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  • What Is Cannabinoid Hyperemesis Syndrome?

    What Is Cannabinoid Hyperemesis Syndrome?

    With the acceleration of legalization in many areas of the United States, cannabis is increasingly filling a medical role as an effective treatment for nausea and vomiting.

    However, if a person’s use of the drug becomes chronic and excessive, there is a chance that they can experience the opposite effect.

    Cannabis hyperemesis syndrome (CHS) is a rare medical condition that only develops in individuals with a pattern of heavy, long-term cannabis abuse, often beginning in adolescence. 

    CHS is primarily marked by frequent, recurring episodes of severe and potentially dangerous vomiting and nausea.

    Symptoms Of Cannabinoid Hyperemesis Syndrome (CHS)

    Short-term signs and symptoms of CHS include:

    • severe and persistent nausea and vomiting, often with little warning and with repeated episodes of vomiting occurring in rapid succession
    • avoidance of some or all foods
    • frequent hot showers or hot baths
    • abdominal pain
    • severe dehydration
    • dark or little urine
    • elevated heart rate
    • rapid breathing
    • fatigue
    • fainting
    • delirium
    • frequent visits to emergency departments

    Long-term complications related to CHS can include:

    • unhealthy weight loss
    • kidney failure
    • malnutrition
    • tooth decay
    • esophagitis (inflammation of the esophagus)
    • Mallory-Weiss syndrome (tears in the esophagus)

    Causes Of Cannabinoid Hyperemesis Syndrome

    CHS is directly caused by the effects of heavy, chronic cannabis use on the human body.

    While the exact cause CHS is not fully understood, it is thought to involve a combination of genetics and the long-term effects of tetrahydrocannabinol (THC) on the body’s endocannabinoid system, and cannabinoid receptors in the digestive tract in particular. 

    Experts note that there is always a delay of several years between when a person’s use of cannabis begins and the first signs of CHS. And marijuana use, even heavy use of marijuana, does not always lead to the development of CHS in every case.

    The condition’s true prevalence in the population is not known.

    Stages Of Cannabinoid Hyperemesis Syndrome (CHS)

    From its onset to its resolution, CHS progresses through three primary phases, each with unique symptoms. These stages include:

    Prodromal Phase

    This is the most common phase and typically impacts adults who have used cannabis since adolescence. Common symptoms include abdominal pain, morning nausea, and the sense that you could throw up even if you rarely do.

    Hyperemetic Phase

    This is the acute phase of CHS which occurs in episodes 24-48 hours long.

    During this time, individuals may experience bouts of severe vomiting and nausea. Dehydration, food avoidance, and compulsive showering or bathing in hot water (which stimulates the hypothalamus to calm nausea and prevent vomiting) is common.

    Recovery Phase

    Those in recovery from CHS (achieved by totally abstaining from cannabis use) may experience a slow, steady reduction in symptoms over the course of weeks or months as the various cannabinoids in marijuana are expelled from the body.

    Diagnosing Cannabinoid Hyperemesis Syndrome (CHS)

    The diagnostic criteria for CHS generally specifies heavy cannabis users with severe, repeated nausea, vomiting, and belly pain that improves after a hot shower.

    However, even if you fit the profile for CHS, your healthcare provider may still need to run tests in order to rule out other causes for your condition. These can include gastrointestinal infections, cyclic vomiting syndrome (CVS), pregnancy, certain nervous system conditions, and others.

    These tests may include:

    • blood tests
    • electrolyte tests
    • pancreas and liver enzyme tests
    • pregnancy test
    • urine analysis
    • drug screens
    • upper endoscopy
    • CT scans

    Treatment Of Cannabinoid Hyperemesis Syndrome (CHS)

    CHS is a curable medical condition that can be reversed by totally and permanently giving up marijuana in all forms, either on your own or with help from a medical detox program. This is the only known permanent treatment for CHS.

    However, once marijuana use is discontinued it can still take a number of days or weeks for your CHS symptoms to improve and ultimately resolve.

    Clinicians may provide a variety of medications to help temporarily relieve side effects during this period, including:

    • proton-pump inhibitors to treat stomach inflammation
    • antiemetics like metoclopramide or ondansetron to decrease vomiting
    • antihistamines to decrease nausea and vomiting
    • over the counter pain medications including ibuprofen (Advil/Motrin) and acetaminophen (Tylenol)
    • benzodiazepines like lorazepam (Ativan) to decrease cannabinoid receptor activation, relieve agitation and anticipation of vomiting, and encourage sleep
    • antipsychotics like haloperidol and olanzapine to stabilize your mental health and, in some cases, provide complete symptom relief
    • topical capsaicin cream, which can calm the urge to vomit using a similar mechanism as hot showers

    In addition, clinicians will closely monitor your vital signs and provide IV (intravenous) fluids for hydration support if needed. Follow-up appointments should be scheduled and attended.

    CHS Outlook

    After your substance use ends, your symptoms should ease after 1-10 days and resolve over the next several weeks.

    If you begin using cannabis again, your symptoms may also return.

    If you or your loved one have been struggling with drug abuse and are interested in learning about our proven treatment options, please contact Ark Behavioral Health today.

    Written by Ark Behavioral Health Editorial Team
    ©2023 Ark National Holdings, LLC. | All Rights Reserved.
    This page does not provide medical advice.
    Medically Reviewed by
    Kimberly Langdon M.D.
    on February 17, 2023
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