A palliative care patient developed cannabinoid hyperemesis syndrome from prescribed nabilone | Research

The takeaway

A 70-year-old cancer patient on long-term nabilone developed refractory nausea and vomiting that resolved only after stopping the drug, highlighting CHS risk even with prescribed synthetic cannabinoids.

Palliative care clinicians, oncologists prescribing cannabinoids, and patients using long-term nabilone.

5 years of nabilone use before CHS symptoms emerged

What the researchers found

A 70-year-old palliative care patient with small-cell lung cancer who had used nabilone for 5 years developed refractory nausea and vomiting consistent with cannabinoid hyperemesis syndrome. Symptoms resolved after nabilone cessation.

Why it matters

This case demonstrates that CHS can occur with prescribed synthetic cannabinoids (not just recreational cannabis), a recognition gap that may lead clinicians to increase the very drug causing symptoms.

The numbers in context

Patient used nabilone for 5 years. Dose increased from 0.5 to 2 mg. Nabilone discontinued after 7 weeks of refractory symptoms. Hot baths provided temporary relief. Pain was successfully managed with opioids and adjuvants after nabilone cessation.

How the study worked

Single case report of a palliative care patient. Nabilone dose had been incrementally increased from 0.5 to 2 mg over the disease course. CHS was suspected when increasing nabilone worsened rather than alleviated nausea and vomiting.

What this study cannot tell us

Single case report, so the findings cannot be generalized. The diagnosis was clinical, without a definitive biomarker for CHS.

How to read the evidence

Preliminary: single case report with no controlled comparison.

When this study was published

Published in 2022.

The bigger picture

As synthetic cannabinoids are increasingly prescribed in oncology and palliative care, awareness that they can cause the same hyperemesis syndrome as recreational cannabis is critical for avoiding a harmful cycle of dose escalation.

Questions still open

How common is CHS in patients on prescribed synthetic cannabinoids? Is there a dose or duration threshold that predicts CHS onset? Should nabilone prescribing guidelines include CHS monitoring?

Common questions

What is nabilone?

Nabilone is a synthetic cannabinoid prescribed for nausea, vomiting, and pain. It mimics THC but is a pharmaceutical product, not derived from the cannabis plant.

How was CHS recognized in this case?

The patient's nausea and vomiting worsened as the nabilone dose was increased, and hot baths provided temporary relief, both classic signs of CHS. Symptoms resolved completely after stopping nabilone.

Can CHS happen with any cannabinoid product?

This case suggests yes. CHS has been reported with recreational cannabis, medical cannabis, and now prescribed synthetic cannabinoids like nabilone.

Read the original research

A Case Report on Cannabinoid Hyperemesis Syndrome in Palliative Care: How Good Intentions Can Go Wrong.

Oncology research and treatment, 45(7-8), 438-443

View on PubMed ↗Publisher’s paper ↗

Citation

Senderovich, Helen; Waicus, Sarah. (2022). A Case Report on Cannabinoid Hyperemesis Syndrome in Palliative Care: How Good Intentions Can Go Wrong.. Oncology research and treatment, 45(7-8), 438-443. https://doi.org/10.1159/000524746