Discussion

Cannabinoid hyperemesis syndrome was first described in 2004 ¹ and diagnostic criteria were suggested in 2012 ². This condition affects chronic cannabis users and is characterized by cyclical episodes of incoercible vomiting and compulsive bathing in and/or showering with hot water that last for two to four days. Vomiting is usually refractory to usual antiemetics and improves with cannabis discontinuation. The etiology and pathophysiology remain unclear, but cannabis seems to affect gastrointestinal motility. This was recently supported by a study published in this journal on chronic cannabis use and its potential association with intestinal invagination ³. As pointed out in a recent review ⁴, once the condition has been recognized, hot water bathing and/or showering is a key factor for establishing a diagnosis. Given the high prevalence of cannabis use, this is likely an underdiagnosed condition at present. While management only requires cannabis discontinuation, this is not achieved for most patients due to the deleterious effects of cannabis on decision making ⁵, which usually leads to a chronic condition.