Managing Abdominal Pain in Marijuana Users

Initial Diagnostic Approach

The American Gastroenterological Association suggests that CHS should be suspected in any chronic cannabis user presenting with cyclic vomiting and abdominal pain 1, 2
Key diagnostic features of CHS include recurrent episodes of nausea, vomiting, and abdominal pain in patients with chronic cannabis use, compulsive hot bathing or showering that provides symptom relief, and resolution of symptoms with cannabis cessation 1, 2

The American Gastroenterological Association recommends avoiding opioids, as they worsen nausea and carry high addiction risk, and considering butyrophenones, such as haloperidol or droperidol, for suspected CHS 1, 3, 5
Topical capsaicin (0.1% cream) may provide symptom relief through activation of transient receptor potential vanilloid type 1 receptors 1
Supportive care with intravenous fluids and electrolyte replacement is essential for patients with suspected CHS 3

The American Gastroenterological Association recommends that cannabis cessation is essential for the definitive treatment of CHS, and providing counseling to achieve marijuana cessation as the primary intervention 1, 2, 3
Consider tricyclic antidepressants, such as amitriptyline, for long-term symptom management, starting at 25 mg at bedtime and titrating weekly to reach a minimal effective dose of 75-100 mg 1, 2

The Canadian Association of Gastroenterology recommends against using marijuana to treat abdominal pain in conditions like Crohn's disease, as evidence shows it does not induce symptomatic remission 7
Heavy cannabis users may require higher analgesic doses postoperatively due to tolerance, but cannabis use is not a contraindication to NSAIDs, opioids, local anesthetics, ketamine, gabapentin/pregabalin, dexmedetomidine, or acetaminophen 3, 5, 8