) on chronic health conditions (coronary heart disease, hypertension, COPD, chronic non-cancer pain), acute health events (myocardial infarction, respiratory symptoms, stroke, persistent or cyclic vomiting, injuries), and healthcare utilization (outpatient, inpatient, and emergency department visits) following case identification for two years.. Participants were 19.3% Native Hawaiian/Pacific Islander, 24.4% Asian, 47.8% White, and 8.5% Other/Unknown, with an average age of 62.8 years (SD=7.3). Adjusting for covariates as possible, participants with a cannabis diagnosis had significantly greater risk of coronary heart disease, chronic non-cancer pain, stroke, myocardial infarction, cyclic vomiting, and injuries, over time, compared to controls. Cannabis use was associated with any and greater frequency of outpatient, inpatient, and emergency department visits.. In a diverse sample, older adults who used cannabis had worse health conditions and events and used more health services over a two-year period. Future studies should evaluate cannabis-related health outcomes, effects of cannabis problem severity, as well as implications for healthcare in aging populations.

Topics: Aged; Analgesics, Opioid; Cannabis; Chronic Disease; Chronic Pain; Cohort Studies; Hallucinogens; Hawaii; Humans; Middle Aged; Myocardial Infarction; Patient Acceptance of Health Care; Stroke; Vomiting

To investigate if clinical features associated with acute cannabis intoxication in patients presenting to Emergency Departments for medical assistance differ according to patient age and sex.. We analysed presentations in the Euro-DEN Plus dataset from 2014 to 2019 in which cannabis was the only drug involved (except for alcohol), and age, sex and alcohol co-ingestion had been recorded. Age was considered as categorical (five groups; <20, 20-29, 30-39, 40-49 and ≥50 years), and sex as binary variable (male/female). We evaluated 12 key clinical features recorded during emergency department (ED) care. Risks of presenting with each of these clinical features according to patient age and sex were calculated by logistic regression models, and adjusted for sex, age and alcohol co-ingestion.. 4,268 of 43,633 Euro-DEN presentations (9.8%) fulfilled the inclusion criteria (median age: 26 years (IQR = 20-34), 70% male, 52% co-ingested alcohol). The frequency of clinical features was: anxiety 28%, vomiting 24%, agitation 23%, palpitations 14%, reduced consciousness 13%, acute psychosis 9%, hallucinations 9%, chest pain 7%, headache 6%, hypotension 4%, hypertension 3% and seizures 2%. Patients younger than 20 years more frequently had vomiting (34.7% of cases), reduced consciousness (21.5%), and headache (10.8%); and less frequently acute psychosis (5.5%). Patients older than 49 years more often had hypotension (6.5%) and less frequently vomiting (20%), anxiety (14%), agitation (14%) and reduced consciousness (10%). Males more frequently presented with hypertension (3.7 vs. 1.5%; OR = 2.311, 95%CI = 1.299-3.816), psychosis (10.4 vs 6.3%; 1.948, 1.432-2.430), chest pain (8.1 vs 4.5%; 1.838, 1.390-2.430) and seizures (2.5 vs 1.4%; 1.805, 1.065-3.060), and less frequently with vomiting (21.8 vs 28.2%; 0.793, 0.677-0.930), anxiety (25.4 vs 32.3%; 0.655, 0.561-0.766) and hypotension (2.9 vs 5.8%; 0.485, 0.350-0.671).. The prevalence of some clinical features typically associated with acute cannabis intoxication differed according to age and sex. The causes for these differences should be further investigated in order to better understand the pathophysiology of cannabis-related acute toxicity, and they may be relevant particularly for developing prevention campaigns and for treatment in specific sex and/or age groups.

Topics: Adult; Cannabis; Chest Pain; Emergency Service, Hospital; Ethanol; Female; Headache; Humans; Hypertension; Hypnotics and Sedatives; Hypotension; Male; Middle Aged; Psychotropic Drugs; Seizures; Vomiting

Topics: Analgesics; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Syndrome; Vomiting

Topics: Analgesics; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Syndrome; Vomiting

To study whether there are age-related differences in the clinical effects of cannabis poisoning and whether any age differences found are also related to sex or coingestion of alcohol.. Descriptive observational study of patients treated in 11 emergency departments for symptoms related to cannabis use. We collected data on 11 clinical manifestations and used a restricted cubic spline model to analyze their relative frequency according to age. We also looked for any interactions between the findings and patient sex or alcohol coingestion.. A total of 949 patients were studied. The mean age was 29 years, 74% were males, and 39% had also consumed alcohol. We identified 3 symptom patterns related to age. One set of symptoms (vomiting, headache, convulsions, and hypotension) remained stable across all ages. Manifestations that increased in the middle of the age range studied were agitation and aggressivity, psychosis, palpitations and hallucinations. Chest pain and hypertension increased in older-aged patients. The frequencies of palpitations, vomiting, and headache differed according to sex. These manifestations held constant in males but were markedly higher in young-adult females. Coingestion of alcohol was associated with agitation and aggressivity (in 34.0% vs 23.4%, P .001), fewer reports of palpitations (in 9.8% vs 15.6%, P = .01), less anxiety (in 20.7% vs 27.8%, P = .01), less psychosis (in 10.3% vs 16.6%, P = .007), and less chest pain (in 3.8% vs 9.5%, P = .001). The only significant interaction between age and alcohol coingestion occurred with respect to vomiting and psychosis.. There are age-related differences in the acute clinical manifestations of cannabis poisoning requiring emergency hospital care. Sex and coingestion of alcohol modify the relationship between age and frequency of some manifestations.. Investigar si existen diferencias en las manifestaciones clínicas por consumo de cannabis según la edad, y si estas se modifican en función del sexo o el consumo de etanol.. Estudio observacional descriptivo de pacientes atendidos en 11 servicios de urgencias con consumo de cannabis como motivo de consulta. Se recogieron 11 manifestaciones clínicas y se analizó su frecuencia relativa en función de la edad mediante curvas spline cúbicas restringidas. Se analizó si existía interacción en el comportamiento etario de cada uno de los síntomas en función del sexo y del consumo de etanol.. Se analizaron 949 pacientes, edad media 29 años, 74% varones y 39% con coingesta de etanol. Se identificaron tres patrones de síntomas según la edad: estable (vómitos, cefalea, convulsiones, hipotensión), incrementada en edades medias (agresividad-agitación, ansiedad, psicosis, palpitaciones, alucinaciones) y con aumento progresivo con la edad (dolor torácico e hipertensión). En la relación síntoma-edad, la frecuencia de palpitaciones, vómitos y cefalea tuvo un comportamiento significativamente diferente según el sexo, más constante en hombres y con un incremento marcado en edades medias en mujeres. La coingesta de etanol se asoció con más agitación-agresividad (34,0%/23,4%, p 0,001) y menos palpitaciones (9,8%/15,6%, p = 0,01), ansiedad (20,7%/27,8%, p = 0,01), psicosis (10,3%/16,6%, p = 0,007) y dolor torácico (3,8%/9,5%, p = 0,001). En cuanto a la relación síntoma-edad, el etanol solo modificó significativamente la frecuencia de vómitos y de psicosis.. La edad condiciona efectos clínicos diferenciales en algunas manifestaciones agudas de la intoxicación por cannabis que precisa asistencia hospitalaria, y el sexo y el consumo simultáneo de alcohol modifican esta relación entre edad y frecuencia de algunos síntomas.

