Capsaicin for Cannabis Hyperemesis

Spoon Feed
Capsaicin cream for cannabis hyperemesis has been described in adults; this is the first reported use in adolescent patients.  It appeared to help, N = 2.

Why does this matter?
Cannabis hyperemesis is well described.  It is often refractory to the usual antiemetic agents.  Some only get relief from hot showering.  Capsaicin cream has been purported to help via the following mechanism.  "The transient receptor potential vanilloid-1 receptor (TRPV1), a nociceptor found in the peripheral nervous system that is involved in the pain relief we feel from endocannabinoid stimulation and which also regulates body heat TRPV1 is activated by exposure to scalding heat (109°F). Interestingly, capsaicin also stimulates the TRPV1 receptor."

Wacky weed
This was a case report of 2 "adolescents," one age 16, one 20.  Since when was a 20 year old considered an adolescent? Seriously? Anyway, they both had cannabis hyperemesis and both got better after slathering capsaicin on their respective abdominal walls.  Authors reported, "Our patients did not return to our ED after treatment with capsaicin cream. By effectively alleviating symptoms in our patients, we prevented further unnecessary medical workup as well as unnecessary treatment..."  Either that or they were afraid they would rub more stinging lotion on them for coming back...  The point is, this is a novel, relatively harmless treatment for cannabis hyperemesis that makes physiologic sense.

Source
Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series.  Pediatrics. 2017 Nov 9. pii: e20163795. doi: 10.1542/peds.2016-3795. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

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