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Cyclic Vomiting and Compulsive Bathing With Chronic Cannabis Abuse

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Cannabis is commonly recognized for its anti-emetric properties. However, chronic cannabis use can lead to paroxysmal vomiting. In some patients this vomiting can take on a pattern identical to cyclic vomiting syndrome. Interestingly cyclic vomiting syndrome has been associated with compulsive bathing which patients report can relieve their intense feelings of nausea and lessen their vomiting intensity. We report a case of a patient with chronic cannabis use who developed symptoms similar to cyclic vomiting syndrome who also engaged in compulsive bathing behavior as observed by members of the medical and nursing staff. The patient reported that frequent hot showers would prevent him from vomiting and also relieve his concomitant abdominal pain. Previous hospitalizations at our hospital for the same complaint also noted similar showering behavior. During the hospital stay, the patient agreed to engage in a outpatient drug rehabilitation program which he subsequently completed. Abstinence from cannabis use caused the patients vomiting symptoms and abdominal pain to disappear completely. Likewise, his compulsive showering behavior also ceased. Other investigators have reported similar findings in patients with cyclic vomiting syndrome who initially used cannabis to treat their vomiting episodes but subsequently found that it contributed to their vomiting. Our patient has lead us to conclude that in patients seen for chronic severe vomiting and abdominal pain which has no obvious structural or chemical etiology and which is accompanied by compulsive showering and/or bathing behavior a diagnosis of cyclic vomiting syndrome with concomitant cannabis abuse needs to be considered.

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Discussion

Cannabis use is common among high school and college students.6, 7 The prevalence of marijuana use in the US population is 4%, and has increased significantly over the past decade among 45- to 64-year-old men and women.1 THC is the major ingredient in marijuana. THC along with endogenous and synthetic cannabinoids exert many biological functions by activating 2 types of cannabinoid receptors: CB(1) and CB(2) receptors.8 CB(1) receptors have been detected on enteric nerves and pharmacologic

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