Topics: Adult; Cannabis; Chest Pain; Female; Headache; Humans; Male; Psychotic Disorders; Vomiting

Our objective was to evaluate whether cannabis use was associated with nausea and vomiting in early pregnancy. Participants from nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be) enrolled from October 2010 through September 2013 with a PUQE (Pregnancy-Unique Quantification of Emesis) questionnaire and an available stored urine sample from the first study visit (median gestational age 12 weeks) were included. Cannabis exposure was ascertained by urine immunoassay for 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH); positive results were confirmed with liquid chromatography tandem mass spectrometry. The primary outcome was moderate-to-severe nausea by the PUQE score. Overall, 9,250 participants were included, and 5.8% (95% CI 5.4-6.3%) had detectable urine THC-COOH. In adjusted analyses, higher THC-COOH levels were associated with greater odds of moderate-to-severe nausea (20.7% in the group with THC-COOH detected vs 15.5% in the group with THC-COOH not detected, adjusted odds ratio 1.6, 95% CI 1.1-2.2 for a 500 ng/mg Cr THC-COOH increment).

Topics: Analgesics; Cannabis; Dronabinol; Female; Gas Chromatography-Mass Spectrometry; Humans; Infant; Nausea; Pregnancy; Substance Abuse Detection; Vomiting

Prior research suggests that the legalization of recreational cannabis is associated with increases in cannabis hyperemesis syndrome (CHS), but it is unclear how cannabis commercialization (ie, greater retail store access as well as increased variety and potency of cannabis products) may be associated with these changes.. To examine changes in the number and characteristics of CHS emergency department (ED) visits from before to after legalization of cannabis in Ontario, Canada.. This repeated cross-sectional study used interrupted time-series analyses to examine immediate and gradual changes in ED visits for CHS in Ontario, Canada, during 3 time periods: prelegalization (January 2014-September 2018), legalization with product and retail store restrictions (October 2018-February 2020), and commercialization with new products and expanded stores, which coincided with the COVID-19 pandemic (March 2020-June 2021). Data were obtained from routinely collected and linked health administrative databases. All individuals aged at least 15 years and who were eligible for Ontario's Universal Health Coverage were included. Data were analyzed between March and July 2022.. Monthly counts of ED visits for CHS per capita.. There were 12 866 ED visits for CHS from 8140 individuals during the study. Overall, the mean (SD) age was 27.4 (10.5) years, with 2834 individuals (34.8%) aged 19 to 24 years, 4163 (51.5%) females, and 1353 individuals (16.6%) with a mental health ED visit or hospitalization in the 2 years before their first CHS ED visit. Nearly 10% of visits (1135 visits [8.8%]) led to hospital admissions. Monthly rates of CHS ED visits increased 13-fold during the 7.5-year study period, from 0.26 visits per 100 000 population in January 2014 to 3.43 visits per 100 000 population in June 2021. Legalization was not associated with an immediate or gradual change in rates of ED visits for CHS; however, commercialization during the COVID-19 pandemic period was associated with an immediate increase in rates of CHS ED visits (incidence rate ratio [IRR], 1.49; 95% CI, 1.31-1.70). During commercialization, rates of CHS ED visits increased more in women (IRR, 1.49; 95% CI, 1.16-1.92) and individuals older than the legal age of cannabis purchase (eg, age 19-24 years: IRR, 1.60; 95% CI, 1.19-2.16) than men (IRR, 1.08; 95% CI, 0.85-1.37) and individuals younger than the legal age of purchase (IRR, 0.78; 95% CI, 0.42-1.45).. This cross-sectional study found large increases in CHS ED visits during the period of time when the market commercialized and the COVID-19 pandemic occurred. Greater awareness of CHS symptoms by ED staff in regions where legal commercialized cannabis markets exist is indicated.

Topics: Cannabis; COVID-19; Cross-Sectional Studies; Emergency Service, Hospital; Female; Hallucinogens; Humans; Male; Ontario; Pandemics; Syndrome; Vomiting

Cannabis use has been increasing in the United States and throughout the world. It is derived from one of the earliest plants cultivated by humans - Cannabis sativa. Cannabis (also called marijuana) is the most commonly used psychoactive substance worldwide. The cannabis plant has more than 400 chemicals, of which more than 100 cannabinoids (such as cannabigerol, cannabidiol, and cannabinol) have been identified. The endocannabinoid system (ECS) plays an essential role in the effects of cannabis on end organs. Although cannabis use has been reported for many decades, some of its unique adverse effects of nausea, vomiting, and abdominal pain, termed as cannabis hyperemesis syndrome (CHS), were noted recently. The legal status of cannabis in the United States has been rapidly changing from state to state. The incidence of CHS is expected to rise with rising access to cannabis in the United States. Furthermore, CHS is frequently underdiagnosed due to a lack of uniform criteria, subjective nature of symptoms, and overlap with cyclical vomiting syndrome (CVS). Understanding the ECS and its role in biphasic response (proemetic and antiemetic) of CHS is critical to explain its pathophysiology. As the use of cannabis increases globally, awareness of CHS is warranted for early recognition and prompt treatment to avoid complications. We describe the putative mechanism of CHS with an overview of the clinical features in these patients. Furthermore, we highlight the differences between CHS and CVS with important differentials to consider. We provide a narrative update on the current evidence on CHS pathophysiology, diagnosis, treatment, and identifying research gaps.

Topics: Analgesics; Cannabis; Endocannabinoids; Humans; Marijuana Abuse; Nausea; Syndrome; Vomiting

The use of cannabis is not unfamiliar to many cancer patients, as there is a long history of its use for cancer pain and/or pain, nausea, and cachexia induced by cancer treatment. To date, the US Food and Drug Administration has approved 2 cannabis-based pharmacotherapies for the treatment of cancer chemotherapy-associated adverse effects: dronabinol and nabilone. Over the proceeding decades, both research investigating and societal attitudes toward the potential utility of cannabinoids for a range of indications have progressed dramatically. The following monograph highlights recent preclinical research focusing on promising cannabinoid-based approaches for the treatment of the 2 most common adverse effects of cancer chemotherapy: chemotherapy-induced peripheral neuropathy and chemotherapy-induced nausea and vomiting. Both plant-derived and synthetic approaches are discussed, as is the potential relative safety and effectiveness of these approaches in relation to current treatment options, including opioid analgesics.

