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Abstract
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This article is linked to Andrews et al papers. To view these articles, visit https://doi.org/10.1111/apt.17265 and https://doi.org/10.1111/apt.17300
We very much appreciate the commentary by Professor Törnblom on our article.1, 2 In particular, we are in agreement with his exhortation to improve treatment options for cannabis use disorders, which are particularly limited.
A second salient point that Professor Törnblom raises is the paradox of further cannabis use as a means to treat the "sneaky" gastrointestinal symptoms associated with cannabis abuse. The leading hypothesis for cannabis hyperemesis syndrome (CHS) suggests that chronic cannabis (particularly, high tetrahydrocannabinol [THC]) use leads to a downregulation of CB1 receptor function in the brain and can lead to disruption of the hypothalamic-pituitary axis, exaggerated stress responses3 and inducement of anxiety.4 Despite this significant dysregulation of the function of the endocannabinoid system, a forceful stimulation (such as with inhalation of high THC cannabis) may still provide some anti-emetic benefit. Thus, CHS sufferers may perceive that cannabis is "the only thing that works" for acute attacks and may see cannabis as the treatment and not the ultimate cause of their symptoms. This mindset, of course, leads to further difficulty in convincing them to abstain from cannabis use, which remains the only effective long-term treatment option for this condition...
Language: en |