Chronic Cannabis Use with Hyperemesis, Epigastric Pain and Conditioned Showering Behavior

Abstract

This report promotes awareness to an emerging cannabisinduced syndrome that is beguiling to primary care doctors and gastroenterologist specialists and a major expense on the healthcare system. It is also a diagnosis of exclusion. Four different young adults presented with recurrent admissions complaining of intractable nausea, vomiting, and epigastric pain with an incidental finding of excessive showering. They were all chronic heavy marijuana smokers. After extensive negative work up and observation of symptomatic cessation upon the discontinuation of marijuana, a diagnosis of exclusion was determined. Under the extrapolation of different animal model studies and basic science research, a hypothetical mechanism may explain why these patients present with these characteristic symptoms. The manifestation of chronic Δ9-tetrahydrocannabinol (Δ9-THC) may not show until after a long time and is reproducible when exposure to Δ9-THC supersaturates the cannabinoid receptor-1 (CB-1). Chronic Δ9-THC exposure appears to desensitize the gabanergic effects of CB-1 which is known to cause intestinal hypomotility, analgesia, and hypothermia. Extensive gastrointestinal workup is usually non-yielding and may impose financial burden on the healthcare system.