Topics: Cannabinoids; Cannabis; Humans; Nausea; Neoplasms; Vomiting

Topics: Animals; Cannabis; Diabetes Mellitus, Type 1; Humans; New Zealand; Sheep; Vomiting

Topics: Adolescent; Cannabis; Humans; Nausea; Syndrome; Vomiting

Topics: Adult; Cannabis; Cytochrome P-450 CYP2C19; Cytochrome P-450 CYP2C9; Humans; Male; Marijuana Abuse; Pharmacogenomic Variants; Syndrome; Vomiting

Topics: Antiemetics; Cannabis; Haloperidol; Humans; Nausea; Vomiting

Topics: Cannabis; Haloperidol; Humans; Ondansetron; Syndrome; Vomiting

Topics: Antiemetics; Cannabis; Female; Haloperidol; Humans; Hyperemesis Gravidarum; Ondansetron; Pregnancy; Vomiting

Topics: Bulimia; Bulimia Nervosa; Cannabis; Feeding and Eating Disorders; Humans; Vomiting

Medical cannabis access has been legalized in more than 30 countries worldwide and popularity among patients is increasing rapidly. Cannabinoid-based treatments have been shown to be beneficial for several symptoms such as chemotherapy-induced nausea and vomiting, spasticity, chronic pain, intractable seizures and insomnia, yet high-quality clinical trials are still limited. As millions of patients now have legal access to medical cannabis, little information is available about the development of best clinical practices and an effective medical cannabis clinic model. A medical cannabis clinic is an innovative and emergent practice model that may be necessary to bridge the gap between patient and healthcare provider interest and existing barriers to the prescription of medical cannabis treatments, such as limited medical education, lack of high-quality clinical research and challenging or evolving regulatory frameworks. In this paper, we describe the model of care and organization of a dedicated medical cannabis clinic operating in Quebec, Canada since 2014. We share the principles of medical cannabis practice, including the structure of its medical and support team, clinic organisation and procedure guidelines. Key clinic statistics and patient demographics are shared with year by year comparison. Operating since 2014, the clinic has endured a rapidly changing regulatory landscape in Canada, overcoming numerous challenges including medical and social stigma, limited funding, resources and institutional support combined with a high demand for services. To support medical cannabis leaders globally, an important knowledge-sharing is required. The clinic has expanded to a network of four clinic sites across Quebec and offers continuing education and preceptorships to health care providers and trainees as well as research services to both academic and industry partners. The description of the clinic offers guidance on medical cannabis treatment and care and discusses possible solutions to associated challenges. The clinic model of care can be adapted to different healthcare settings and regulatory frameworks; it may assist physicians and health care providers in the development of medical cannabis clinics or the implementation of best practices as medical cannabis access continues to evolve.

Topics: Canada; Cannabis; Humans; Medical Marijuana; Nausea; Vomiting

Topics: Cannabinoids; Cannabis; Humans; Syndrome; Vomiting

Topics: Cannabinoids; Cannabis; Humans; Syndrome; Vomiting

Topics: Adolescent; Adult; Cannabis; Emergency Service, Hospital; Female; Humans; Male; Marijuana Abuse; Marijuana Use; Michigan; Retrospective Studies; Syndrome; Vomiting; Young Adult

Cannabis Hyperemesis Syndrome (CHS) is characterized by recurrent episodes of intractable emesis associated with heavy use of cannabis. Recognition of CHS can be problematic due to the lack of specific biomarkers, which can point the clinician to the diagnosis. We present, retrospectively, a series of adolescent/young adult patients who presented to a pediatric gastroenterology (GI) service with acute on chronic nausea and vomiting, subsequently found to have CHS with associated elevated urinary cannabis metabolite concentrations.. We describe 15 patients referred to our pediatric GI division for intractable emesis with spot urinary cannabis metabolite carboxy-THC (THC-COOH) concentrations from January 1, 2018 through April 20, 2019. Urinary testing was performed using gas chromatography mass-spectrometry (GC-MS) in a manner consistent with Clinical Laboratory Improvement Amendments (CLIA) requirements at Mayo Clinic laboratory (Rochester, MN). The laboratory cutoffs were 3.0 ng/mL. Data was extracted via chart review and analyzed via online statistical application.. Fifteen patients (seven females, eight males) were studied with an average age of 17.7 years. All patients reported frequent cannabis use for at least 1 month and exhibited intractable, non-bilious emesis for at least 2 weeks. Twelve patients also reported weight loss. Two patients had underlying gastrointestinal disease (one with Crohn disease and one with irritable bowel syndrome). All patients had essentially normal GI workup including laboratory tests, imaging studies and endoscopies.Fourteen of 15 patients had urinary THC-COOH concentrations >100 ng/mL, with seven individuals exhibiting levels >500 ng/mL. One patient had a urinary TCH-COOH concentration level under 100 ng/mL had not used cannabis for 2 weeks. Most other patients had used cannabis within 2 days of providing a urine sample. The Binomial test for CHS patients with urinary THC-COOH levels over 100 ng/mL was significant with a P-value of <0.0005 (one tail test).. CHS is associated with an elevated urinary THC-COOH level usually exceeding 100 ng/mL, which is indicative of significant chronic cannabis exposure. In patients with a history consistent with CHS, urine THC-COOH testing may help guide the diagnostic evaluation of these patients and decrease the need for further workup.

Topics: Adolescent; Cannabis; Child; Dronabinol; Humans; Retrospective Studies; Substance Abuse Detection; Vomiting

To describe the adverse events (AEs) of recreational cannabis use in France between 2012 and 2017.. AEs related to recreational cannabis use, alone or in combination with alcohol and/or tobacco reported to the French Addictovigilance Network were analysed (excluding cannabidiol and synthetic cannabinoids).. Reporting of AEs tripled between 2012 (n = 179, 6.3%, 95% confidence interval [CI] = 5.4-7.2) and 2017 (n = 562, 10.1%, 95% CI = 9.3-10.9), reaching 2217 cases. They concerned mainly men (76.4%) and users aged between 18 and 34 years (18-25: 30.9%; 26-34: 26.3%, range: 12-84 years). Cannabis was mainly inhaled (71.6%) and exposure was most often chronic (64.2%). Many types of AEs were reported: psychiatric (51.2%), neurological (15.6%), cardiac (7.8%) and gastrointestinal (7.7%), including unexpected AEs (n = 34, 1.1%). The most common effect was dependence, ranging from 10.1% (95% CI = 7.9-12.3) to 20.3% (95% CI = 17.3-23.2) over the study period. Cannabinoid hyperemesis syndrome (n = 87, 2.8%) emerged from 2015. Deaths accounted for 0.2% of all AEs (4 men and 3 women aged on average 35 years). A chronic pattern of cannabis use was reported in 4 of them (intracranial hypertension in the context of lung cancer, suicide, cerebral haematoma, neonatal death with concomitant chronic alcohol use), while in the other cases the toxicological analysis identified cannabis use (ruptured aneurysm and unknown aetiology).. This study showed a multitude of AEs related to recreational cannabis use, including unexpected AEs and deaths. It highlights the problem of dependence and the emergence of cannabinoid hyperemesis syndrome.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cannabidiol; Cannabinoids; Cannabis; Child; Hallucinogens; Humans; Infant, Newborn; Middle Aged; Vomiting; Young Adult

To investigate changes in emergency nursing workload related to cannabis ingestion or inhalation by adult and pediatric patients in states and bordering states where recreational cannabis is legal.. Qualitative exploratory design using data collected from focus groups.. Twenty-four English-speaking emergency nurses over the age of 18 who provide direct care to patients and work in US emergency departments located in a state, or bordering state, where recreational cannabis use is legal.. Qualitative data were gathered using a semi-structured interview format and analyzed using situational analysis.. The legalization of recreational cannabis in some US states is reported as resulting in an increase in patients presenting with cyclic vomiting syndromes, and increased difficulty in managing both associated behaviors and repetitive ED presentations. New presentations also include unintentional intoxication in both pediatric and geriatric populations. An unexpected finding was the displacement of local homeless populations by younger, indigent "cannabis tourists"; social services agencies might consider this while planning for cannabis legalization in their state or territory.. To protect public health and safety, regulatory efforts to standardize the formulation, dosing and labeling of cannabis products would be beneficial along with educational initiatives for both consumers and health care providers.

