Nausea: Cannabinoids and CBD Research Overview

Nausea is having an uneasy and discomforting feeling of the stomach with an associated urge to vomit. It can be caused by a wide variety of reasons, ranging from relatively benign to serious illnesses. Studies have shown cannabinoids are effective at both treating nausea once it’s developed and at helping to prevent anticipatory nausea.

Overview of Nausea

Nausea is having the feeling or urge to vomit. In some cases, nausea can be debilitating and lead to vomiting, which means to forcefully throw-up the contents of the stomach out through the mouth. While nausea is most commonly caused by viral gastroenteritis (“stomach flu”), it can develop for a wide variety of reasons, including, but not limited to, medications, chemotherapy, food poisoning, morning sickness, general anesthesia, motion sickness, migraines, Crohn’s disease and other irritable bowel syndromes, and liver or pancreatic cancer.

Nausea and vomiting both play an important defensive role by rejecting the ingestion or digestion of potentially harmful substances. The sensitivity of the nausea and vomiting reflex, however, is very low and it can be easily activated, causing additional problems and impacting the quality of a patient’s life⁸. For example, nausea and vomiting can prevent the body from keeping down much-needed medications intended to treat serious conditions.

For cancer patients, nausea can develop after chemotherapy or radiation treatment, but it’s not uncommon for them to also experience anticipatory nausea. If a patient has previously gotten sick numerous times following treatment, for example, the smells, sights and sounds of the treatment room can trigger nausea even before treatment has begun.

Controlling nausea is important for allowing patients to continue their necessary medical treatment and to have a better quality of life. Not controlling nausea and vomiting can lead to chemical changes in the body, mental changes, loss of appetite, malnutrition, dehydration, a torn esophagus, broken bones and reopening of surgical wounds. In addition, nausea can cause longer hospital stays, difficulty handling everyday activities, lost work hours and depression.

Findings: Effects of Cannabinoids and CBD on Nausea

Cannabis has long been known to limit or prevent nausea and vomiting from a variety of causes^5,8. The major cannabinoids within cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD), have both been shown effective at regulating nausea and vomiting because they interact with cannabinoid receptor 1 (CB₁) of the endocannabinoid system. Activating the CB₁ receptor suppresses vomiting⁴. Studies have shown that CBD’s effectiveness at producing anti-nausea effects may also be in part of its indirect activation of the sommatodendritic 5-HT(1A) autoreceptors in the brain stem⁷.

For patients suffering from nausea following cancer treatments, cannabis has shown it can provide relief. Studies have found that cannabinoids, including CBD contained in cannabis, are effective at treating the more difficult to control symptoms of nausea, as well as preventing anticipatory nausea in chemotherapy patients⁶. Another study found that THC was also effective at reducing conditioned rejection and chemotherapy-induced nausea¹.

States That Have Approved Medical Cannabis for Nausea

Currently, 19 states have approved medical cannabis specifically for the treatment of nausea. These states include: Alaska, Arizona, Arkansas, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, and Washington.

A couple of other states will consider allowing medical cannabis to be used for the treatment of nausea with the recommendation by a physician. These states include: Connecticut (other medical conditions may be approved by the Department of Consumer Protection) and Massachusetts.

In Washington D.C., any condition can be approved for medical cannabis as long as a DC-licensed physician recommends the treatment.

Recent Studies on Cannabinoids and CBD’s Effect on Nausea

Numerous studies have demonstrated that cannabinoids’ impact on the endocannabinoid system helps to regulate nausea.
Regulation of nausea and vomiting by cannabinoids.
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883513/)

Cannabinoids, including CBD found in cannabis, may be effective clinically for treating both nausea and vomiting produced by chemotherapy or other therapeutic treatments.
Cannabinoids suppress acute and anticipatory nausea in preclinical rat models of conditioned gaping.
(https://www.ncbi.nlm.nih.gov/pubmed/25691302)

Resources:

1. Limebeer, C.L., and Parker, L.A. (1999, December 16). Delta-9-tetrahydrocannabinol interferes with the establishment and the expression of conditioned rejection reactions produced by cyclophosphamide: a rat model of nausea. Neuroreport, 10(19), 3769-72.
2. Nausea and vomiting. (2014, September 4). Mayo Clinic. Retrieved from http://www.mayoclinic.org/symptoms/nausea/basics/definition/sym-20050736.
3. Nausea and vomiting – adults. (2013, October 13). MedlinePlus. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/003117.htm.
4. Parker, L.A., Mechoulam, R., Schlievert, C., Abbott, L., Fudge, M.L., and Burton, P. (2003, March). Effects of cannabinoids on lithium-induced conditioned rejection reactions in a rat model of nausea. Psychopharmacology, 166(2), 156-62.
5. Parker, L.A., Rock, E.M., Sticht, M.A., Wills, K.L., and Limebeer, C.L. (2015). Cannabinoids suppress acute and anticipatory nausea in preclinical rat models of conditioned gaping. Clinical Pharmacology and Therapeutics, 97(6), 559-61.
6. Parker, L.A., Rock, E.M., and Limbeer, C.L. (2011, August). Regulation of nausea and vomiting by cannabinoids. British Journal of Pharmacology, 163(7), 1411-22.
7. Rock, E.M., Bolognini, D., Limebeer, C.L., Cascio, M.G., Anavi-Goffer, S., Fletcher, P.J., Mechoulam, R., Pertwee, R.G., and Parker, L.A. (2012, April). Cannabidiol, a non-psychotropic component of cannabis, attenuates vomiting and nausea-like behavior via indirect agonism of 5-HT(1A) somatodendritic autoreceptors in the dorsal raphe nucleus. British Journal of Pharmacology, 165(8), 2620-34.
8. Sharkey, K.A., Darmani, N.A., and Parker, L.A. (2014). Regulation of nausea and vomiting by cannabinoids and the endocannabinoid system. European Journal of Pharmacology, 722, 134-46.