Abstract
Cyclic vomiting syndrome (CVS) is a chronic disorder characterized by episodic nausea and vomiting. A large proportion of patients use marijuana to control their symptoms. Several case reports implicate marijuana as a cause of intractable vomiting with compulsive hot water bathing considered pathognomonic of “cannabinoid hyperemesis.” We sought to examine the relationship between marijuana use and CVS. Patients >18 years of age diagnosed by a health care provider were invited to participate in an anonymous internet-based survey. A total of 514 patients participated and 437 completed questions about marijuana use. Mean age was 34 ± 12 years with patients being predominantly female (63 %), Caucasian (92 %) and from the USA (82 %). Nineteen percent never used marijuana and 81 % did. Fifty-four percent used marijuana for health issues and 43 % for recreational purposes. Users stated that it improved nausea, appetite, general well-being, stress levels and vomiting. Users were more likely to be male and have an associated anxiety disorder. Sixty-seven percent of patients reported taking hot showers/baths for symptom relief, and this was associated with marijuana use. (OR 2.54, CI 1.50–4.31, P = 0.0006). Eighty-one percent of patients with CVS who completed an internet survey reported frequent use of marijuana. With marijuana use, patients noted the greatest improvement with stress levels, appetite and nausea. Marijuana users were more likely to be male and have associated anxiety. Hot showers were not pathognomonic of marijuana use though they were more likely to be associated with its use.
Similar content being viewed by others
References
Abell TL, Adams KA, Boles RG, Bousvaros A, Chong SK, Fleisher DR, Hasler WL, Hyman PE, Issenman RM, Li BU, Linder SL, Mayer EA, McCallum RW, Olden K, Parkman HP, Rudolph CD, Tache Y, Tarbell S, Vakil N (2008) Cyclic vomiting syndrome in adults. Neurogastroenterol Motil 20:269–284
Bergman J, Delatte MS, Paronis CA, Vemuri K, Thakur GA, Makriyannis A (2008) Some effects of CB1 antagonists with inverse agonist and neutral biochemical properties. Physiol Behav 93:666–670
Bjarnason T, Adalbjarnardottir S (2000) Anonymity and confidentiality in school surveys on alcohol, tobacco, and cannabis use. J Drug Issues 30:335–344
Boles RG, Zaki EA, Lavenbarg T, Hejazi R, Foran P, Freeborn J, Trilokekar S, McCallum R (2009) Are pediatric and adult-onset cyclic vomiting syndrome (CVS) biologically different conditions? Relationship of adult-onset CVS with the migraine and pediatric CVS-associated common mtDNA polymorphisms 16519T and 3010A. Neurogastroenterol Motil 21:e936–e972
Chepyala P, Olden KW (2008) Cyclic vomiting and compulsive bathing with chronic cannabis abuse. Clin Gastroenterol Hepatol 6:710–712
Cheung JT, Mann RE, Lalomiteanu A, Stoduto G, Chan V, AlaLeppilampi K, Rehn J (2010) Anxiety and mood disorders and cannabis use. Am J Drug Alcohol Abuse 36(2):118–122. doi:10.3109/00952991003713784
Chiang KP, Gerber AL, Sipe JC, Cravatt BF (2004) Reduced cellular expression and activity of the P129T mutant of human fatty acid amide hydrolase: evidence for a link between defects in the endocannabinoid system and problem drug use. Hum Mol Genet 13:2113–2119
Chouker A, Kaufmann I, Kreth S, Hauer D, Feuerecker M, Thieme D, Vogeser M, Thiel M, Schelling G (2010) Motion sickness, stress and the endocannabinoid system. PLoS ONE 5:e10752
Choung RS, Locke GR 3rd, Lee RM, Schleck CD, Zinsmeister AR, Talley NJ (2012) Cyclic vomiting syndrome and functional vomiting in adults: association with cannabinoid use in males. Neurogastroenterol Motil 24(20–26):e21
Di Marzo V, Fontana A (1995) Anandamide, an endogenous cannabinomimetic eicosanoid: ‘killing tow birds with one stone’. Prostaglandins Leukot Essent Fatty Acids 53(1):1–11
D’Souza DC, Perry E, MacDougall L, Ammerman Y, Cooper T, Wu YT, Braley G, Gueorguieva R, Krystal JH (2004) The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology. 29(8):1558–1572
Durant LE, Carey MP, Schroder KE (2002) Effects of anonymity, gender, and erotophilia on the quality of data obtained from self-reports of socially sensitive behaviors. J Behav Med 25:438–467