Topics: Adult; Aged; Cannabis; Child; Emergency Nursing; Emergency Service, Hospital; Female; Focus Groups; Humans; Infant; Legislation, Drug; Male; Middle Aged; Nursing Staff, Hospital; Qualitative Research; United States; Vomiting; Workload

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Vomiting

Topics: Analgesics; Cannabinoids; Cannabis; Humans; Vomiting

Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder which leads to multiple hospitalizations and causes significant impairment of quality of life. Cannabis use is common in patients with CVS, and there are limited data on the national trends in the prevalence of its use in the United States.. We used the National Inpatient Sample (NIS) database from 2005 to 2014 and identified hospitalizations with a primary diagnosis of CVS by utilizing the International Classification of Diseases, 9th revision Clinical Modification (ICD-9 CM) coding system. The primary objective of the study was to analyze the prevalence and trends in cannabis use in CVS patients. We also assessed healthcare resource utilization associated with cannabis use.. A total of 129 090 hospitalizations with a primary diagnosis of CVS were identified and included in the study. In the United States, the overall rate of cannabis use among these patients was 104 per 1000 hospitalizations (N = 13 460). Over the last decade, the prevalence of cannabis use increased by 10-fold, from 2.2% in 2005 to 21.2% in 2014.. Our analysis of the national database suggests that nearly 1 in 5 CVS hospitalizations have concurrent cannabis use. This prevalence is significantly rising over the last decade, perhaps due to changing legislation and increased utilization of cannabis. Age younger than 35, male gender, African American and Native American race, personal history of alcohol abuse and tobacco use were some of the strongest predictors of cannabis use.

Topics: Adolescent; Adult; Aged; Cannabis; Female; Humans; Male; Middle Aged; Prevalence; Self Medication; United States; Vomiting; Young Adult

Pneumopericardium is a potential complication to frequent cannabis smoking due to barotrauma of the airways caused by forceful coughing and Valsalva's manoeuvre. This is a case report of a 27-year-old man, who had a daily consumption of cannabis and presented with abdominal pain and nausea consistent with cannabinoid hyperemesis syndrome. A CT scan revealed an asymptomatic isolated minor pneumopericardium. The patient was observed, and no intervention was needed. At an outpatient control ten days later the pneumopericardium had spontaneously resolved.

Topics: Adult; Cannabinoids; Cannabis; Humans; Male; Nausea; Pneumopericardium; Smokers; Vomiting

Topics: Antiemetics; Antineoplastic Agents; Cannabinoids; Cannabis; Cross-Over Studies; Dronabinol; Humans; Nausea; Plant Extracts; Vomiting

Some patients with cyclic vomiting syndrome (CVS) use cannabis to relieve stress and for its antiemetic properties. However, chronic cannabis use has been associated paradoxically with cannabinoid hyperemesis syndrome (CHS) and some patients with CVS are thought to have CHS. We sought to characterize patterns of cannabis use by patients with CVS and identify those who could be reclassified as having CHS.. We performed a cross-sectional study of 140 patients with CVS (72% female; mean age, 37 ± 13 y) seen at a specialized clinic. Patients were screened for cannabis use with the cannabis use disorder identification test. Patients were classified as regular (use ≥4 times/wk) or occasional users (<4 times/wk).. Forty-one percent of patients were current cannabis users, with 21% reporting regular use. Regular users were more likely to be male and to report an anxiety diagnosis, and smoked cannabis with higher tetrahydrocannabinol content and for a longer duration. Most users reported that cannabis helped control CVS symptoms. Among all cannabis users, 50 of 57 (88%) reported that they had abstained for longer than 1 month, but only 1 user reported resolution of CVS episodes during the abstinence period. This patient subsequently resumed using cannabis but remains free of symptoms.. Cannabis is used commonly among patients with CVS-patients report relief of symptoms with use. We found 21% of patients with CVS to be regular users, but only 1 met the Rome IV criteria for CHS. Longitudinal studies are needed to determine the relationships among cannabis use, hyperemesis, and mood symptoms.

Topics: Adult; Antiemetics; Cannabis; Cross-Sectional Studies; Female; Humans; Male; Vomiting

Topics: Cannabis; Humans; Nausea; Syndrome; Vomiting

Topics: Cannabinoids; Cannabis; Female; Humans; Hyperemesis Gravidarum; Pregnancy; Vomiting

Topics: Cannabis; Humans; Nausea; Syndrome; Vomiting

Functional nausea and vomiting disorders (FNVDs) are classified as chronic nausea and vomiting syndrome (CNVS) or cyclic vomiting syndrome (CVS)-CVS includes cannabinoid hyperemesis syndrome. We investigated the population prevalence of FNVDs, their characteristics, and associated factors.. In the year 2015, an Internet cross-sectional health survey was completed by 5931 adults in the general populations of 3 English-speaking countries; 2100 participants were in the United States, Canada, or the United Kingdom. Quota-based sampling was used to generate demographically balanced and population-representative samples. The survey collected data on demographics, health care visits, medications, somatic symptom severity, quality of life, and symptom-based diagnostic criteria for Rome IV FNVDs as well as for irritable bowel syndrome and functional dyspepsia. Subsequent comparisons were made between Rome IV FNVD subjects and individuals without FNVDs (controls).. Overall, 2.2% of the population (n = 131) fulfilled symptom-based diagnostic criteria for Rome IV FNVDs: the United States (3%) had a greater prevalence than Canada (1.9%) or the United Kingdom (1.8%) (P = .02). The prevalence of CNVS was similar among the countries, ranging from 0.8% to 1.2%. However, the prevalence of CVS was higher in the United States (2%) than in Canada (0.7%) or the United Kingdom (1%) (P = .03). The proportion of subjects with CVS taking cannabis did not differ significantly among countries (P = .31), although the 7 cases of cannabinoid hyperemesis syndrome were in the United States. A significantly higher proportion of subjects with CVS reported a compulsive need for hot water bathing to alleviate emetic symptoms than subjects with CNVS (44% vs 19%; P = .03); this behavior was independent of cannabis but augmented by its use. Subjects with FNVDs had significantly greater health impairment and health care utilization than controls. On multivariate analysis, independent factors associated with FNVDs were younger age, increasing somatic symptom severity, lower quality of life, presence of irritable bowel syndrome, and functional dyspepsia. However, on subgroup analysis, somatic symptom severity was associated with CVS but not CNVS, whereas poor quality of life was associated with CNVS but not CVS.. Based on a cross-sectional health survey of adults in the general populations of 3 English-speaking countries, approximately 2% of subjects meet symptom-based criteria for Rome IV FNVDs and have considerable health impairments. Hot water bathing to alleviate emetic symptoms is reported for all FNVDs, and is perpetuated by cannabis use.

