Cannabinoid hyperemesis syndrome from delta-8 tetrahydrocannabinol after discontinuing regular cannabis use

Abstract

Cannabis is the most frequently used illicit substance in the United States and its use has only continued to grow as more states legalize or decriminalize its use and an ever-expanding array of cannabinoid products have continued to enter the market. Excessive cannabis use is associated with multiple neuropsychiatric and medical effects. One notable effect of excessive cannabis use is cannabinoid hyperemesis syndrome (CHS), a syndrome of cyclic nausea, vomiting and abdominal pain following prolonged cannabis use. While most existing literature associates CHS with excessive cannabis use, the role of other cannabinoid-related products in the development of CHS is less established. To date, there is only one published case report of CHS developing in a patient exclusively using delta-8 tetrahydrocannabinol (THC). We present the case of a 35-year-old female who was admitted to our hospital for suicidal ideations. During admission, she exhibited classic signs and symptoms of CHS in the setting of a long multiyear history of daily cannabis use. However, she reported that she had discontinued smoking cannabis about 5 months ago after being told about CHS and had been exclusively using delta-8 THC daily with the assumption that this cannabinoid product would not cause the same effect. This case adds to the growing body of evidence to support delta-8 THC being associated with the development of CHS, thus highlighting the importance of educating patients with CHS on complete abstinence from all forms of cannabinoid products including delta-8 THC.