Topical capsaicin for cannabinoid hyperemesis syndrome reduced medication use and opioid requirements in the ER | Research

The takeaway

Topical capsaicin applied to patients with cannabinoid hyperemesis syndrome in the emergency department did not significantly shorten visits but reduced the number of additional medications needed and lowered opioid use.

Emergency physicians treating CHS, patients with cannabinoid hyperemesis seeking non-opioid relief, and hospital pharmacists evaluating CHS treatment protocols.

67% of capsaicin-treated CHS patients needed no further medication

What the researchers found

ED length of stay was reduced by a median of 22 minutes with capsaicin but this was not statistically significant. Capsaicin-treated patients received fewer additional medication doses (3 vs. 4, p=0.015), and 67% required no further treatment. Opioid use was lower in the capsaicin group (69 vs. 166.5 mg oral morphine equivalents). 42% had no repeat ED visit for CHS in the following 3 months.

Why it matters

CHS is notoriously difficult to treat with standard antiemetics. Topical capsaicin is inexpensive, available over-the-counter, and could reduce opioid use in a population that frequently presents to emergency departments.

The numbers in context

43 patients. ED LOS: 179 vs. 201 minutes (not significant, p=0.33). Fewer additional medications: 3 vs. 4 doses (p=0.015). 67% needed no further treatment after capsaicin. Opioid use: 69 vs. 166.5 mg OME. Cost difference: $3.26 more for capsaicin. No significant adverse events.

How the study worked

Retrospective cohort analysis of 43 patients presenting with CHS. Compared ED visits where capsaicin was used versus visits without capsaicin. Outcomes included ED length of stay, rescue medication use, opioid requirements, costs, and adverse events.

What this study cannot tell us

Retrospective design with a small sample. No randomization or blinding. Some patients served as their own controls across visits, but confounders were not fully controlled. The p-value for the primary outcome (LOS) was not significant.

How to read the evidence

Retrospective cohort with a small sample and no randomization. Suggestive findings that need confirmation in controlled trials.

When this study was published

2020 retrospective study. Adds to growing case evidence for topical capsaicin in CHS management.

The bigger picture

An inexpensive OTC treatment that reduces opioid use and additional medications in the ER could change CHS management. The potential for at-home self-treatment with capsaicin cream could also reduce unnecessary ED visits.

Questions still open

Would a randomized controlled trial confirm capsaicin's benefits for CHS? Could at-home capsaicin use prevent ED visits? What is the optimal capsaicin concentration and application site?

Common questions

How does capsaicin help with CHS?

Capsaicin activates TRPV1 receptors, the same receptors involved in the body's temperature regulation system that is disrupted in CHS. This activation may counteract the mechanism causing symptoms.

Can capsaicin be used at home for CHS?

The study authors suggest that capsaicin's availability as an over-the-counter product could empower at-home treatment, potentially reducing unnecessary emergency department visits.

Read the original research

Efficacy and safety of topical capsaicin for cannabinoid hyperemesis syndrome in the emergency department.

Clinical toxicology (Philadelphia, Pa.), 58(6), 471-475

View on PubMed ↗Publisher’s paper ↗

Citation

Wagner, Samantha; Hoppe, Jason; Zuckerman, Matthew; Schwarz, Kerry; McLaughlin, Julie. (2020). Efficacy and safety of topical capsaicin for cannabinoid hyperemesis syndrome in the emergency department.. Clinical toxicology (Philadelphia, Pa.), 58(6), 471-475. https://doi.org/10.1080/15563650.2019.1660783