Topics: Adult; Aged; Canada; Cannabis; Cross-Sectional Studies; Female; Health Status; Humans; Male; Middle Aged; Nausea; Prevalence; Surveys and Questionnaires; United Kingdom; United States; Vomiting

Topics: Cannabis; Female; Humans; Marijuana Smoking; Marijuana Use; Nausea; Pregnancy; Vomiting

Topics: Cannabis; Female; Humans; Marijuana Smoking; Marijuana Use; Nausea; Pregnancy; Vomiting

Currently, an unprecedented number of individuals can legally access cannabis. Vaporization is increasingly popular as a method to self-administer cannabis, partly due to perception of reduced harm compared with smoking. Few controlled laboratory studies of cannabis have used vaporization as a delivery method or evaluated the acute effects of cannabis among infrequent cannabis users. This study compared the concentrations of cannabinoids in whole blood and oral fluid after administration of smoked and vaporized cannabis in healthy adults who were infrequent users of cannabis. Seventeen healthy adults, with no past-month cannabis use, self-administered smoked or vaporized cannabis containing Δ9-tetrahydrocannabinol (THC) doses of 0, 10 and 25 mg in six double-blind outpatient sessions. Whole blood and oral fluid specimens were obtained at baseline and for 8 h after cannabis administration. Cannabinoid concentrations were assessed with enzyme-linked immunosorbent assay (ELISA) and liquid chromatography-tandem mass spectrometry (LC-MS-MS) methods. Sensitivity, specificity and agreement between ELISA and LC-MS-MS results were assessed. Subjective, cognitive performance and cardiovascular effects were assessed. The highest concentrations of cannabinoids in both whole blood and oral fluid were typically observed at the first time point (+10 min) after drug administration. In blood, THC, 11-OH-THC, THCCOOH and THCCOOH-glucuronide concentrations were dose-dependent for both methods of administration, but higher following vaporization compared with smoking. THC was detected longer in oral fluid compared to blood and THCCOOH detection in oral fluid was rare and highly erratic. For whole blood, greater detection sensitivity for ELISA testing was observed in vaporized conditions. Conversely, for oral fluid, greater sensitivity was observed in smoked sessions. Blood and/or oral fluid cannabinoid concentrations were weakly to moderately correlated with pharmacodynamic outcomes. Cannabis pharmacokinetics vary by method of inhalation and biological matrix being tested. Vaporization appears to be a more efficient method of delivery compared with smoking.

Topics: Adult; Cannabis; Chromatography, Liquid; Double-Blind Method; Dronabinol; Enzyme-Linked Immunosorbent Assay; Female; Hallucinations; Humans; Male; Marijuana Smoking; Osmolar Concentration; Psychotropic Drugs; Saliva; Sensitivity and Specificity; Sex Factors; Substance Abuse Detection; Tandem Mass Spectrometry; Volatilization; Vomiting; Young Adult

Topics: Acute Disease; Cannabis; Child; Colorado; Emergency Service, Hospital; Humans; Vomiting

Little is known about the relative harms of edible and inhalable cannabis products.. To describe and compare adult emergency department (ED) visits related to edible and inhaled cannabis exposure.. Chart review of ED visits between 1 January 2012 and 31 December 2016.. A large urban academic hospital in Colorado.. Adults with ED visits with a cannabis-related International Classification of Diseases, Ninth or 10th Revision, Clinical Modification (ICD-9-CM or ICD-10-CM), code.. Patient demographic characteristics, route of exposure, dose, symptoms, length of stay, disposition, discharge diagnoses, and attribution of visit to cannabis.. There were 9973 visits with an ICD-9-CM or ICD-10-CM code for cannabis use. Of these, 2567 (25.7%) visits were at least partially attributable to cannabis, and 238 of those (9.3%) were related to edible cannabis. Visits attributable to inhaled cannabis were more likely to be for cannabinoid hyperemesis syndrome (18.0% vs. 8.4%), and visits attributable to edible cannabis were more likely to be due to acute psychiatric symptoms (18.0% vs. 10.9%), intoxication (48% vs. 28%), and cardiovascular symptoms (8.0% vs. 3.1%). Edible products accounted for 10.7% of cannabis-attributable visits between 2014 and 2016 but represented only 0.32% of total cannabis sales in Colorado (in kilograms of tetrahydrocannabinol) during that period.. Retrospective study design, single academic center, self-reported exposure data, and limited availability of dose data.. Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected.. Colorado Department of Public Health and Environment.

Topics: Acute Disease; Adult; Cannabis; Cardiovascular Diseases; Colorado; Emergency Service, Hospital; Female; Humans; Male; Marijuana Smoking; Middle Aged; Plants, Edible; Psychoses, Substance-Induced; Retrospective Studies; Vomiting

Topics: Cannabinoids; Cannabis; Capsaicin; Emergency Service, Hospital; Humans; Smoke; Vomiting

Topics: Cannabinoids; Cannabis; Capsaicin; Emergency Service, Hospital; Humans; Smoke; Vomiting

Epidemiological data, including prevalence, for cannabinoid hyperemesis syndrome (CHS) remain largely unknown. Without these data, clinicians often describe CHS as 'rare' or 'very rare' without supporting evidence. We seek to estimate the prevalence of CHS in a population of patients presenting to a socio-economically and racially diverse urban Emergency Department of a public hospital. This study consisted of a questionnaire administered to a convenience sample of patients presenting to the ED of the oldest public hospital in the United States. Trained Research Associates (RAs) administered the questionnaire to patients between the ages of 18-49 years who reported smoking marijuana at least 20 days per month. The survey included questions related to CHS symptoms (nausea and vomiting) and Likert scale rankings on eleven symptom relief methods, including 'hot showers'. Patients were classified as experiencing a phenomenon consistent with CHS if they reported smoking marijuana at least 20 days per month and also rated 'hot showers' as five or more on the ten-point symptom relief method Likert scale for nausea and vomiting. Among 2127 patients approached for participation, 155 met inclusion criteria as smoking 20 or more days per month. Among those surveyed, 32.9% (95% CI, 25.5-40.3%) met our criteria for having experienced CHS. If this is extractable to the general population, approximately 2.75 million (2.13-3.38 million) Americans may suffer annually from a phenomenon similar to CHS.

Topics: Adolescent; Adult; Cannabis; Emergency Medical Services; Female; Hospitals, Public; Hospitals, Urban; Humans; Male; Marijuana Smoking; New York City; Prevalence; Syndrome; Vomiting; Young Adult

Topics: Cannabinoids; Cannabis; Humans; Medical Marijuana; Multiple Sclerosis; Muscle Spasticity; Nausea; Neuralgia; Vomiting

A young woman with chronic cannabis use presents with 2-day history of cyclical nausea, vomiting and abdominal pain. Clinical and laboratory examination excluded other causes. Patient's symptoms improved with topical capsaicin, hot showers, antiemetics and she was subsequently discharged home 4 days later. The patient was educated on side effects of cannabis use and chose to stop cannabis use completely.

Topics: Antiemetics; Cannabis; Female; Humans; Marijuana Smoking; Nausea; Treatment Outcome; Vomiting; Young Adult

The use of medical marijuana-both the psychoactive tetrahydrocannabinol and its nonpsychoactive relative cannabidiol-is a growing practice in facilities served by senior care pharmacists. Currently, 30 states have approved its use under a variety of different regulations and for a number of conditions. Its use is bolstered by a growing number of Americans who support legalization of cannabis. Though oral synthetic cannabinoid compounds are approved by the Food and Drug Administration for chemotherapy-induced nausea and vomiting and appetite stimulation associated with AIDS, synthetic products differ from plant-derived products in several ways. In addition, use of these substances has created a regulatory and legal quagmire that differs considerably depending on the state in which the pharmacist practices. In long-term care, pharmacists face an entirely different set of challenges than pharmacists who practice in other settings: Increasingly, long-term care residents and their attending physicians are asking to use medical marijuana. This manuscript discusses how some long-term care facilities are accommodating this substance that federally and in many states is considered illegal. It also discusses some of the challenges faced by pharmacists who work in dispensaries.