Fleisher DR, Matar M (1993) The cyclic vomiting syndrome: a report of 71 cases and literature review. J Pediatr Gastroenterol Nutr 17:361–369
Galli JA, Sawaya RA, Friedenberg FK (2011) Cannabinoid hyperemesis syndrome. Curr Drug Abuse Rev 4:241–249
Gee S (1882) On fitful or recurrent vomiting. Saint Bartholomew’s Hospital Reports, pp 1–6
Haller J, Barna I, Barsvari B, Gyimesi Pelczer K, Yasar S, Panlilio LV, Goldberg S (2009) Interactions between environmental aversiveness and the anxiolytic effects of enhanced cannabinoid signaling by FAAH inhibition in rats. Psychopharmacology 204(4):607–616. doi:10.1007/s00213-009-1494-7
Hejazi RA, McCallum RW (2011) Review article: cyclic vomiting syndrome in adults–rediscovering and redefining an old entity. Aliment Pharmacol Ther 34:263–273
Hejazi RA, Lavenbarg TH, Foran P, McCallum RW (2010) Who are the nonresponders to standard treatment with tricyclic antidepressant agents for cyclic vomiting syndrome in adults? Aliment Pharmacol Ther 31:295–301
Hill MN, McLaughlin RJ, Morrish AC, Viau V, Floresco SB, Hillard CJ, Gorzalka BB (2009) Suppression of amygdalar endocannabinoid signaling by stress contributes to activation of the hypothalamic-pituitary-adrenal axis. Neuropsychopharmacology 34(13):2733–2745. doi:10.1038/npp.2009.114
Kirkham TC (2005) Endocannabinoids in the regulation of appetite and body weight. Behav Pharmacol 16:297–313
Kumar N, Bashar Q, Reddy N, Sengupta J, Ananthakrishnan A, Schroeder A, Hogan WJ, Venkatesan T (2012) Cyclic Vomiting Syndrome (CVS): is there a difference based on onset of symptoms—pediatric versus adult? BMC Gastroenterol 12:52
Loga S, Loga-Zec S, Spremo M (2010) Cannabis and psychiatric disorders. Psychiatr Danub 22:296–297
Mechoulam R (2005) Plant cannabinoids: a neglected pharmacological treasure trove. Br J Pharmacol 146:913–915
Namin F, Patel J, Lin Z, Sarosiek I, Foran P, Esmaeili P, McCallum R (2007) Clinical, psychiatric and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy. Neurogastroenterol Motil 19:196–202
Parker LA, Rock EM, Limebeer CL (2011) Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol 163:1411–1422
Pujazon-Zazik M, Park MJ (2009) Marijuana: use among young males and health outcomes. Am J Men’s Health. 3:265–274
Thaler A, Gupta A (2011) Cohen SP Cannabinoids for pain management. Adv Psychosom Med 30:125–138
Tyndale RF, Payne JI, Gerber AL, Sipe JC (2007) The fatty acid amide hydrolase C385A (P129T) missense variant in cannabis users: studies of drug use and dependence in Caucasians. Am J Med Genet B Neuropsychiatr Genet 144B:660–666
Van Ours JC, Williams J, Fergusson D, Horwood LJ (2013) Cannabis use and suicidal ideation. J Health Econ 32:524–537
Van Sickle M, Oland L, Ho W, Hillard C, Mackie K, Davison J, Sharkey K (2001) Cannabinoids inhibit emesis through CB1 receptors in the brainstem of the ferret. Gastroenterology 121:767–774
Venkatesan T, Tarbell S, Adams K, McKanry J, Barribeau T, Beckmann K, Hogan WJ, Kumar N, Li BU (2010) A survey of emergency department use in patients with cyclic vomiting syndrome. BMC Emerg Med 10:4
Wade DT, Robson P, House H, Makela P, Aram J (2003) A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil. 17(1):21–29
Wallace EA, Andrews SE, Garmany CL, Jelley MJ (2011) Cannabinoid hyperemesis syndrome: literature review and proposed diagnosis and treatment algorithm. South Med J 104:659–664
Acknowledgments
Statistical analysis was supported, IN PART, by grant 1UL1RR031973 from the Clinical and Translational Science Award (CTSI) program of the National Center for Research Resources, National Institutes of Health. We would also like to gratefully acknowledge the Cyclic Vomiting Association for use of its website and input with survey design. There is no financial support for this research study.
Conflict of interest
None of the authors of the above manuscript has declared any conflict of interest within the last three years which may arise from being named as an author on the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Venkatesan, T., Sengupta, J., Lodhi, A. et al. An Internet survey of marijuana and hot shower use in adults with cyclic vomiting syndrome (CVS). Exp Brain Res 232, 2563–2570 (2014). https://doi.org/10.1007/s00221-014-3967-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00221-014-3967-0