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Conducting clinical trials over the internet: feasibility study

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7413.484 (Published 28 August 2003) Cite this as: BMJ 2003;327:484

Rapid Response:

The Internet,NETPRINTS,and Cannabis Hyperemesis

Dear Editor,

The medium of the internet,as shown here in the
dissemination of clinical information(1),is of great value.The recent SARS
outbreak is another case in point.Several years ago,an attempt to publish
the paradoxical effect of Marijuana as the causative agent in a vomiting
syndrome,was seen as iconoclasm.The BMJ,however, through it's innovative
NETPRINTS server,allowed this information to be showcased(2).

In South Australia, over the past few years,it has dawned on some of us
that what was being described as "Psychogenic Vomiting" or "Adult Cyclical
Vomiting Syndrome" was,in fact,a Cannabis related illness.

This disorder was characterised by: A history of
several years of chronic cannabis abuse prior to the onset of the
hyperemesis in susceptible individuals.The hyperemesis followed a cyclical
pattern every few weeks or months,often for many years ,against a
background of regular cannabis abuse.Cessation of the cannabis lead to a
cessation of the cyclical vomiting in the presence of a negative urine
drug screen for cannabis. A return to regular heavy cannabis use resulted
in a return of the vomiting many weeks or months later. The patient would
"Compulsively bathe"i.e would take multiple hot showers or baths during
the active phase of the illness only,in an attempt to quell the
hyperemesis.

We postulate that cannabis, which is highly
lipophilic and has a long half-life(3),accumulates.Cannabinoid
toxicity(4),in susceptible patients,gives rise to this sterotyped
response. Ninteen patients in
the Adelaide area alone have been identified with this syndrome over the
past two years.Similar Clinical findings have been reported to us from
inter-state and overseas.A series of these cases will be submitted for
publication shortly.

REFERENCES:

(1)Mc Alindon T. et al "Conducting clinical trials on the
internet:feasibility study" BMJ 2003;327:484-487.

(2)Allen
J.H."Cannabinoid Hyperemesis or Marijuana Morning Sickness"
ClinMed.Netprints/200111000141.BMJ/Stanford University Highwire Press.

(3)Pertwee R.G."Pharmacology of cannabinoid CB1 and CB2
receptors."Pharmacol.Ther.1997;74:129-180

(4)Va Ziri N.D.
et al"Toxicity with Intravenous Injection of crude marijuana
extract."Clinical Toxicology 18.(3):353:66 1981 March.

Competing interests:  
None declared

Competing interests: No competing interests

01 September 2003
James H. Allen.
Visiting Medical Officer
Gregory M. de Moore(FRANZCP),Richard Heddle(FRACP),John Twartz(FRACP)
Mt.Barker Hospital.Wellington rd.Mt.Barker.South Australia.5255.