Topics: Cannabis; Dronabinol; Humans; Medical Marijuana; Nausea; Pharmacists; United States; Vomiting

Topics: Biomedical Research; Cannabinoids; Cannabis; Chronic Pain; Humans; Marijuana Use; Medical Marijuana; Muscular Dystrophies; Nausea; United States; Vomiting

Cannabinoid hyperemesis syndrome (CHS), a variant of cyclic vomiting syndrome, is an enigmatic and challenging clinical disorder. As cannabis legalization, use, and potency has increased worldwide over the past decade, so has the prevalence of CHS. These patients often require acute care and inpatient treatment for refractory emesis, electrolyte derangement, dehydration, acute renal failure, and injury to the upper gastrointestinal tract. Routinely-prescribed antiemetics are frequently associated with treatment failure in CHS, necessitating use of sedating agents such as benzodiazepines and antipsychotics. Hydrotherapy with hot water provides short-term symptomatic relief from acute episodes of CHS. The reasons for this may be from chronic and/or excessive cannabis use leading to abnormal stimulation of the hypothalamic-pituitary-adrenal axis (HPA) and sympathetic nervous system (SNS) in CHS patients. Overuse of cannabis may also lead to dysfunction of the endocannabinoid system, which is essential for allostasis of the autonomic nervous system after stress.

Topics: Acute Disease; Antiemetics; Cannabinoids; Cannabis; Gastrointestinal Tract; Humans; Hypothalamo-Hypophyseal System; Marijuana Abuse; Marijuana Smoking; Models, Theoretical; Nausea; Pituitary-Adrenal System; Sympathetic Nervous System; Syndrome; Vomiting

Topics: Adult; Cannabinoids; Cannabis; Colorado; Emergency Service, Hospital; Humans; Infant; Male; Poison Control Centers; Vomiting; Young Adult

Topics: Cannabinoids; Cannabis; Capsaicin; Humans; Syndrome; Vomiting

Topics: Cannabinoids; Cannabis; Capsaicin; Humans; Syndrome; Vomiting

The antiemetic properties of marijuana are well known, but there is increasing evidence of its paradoxical hyperemetic effects on the gastrointestinal tract and central nervous system, known as 'cannabinoid hyperemesis syndrome' (CHS). We report a case of CHS encountered in our outpatient clinic. We also completed a review of the literature using PubMed in patients over 18 years of age with CHS. Understanding the diagnostic criteria and risk factors associated with CHS may reduce the ordering of unnecessary and expensive investigations, and pursuing inappropriate medical and surgical treatments. Ultimately, abstaining from cannabis use leads to resolution of symptoms in the majority of patients.

Topics: Adult; Antiemetics; Cannabis; Diagnosis, Differential; Humans; Male; Marijuana Abuse; Nausea; Syndrome; Vomiting

Topics: Adolescent; Adult; Cannabinoids; Cannabis; Child; Colorado; Emergency Service, Hospital; Humans; Legislation, Drug; Marijuana Smoking; Medical Marijuana; Syndrome; Vomiting; Young Adult

Chronic cannabis users may experience cyclical episodes of nausea and vomiting and learned behavior of hot bathing. This clinical condition, known as cannabis hyperemesis syndrome, was first reported in 2004.. Our aim was to promote early recognition of this syndrome in emergency departments (EDs) and to increase referral to addiction specialists.. Cannabis abusers were admitted to the ED for vomiting or abdominal pain from June 1, 2014 to January 1, 2015 and diagnosed with cannabis hyperemesis syndrome by a specialized addiction team. Then, medical records were examined retrospectively.. Seven young adults were included. Their mean age was 24.7 years (range 17-39 years) and the majority were men (male-to-female ratio 1.2). Biological and toxicological blood samples were taken in all patients. Tetrahydrocannabinol blood level was measured in 4 patients, with a mean blood concentration of 11.6 ng/mL. Radiographic examination including abdominal computed tomography and brain imaging were negative, as was upper endoscopy. Five patients compulsively took hot baths in an attempt to decrease the symptoms. Treatment was symptomatic. Five patients have started follow-up with the specialized addiction team.. Cannabis hyperemesis syndrome is still under-diagnosed 10 years after it was first described. Physicians should be aware of this syndrome to avoid repeated hospitalizations or esophageal complications. Greater awareness should lead to prompt treatment and prevention of future recurrence through cannabis cessation. Addiction specialists, as well as medical toxicologists, are experts in the management of cannabis abusers and can help re-establish the role of medical care in this population in collaboration with emergency physicians.

Topics: Abdominal Pain; Adolescent; Adult; Cannabis; Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Male; Marijuana Abuse; Patient Care Team; Pilot Projects; Referral and Consultation; Substance-Related Disorders; Vomiting

Medicinal cannabis is an invaluable adjunct therapy for pain relief, nausea, anorexia, and mood modification in cancer patients and is available as cookies or cakes, as sublingual drops, as a vaporized mist, or for smoking. However, as with every herb, various microorganisms are carried on its leaves and flowers which when inhaled could expose the user, in particular immunocompromised patients, to the risk of opportunistic lung infections, primarily from inhaled molds. The objective of this study was to identify the safest way of using medicinal cannabis in immunosuppressed patients by finding the optimal method of sterilization with minimal loss of activity of cannabis. We describe the results of culturing the cannabis herb, three methods of sterilization, and the measured loss of a main cannabinoid compound activity. Systematic sterilization of medicinal cannabis can eliminate the risk of fatal opportunistic infections associated with cannabis among patients at risk.

Topics: Administration, Inhalation; Adult; Antineoplastic Agents; Aspergillosis; Aspergillus; Burkitt Lymphoma; Cannabis; Humans; Immunocompromised Host; Male; Medical Marijuana; Nausea; Opportunistic Infections; Pain Management; Phytotherapy; Sterilization; Vomiting; Young Adult

Topics: Acute Kidney Injury; Adult; Cannabis; Female; Fluid Therapy; Humans; Syndrome; Vomiting

Cannabis is the most widely used illicit drug in the United States, with lifetime prevalence of use estimated at 42% to 46%. The antiemetic properties of cannabis are well-known by the medical community and the general public; however, less well-recognized is the paradoxical potential for certain chronic users to develop hyperemesis. We describe in this case a patient with prior extensive work-up for nausea and vomiting and previous diagnosis of cyclic vomiting syndrome who presented with characteristic features of cannabinoid hyperemesis syndrome. We review the current literature for this condition and highlight potential mechanisms for its pathogenesis.

Topics: Adult; Cannabinoids; Cannabis; Humans; Male; Marijuana Abuse; Nausea; Syndrome; Vomiting

Cannabis is one of the most commonly used recreational drugs worldwide. Psychoactive properties of the principal compound, δ-9-tetrahydrocannabinol include euphoria, a sense of relaxation and increased appetite. Chronic cannabis use has been associated with the development of a withdrawal syndrome on abrupt discontinuation. Withdrawal symptoms typically begin within 24 h of abstinence and manifest as irritability, nervousness, sleep disturbances and decreased appetite. There is growing evidence that supports the use of plant-derived and synthetic cannabinoids for the treatment of cannabis withdrawal. In this case report, we present 20-year-old woman who developed protracted nausea and vomiting secondary to cannabis withdrawal and was successfully treated with nabilone. Nausea and vomiting is not listed in the Diagnostic and Statistical Manual-5 diagnostic criteria for cannabis withdrawal syndrome and is an uncommon symptom presentation.

