Chili Peppers Photo

Let’s begin by defining the terms we are using:


1.    Capsaicin is the element in spicy chili peppers that gives them their heat. Capsaicin binds to the TRPV1 pain receptors on our nerves, and can reduce painful transmission. Ultimately, it helps in controlling peripheral nerve pain.


2.    Cannabis Hyperemesis Syndrome is a condition in which THC rich cannabis is used in such excess that abdominal discomfort, nausea and vomiting, or “emesis” develops. The patient soon learns that using more THC lessens the vomiting, as do hot baths and showers. Consulting with a gastroenterologist and undergoing tests and full evaluations often produces little to no results in diagnosis, as nobody is considering that the cannabis itself may be the cause.


3.    TRPV1 Receptors are receptors on certain nerves to which Capsaicin binds, causing a change in the activation of the nerve, often leading to a decrease in peripheral nerve pain and inflammation.


Cannabis Hyperemesis Syndrome has been described for several years as a consequence of down-regulating, or suppression of, the CB-1 (Cannabinoid-1) receptor. When this receptor is suppressed because of excessive THC use, the patient requires even larger THC doses to prevent abdominal discomfort, nausea and vomiting. Additionally, patients often find hot showers or baths relieve their GI discomfort very quickly.


Where additional THC can ease acute symptoms momentarily, we have found that patients who continue to increase their THC intake over time experience a worsening of their syndrome and GI complaints.


I have seen approximately five patients with Cannabis Hyperemesis. I have found treatment to be very difficult. Gaining the patients’ cooperation in discontinuing THC has rarely been successful. I have recommended tapering their THC, as well as adding CBD, without much, if any, benefit.


I’ve recently come across several articles suggesting that rubbing 0.075% Capsaicin on a patient’s lower abdomen resulted in markedly decreased gastrointestinal symptoms. These patients were treated in an Emergency Room setting, so unfortunately, no follow up was given.


There is one point that bears emphasizing. There are a number of patients who are extremely THC sensitive, and they develop nausea and vomiting from very modest amounts of THC. This is simple THC toxicity and is clearly made much worse with more THC, so overuse is not a risk. 


To put it simply, if THC makes the nausea and vomiting worse, it is THC toxicity. If THC makes the nausea better, it is likely Cannabis Hyperemesis Syndrome.

Allan Frankel, MD

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