However, this sex discrepancy may reflect heavier cannabis use reported among men relative to women, rather than a sex-specific sensitivity to this adverse effect of cannabis . More studies are warranted to research these findings. The main point from these six cases was that patients continued to have refractory nausea and vomiting with standard antiemetics. However, once given doses of haloperidol, the patients experienced a clinically significant improvement in their symptoms. And like the other cases, our patient received a multitude of other antiemetics without the relief of symptoms and it was only when she was treated with IV haloperidol followed by oral did her symptoms subside. Our report wasn’t without limitations. During this admission the patient received only one dose of metoclopramide. The attending physician made this decision based on the fact that the first dose didn’t relieve the patient’s symptoms and in previous admissions for gastroparesis but before the CHS diagnosis metoclo-pramide was effective, that this admission her nausea and vomiting were not due to gastroparesis.

Another limitation to consider is that the patient had some confounding conditions such as uncontrolled diabetes with her last A1C being 10.5 and associated gastroparesis. Even with these confounders we believe our patient experienced CHS because none of the typical medications used to treat gastroparesis such as metoclopramide or erythromycin eliminated her symptoms. In Nigeria, there has been a growing trend in the use of psychoactive substances. Current data indicate that drug use cuts across diverse groups, cannabis grow racks with high risk groups including males aged 10 to 29 years, law enforcement agents, commercial sex workers , commercial drivers and motor park touts. However, studies in this area are limited in North Western Nigeria. Several international studies highlighted the socio-demographic factors associated with psychoactive substance use. In Finland, in a nationwide survey of adult population, using a self-administered questionnaire, Kontula and his colleagues reported that in comparison with other European countries, drug use among the Finns was less prevalent, although there was a high prevalence of multiple drug use among the population studied . A survey in the United States showed that 37% of the population reported using one or more illicit substances in their lifetime .

Thirteen percent had used the substance in the past 12 months and 6% had used them in the month before the survey. More than 66% of the people aged 12 to 25 years had used a psychoactive substance, and more than 15% of the United States population older than 18 years of age had serious substance use problems. One United States population survey reported a 2% lifetime prevalence use of amphetamine. Those aged 18 to 25 years reported the highest level of use, with 9% reporting use at least once and 1% described themselves as current amphetamine users . In North Africa, cannabis resin  had been traditionally used by members of the Sufi sect, while in East Africa, the use of khat was reported to be common. Khat chewing was a social, culture based activity and some religious leaders were involved in the habit. High incidence of Khat chewing had been reported among university teachers, parents and other highly placed people in Ethiopia . In a nationwide study of psychoactive substance use among adults in five of the six geopolitical regions of Nigeria, Gureje et al. reported that the prevalence of alcohol was 58%, tobacco 17%, sedatives 14%, stimulants 2.4% and cannabis 3% among the population studied . However, the study was limited to self-report assessment of substance use among the respondents.

In a review of psychoactive substance related cases admitted to the Department of Psychiatry Ahmadu Bello University Teaching Hospital , Kaduna, in the 80’s it was reported that those aged 31 years and over tended to abuse alcohol, with majority being married  . The studies reported that the combined use of alcohol with cannabis was more likely than combining cannabis with amphetamines. Many studies of psychoactive substance use in Nigeria had been conducted on student populations. Students constituted a large portion of youths in Nigeria. Studies of drug use had indicated that the prevalence of drug use was high among the students population. The most commonly used psychoactive substances among university students had been reported to be salicylate analgesics , alcohol was next , stimulants, hypno-sedatives and cigarettes accounted for 35%, 18% and 11%, respectively.