Topics: Cannabinoids; Cannabis; Diagnosis, Differential; Dronabinol; Female; Humans; Nausea; Substance Withdrawal Syndrome; Vomiting; Young Adult

Topics: Anorexia; Cannabinoids; Cannabis; Chronic Pain; Humans; Muscle Spasticity; Nausea; Vomiting

Topics: Anorexia; Cannabinoids; Cannabis; Chronic Pain; Humans; Muscle Spasticity; Nausea; Vomiting

Topics: Anorexia; Cannabinoids; Cannabis; Chronic Pain; Humans; Muscle Spasticity; Nausea; Vomiting

To evaluate the hypothesis that activation of somatodendritic 5-HT(1A) autoreceptors in the dorsal raphe nucleus (DRN) produces the anti-emetic/anti-nausea effects of cannabidiol (CBD), a primary non-psychoactive cannabinoid found in cannabis.. The potential of systemic and intra-DRN administration of 5-HT(1A) receptor antagonists, WAY100135 or WAY100635, to prevent the anti-emetic effect of CBD in shrews (Suncus murinus) and the anti-nausea-like effects of CBD (conditioned gaping) in rats were evaluated. Also, the ability of intra-DRN administration of CBD to produce anti-nausea-like effects (and reversal by systemic WAY100635) was assessed. In vitro studies evaluated the potential of CBD to directly target 5-HT(1A) receptors and to modify the ability of the 5-HT(1A) agonist, 8-OH-DPAT, to stimulate [(35) S]GTPγS binding in rat brainstem membranes.. CBD suppressed nicotine-, lithium chloride (LiCl)- and cisplatin (20 mg·kg(-1) , but not 40 mg·kg(-1) )-induced vomiting in the S. murinus and LiCl-induced conditioned gaping in rats. Anti-emetic and anti-nausea-like effects of CBD were suppressed by WAY100135 and the latter by WAY100635. When administered to the DRN: (i) WAY100635 reversed anti-nausea-like effects of systemic CBD, and (ii) CBD suppressed nausea-like effects, an effect that was reversed by systemic WAY100635. CBD also displayed significant potency (in a bell-shaped dose-response curve) at enhancing the ability of 8-OH-DPAT to stimulate [(35) S]GTPγS binding to rat brainstem membranes in vitro. Systemically administered CBD and 8-OH-DPAT synergistically suppressed LiCl-induced conditioned gaping.. These results suggest that CBD produced its anti-emetic/anti-nausea effects by indirect activation of the somatodendritic 5-HT(1A) autoreceptors in the DRN.. This article is part of a themed section on Cannabinoids in Biology and Medicine. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2012.165.issue-8. To view Part I of Cannabinoids in Biology and Medicine visit http://dx.doi.org/10.1111/bph.2011.163.issue-7.

Topics: 8-Hydroxy-2-(di-n-propylamino)tetralin; Animals; Antiemetics; Behavior, Animal; Cannabidiol; Cannabis; Female; Male; Nausea; Piperazines; Pyridines; Raphe Nuclei; Rats; Rats, Sprague-Dawley; Receptor, Serotonin, 5-HT1A; Serotonin 5-HT1 Receptor Agonists; Serotonin 5-HT1 Receptor Antagonists; Shrews; Vomiting

Topics: Cannabinoids; Cannabis; Female; Health Services Accessibility; Humans; Legislation, Drug; Male; Marijuana Abuse; Marijuana Smoking; Plant Preparations; Vomiting

The Cannabis Hyperemesis Syndrome (CHS) defines a recently described paradoxical association between recurrent vomiting episodes, daily cannabis excess and symptomatic relief with a hot bath or shower. Importantly, symptom resolution only occurs with cessation of cannabis use. We describe a case of CHS which had resulted in repeated hospital admissions. As cannabis use is common, it is important for both patients and Acute Physicians to be aware of this increasingly recognised condition.

Topics: Cannabis; Emergency Service, Hospital; Hot Temperature; Humans; Hydrotherapy; Male; Marijuana Abuse; Nausea; Syndrome; Treatment Outcome; Vomiting; Young Adult

Recently, reports have suggested that chronic cannabis abuse can result in cyclical vomiting, or cannabinoid hyperemesis syndrome. With the increasing prevalence of cannabis use in the United States, this syndrome may be encountered in the emergency department. The authors describe a case of a 30-year-old man who presented to the emergency department with diffuse abdominal pain, nausea, and intractable vomiting. He reported symptomatic relief with prolonged hot showers. Results of a urine drug screen were positive for cannabis, and the patient admitted to chronic cannabis use for years. Results of the drug screen, combined with the patient's symptomatic relief with hot showers, led to the diagnosis of cannabinoid hyperemesis syndrome. The patient was admitted to the hospital and underwent pharmaceutical treatment. However, hot showers continued to be the mainstay of the patient's symptomatic relief. Four days after presentation, the patient's symptoms resolved and he was discharged from the hospital.

Topics: Adult; Cannabis; Humans; Male; Nausea; Syndrome; Vomiting

Cyclic vomiting syndrome (CVS) in adults is a disorder characterized by recurrent and stereotypic episodes of severe nausea, vomiting and abdominal pain separated by symptom-free intervals. Both rapid and delayed gastric emptying (GE) have been observed but the reports involved small numbers of CVS patients.. We performed a retrospective study of 92 adult patients who met Rome Ш diagnostic criteria for CVS between 2003 and 2009 at the Kansas University Medical Center. Gastric emptying was measured by a standardized scintigraphic method involving a low fat (2%) isotope labeled egg white meal of 250 Kcal, with anterior and posterior gastric imaging in the standing position obtained at 0, 1, 2, 4 h after meal ingestion. Rapid GE was defined as <50% isotope retention at 1st h and/or <30% at 2nd h and delayed GE as >10% at 4 h.. Ninety two patients were analyzed: 47 males and 45 females mean of age 37 ± 12 years (range: 20-68 years). There were 27 patients with a personal history of migraine headache, 30 with history of marijuana use, 12 had diabetes mellitus (DM) and 10 had irritable bowel syndrome (IBS) as an accompanying diagnosis. Fifty four patients (59%) met criteria for rapid GE, 25 (27%) had normal GE and 13 (14%) had slow GE. Eighty percent of patients with co-existing IBS symptoms were identified as rapid. The subset with delayed emptying was often associated with narcotics use, DM and marijuana use (P < 0.05).. (i) In adult CVS patients, GE is generally either rapid or normal. (ii) Cyclic vomiting syndrome is an important new etiology to explain the finding of rapid GE on a radionuclide test. (iii) The small subset of CVS patients (14%) whose GE was slow were explained by the role of narcotics and/or marijuana.

Topics: Adult; Animals; Cannabis; Female; Gastric Emptying; Humans; Male; Middle Aged; Narcotics; Retrospective Studies; Vomiting; Young Adult

Cannabinoid hyperemesis has recently been described in the literature. It is a syndrome characterized by severe nausea and hyperemesis in the setting of chronic marijuana abuse and, to date, has been described only in adults. We describe the syndrome in 2 pediatric patients, for whom extensive gastrointestinal workups failed to identify a clear cause and cessation of marijuana use resulted in the alleviation of their symptoms. As in most published adult cases, compulsive bathing was present in both of these cases.

