Cannabinoid Hyperemesis Syndrome from K2 Synthetic Cannabis: A Case Report | Research

The takeaway

A 38-year-old man with a history of cannabis use developed cannabinoid hyperemesis syndrome from K2 (synthetic cannabinoid), highlighting that CHS can occur with synthetic cannabinoids and be missed with standard drug testing.

Read this if you want to understand how cannabinoid hyperemesis syndrome can occur with synthetic cannabinoids.

CHS diagnosis can take up to 9 years; standard drug tests miss synthetic cannabinoids

What the researchers found

A 38-year-old man with a 10-year history of cannabis use and 1-year history of K2 (synthetic cannabinoid) use presented with episodic nausea, vomiting of clear fluids, and epigastric discomfort for one week. His symptoms were relieved only by hot showers, a hallmark of cannabinoid hyperemesis syndrome.

Extensive workup including laboratory tests, imaging, and endoscopy was unrevealing. The diagnosis of CHS was ultimately made based on clinical criteria. The case highlights two important issues: synthetic cannabinoids can cause CHS just like natural cannabis, and conventional urine drug screens do not detect synthetic cannabinoids, leading to potentially expensive and unnecessary workups.

The authors note that CHS diagnosis can take up to 9 years, suggesting widespread underrecognition of this condition.

Why it matters

This case extends the recognition of CHS beyond natural cannabis to synthetic cannabinoids, which are increasingly prevalent. Since K2/Spice is not detected on standard urine drug screens, clinicians need to consider CHS even when drug tests are negative, especially in patients with cyclic vomiting relieved by hot showers.

The numbers in context

Patient age: 38. Cannabis history: 10 years. K2 history: 1 year. Symptom duration: 1 week. Diagnostic delay for CHS: up to 9 years in the literature.

How the study worked

This is a single case report with a review of relevant literature. The patient was evaluated with standard clinical workup. Diagnosis was based on proposed diagnostic criteria for CHS.

What this study cannot tell us

This is a single case report and cannot establish prevalence or risk factors. The patient used both natural cannabis and K2, making it difficult to attribute CHS specifically to the synthetic cannabinoid. The specific K2 product and its active compound were not identified.

How to read the evidence

This is a single case report. It documents CHS from synthetic cannabinoids but cannot establish prevalence or causation.

When this study was published

Published in 2014. CHS from both natural and synthetic cannabinoids is now more widely recognized.

The bigger picture

CHS is increasingly recognized as emergency departments see more cases. This case demonstrates that the syndrome is caused by cannabinoid receptor activation generally, not just by natural cannabis. As synthetic cannabinoids continue to evolve and evade detection, clinicians need a high index of suspicion based on clinical presentation.

Questions still open

Are synthetic cannabinoids more or less likely to cause CHS than natural cannabis? Does the higher receptor efficacy of synthetic cannabinoids affect CHS severity? Would CHS from synthetic cannabinoids respond to the same treatments as CHS from natural cannabis?

Common questions

What is K2/Spice?

K2 and Spice are brand names for synthetic cannabinoid products. They contain laboratory-made chemicals sprayed on plant material and sold as "herbal incense." They are not detected by standard urine drug screens and are often more potent than natural cannabis.

Why does hot water relieve CHS symptoms?

The mechanism is not fully understood, but it may involve activation of TRPV1 receptors (heat-sensing receptors) in the gut and skin that interact with the endocannabinoid system. Hot water may temporarily redirect blood flow or activate competing sensory pathways that reduce nausea.

Read the original research

A Gut Gone to Pot: A Case of Cannabinoid Hyperemesis Syndrome due to K2, a Synthetic Cannabinoid.

Case reports in emergency medicine, 2014, 167098

View on PubMed ↗Publisher’s paper ↗

Citation

Ukaigwe, Anene; Karmacharya, Paras; Donato, Anthony. (2014). A Gut Gone to Pot: A Case of Cannabinoid Hyperemesis Syndrome due to K2, a Synthetic Cannabinoid.. Case reports in emergency medicine, 2014, 167098. https://doi.org/10.1155/2014/167098