Topics: Adolescent; Anti-Asthmatic Agents; Antidepressive Agents; Asthma; Attention Deficit Disorder with Hyperactivity; Baths; Cannabis; Comorbidity; Depressive Disorder; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Nausea; Receptor, Cannabinoid, CB1; Tobacco Use Disorder; Vomiting

The majority of North American pregnant women experience some degree of nausea and vomiting, usually in the first few months of pregnancy. Women utilize many coping strategies, including self-treatment with herbal medicine and other alternative therapies. In a qualitative study of self-care in pregnancy, birth and lactation within a non-random sample of 27 women in British Columbia, Canada, 20 women (74%) experienced pregnancy-induced nausea. Ten of these women used anti-emetic herbal remedies, which included ginger, peppermint, and Cannabis. The safety and efficacy of each of these herbal remedies is discussed here. Only ginger has been subjected to clinical trials among pregnant women, though all three herbs were clinically effective against nausea and vomiting in other contexts, such as chemotherapy-induced nausea and post-operative nausea. While safety concerns exist in the literature for all three herbs with regards to their use by pregnant women, clinical evidence of harm is lacking.

Topics: Antiemetics; British Columbia; Cannabis; Female; Health Care Surveys; Health Knowledge, Attitudes, Practice; Humans; Interviews as Topic; Mentha piperita; Nausea; Patient Participation; Phytotherapy; Plant Preparations; Pregnancy; Pregnancy Complications; Self Care; Vomiting; Zingiber officinale

Topics: Cannabis; Complementary Therapies; Europe; HIV Infections; HIV Wasting Syndrome; Humans; Nausea; Pain Management; Phytotherapy; United States; Vomiting

The use of smoked marijuana as a therapeutic agent is presently a matter of considerable debate in the United States. Many people suffering from a variety of disorders maintain that it is necessary for their adequate treatment. Yet, the evidence to support claims is insufficient for FDA approval. An interim solution is proposed which would allow patients referred by their physicians to participate in a 6-month program of legal marijuana availability, similar to the 'compassionate IND' program of a number of years ago. A technique similar to that used for post-marketing surveillance is proposed for obtaining quantitative data for a limited number of potential indications. These are: (1) nausea and vomiting associated with cancer chemotherapy or other causes, (2) weight loss associated with debilitating illnesses, (3) spasticity secondary to neurological diseases, and (4) chronic pain syndromes.

Topics: Cannabis; Drug Approval; HIV Wasting Syndrome; Humans; Marijuana Smoking; Muscle Spasticity; Nausea; Pain; Phytotherapy; Referral and Consultation; United States; United States Food and Drug Administration; Vomiting

Marijuana has been used for recreational, ceremonial, and medicinal purposes for thousands of years. Because marijuana is classified as an illegal drug and, little research has been done on its potential medical benefits. In May 1999, it became legal for the National Institute on Drug Abuse (NIDA), the only legal source for marijuana, to sell marijuana to privately funded researchers. This move may make research on marijuana more feasible. Many people believe marijuana is effective in treating pain, AIDS wasting syndrome (AWS), and nausea and vomiting, among other ailments. However, even doctors who recommend marijuana use do not advise smoking it. Other ways of taking marijuana, as well as possible side effects of marijuana use, are discussed.

Topics: Cannabis; HIV Wasting Syndrome; Humans; Nausea; Pain, Intractable; Vomiting

Topics: Antiemetics; Cannabis; Clinical Trials as Topic; Dronabinol; Health Surveys; Humans; Marijuana Smoking; Medical Oncology; Nausea; Phytotherapy; Practice Patterns, Physicians'; Research; Vomiting

Topics: Acquired Immunodeficiency Syndrome; Antineoplastic Agents; Cannabis; Dronabinol; Humans; Nausea; Neoplasms; Phytotherapy; Vomiting

Topics: Animals; Cannabis; Dronabinol; Female; Fetal Growth Retardation; Humans; Nausea; Pain; Pregnancy; Schizophrenia; Vomiting

Topics: Antineoplastic Agents; Cannabinoids; Cannabis; Dronabinol; Humans; Marijuana Smoking; Vomiting

A random-sample, anonymous survey of the members of the American Society of Clinical Oncology (ASCO) was conducted in spring 1990 measuring the attitudes and experiences of American oncologists concerning the antiemetic use of marijuana in cancer chemotherapy patients. The survey was mailed to about one third (N = 2,430) of all United States-based ASCO members and yielded a response rate of 43% (1,035). More than 44% of the respondents report recommending the (illegal) use of marijuana for the control of emesis to at least one cancer chemotherapy patient. Almost one half (48%) would prescribe marijuana to some of their patients if it were legal. As a group, respondents considered smoked marijuana to be somewhat more effective than the legally available oral synthetic dronabinol ([THC] Marinol; Unimed, Somerville, NJ) and roughly as safe. Of the respondents who expressed an opinion, a majority (54%) thought marijuana should be available by prescription. These results bear on the question of whether marijuana has a "currently accepted medical use," at issue in an ongoing administrative and legal dispute concerning whether marijuana in smoked form should be available by prescription along with synthetic THC in oral form. This survey demonstrates that oncologists' experience with the medical use of marijuana is more extensive, and their opinions of it are more favorable, than the regulatory authorities appear to have believed.

Topics: Antiemetics; Antineoplastic Agents; Attitude of Health Personnel; Cannabis; Humans; Medical Oncology; Nausea; Neoplasms; Random Allocation; Surveys and Questionnaires; United States; Vomiting

This article summarizes current knowledge about the medicinal value of cannabis and its principal psychoactive ingredient, delta 9-tetrahydrocannabinol (THC), particularly in the control of nausea and vomiting, in glaucoma, and in reduction of spasticity in multiple sclerosis. The major issues in the controversy about marijuana and medicine, primarily moral and ethical, are discussed.

Topics: Antineoplastic Agents; Anxiety; Bronchial Spasm; Cannabis; Dronabinol; Glaucoma; Humans; Muscle Spasticity; Nausea; Pain; Sleep Initiation and Maintenance Disorders; Vomiting

Topics: Adult; Aged; Antiemetics; Antineoplastic Agents; Cannabis; Humans; Illicit Drugs; Middle Aged; Nausea; Nursing Staff, Hospital; United States; Vomiting

Topics: Amphetamines; Behavior; Cannabis; Drug Therapy; Epilepsy; Heroin; Humans; Illicit Drugs; Lysergic Acid Diethylamide; Mental Disorders; Nausea; Obesity; Pain; Vomiting

Topics: Antineoplastic Agents; Cannabinoids; Cannabis; Dronabinol; Humans; Nausea; Neoplasms; Vomiting

Topics: Asthma; Cannabinoids; Cannabis; Depression; Dronabinol; Drug Stability; Epilepsy; Glaucoma; Humans; Pain; Vomiting

Topics: Adult; Bone Neoplasms; Cannabis; Dronabinol; Female; Humans; Hyperalgesia; Hyperesthesia; Leukemia, Myeloid, Acute; Male; Pain; Phytotherapy; Vomiting

Topics: Adolescent; Adult; Affective Symptoms; Behavior; Cannabis; Female; Germany, West; Humans; Male; Personality; Sexual Behavior; Substance-Related Disorders; Vomiting

Topics: Adult; Cannabis; Diarrhea; Humans; Injections, Intravenous; Male; Vomiting