With the widespread use, increased potency and legalization of marijuana in multiple states in the U.S., CHS may be becoming increasingly common. Cannabinoids are compounds in the Cannabis sativa plant that bind to cannabinoid receptors in your brain, spinal cord, gastrointestinal tract and other body tissues. Examples of cannabinoids include tetrahydrocannabinol (THC) and cannabidiol (CBD). While marijuana seems to bring on nausea in the stomach, in the brain it usually has opposite effect.
The rising alarm about the dangers of legalized marijuana
- A recent, published in 2016, case report describes the first use in the literature of propranolol to treat CHS 117.
- Ceasing and abstaining from the use of cannabis is the only treatment that relieves and prevents symptoms of CHS, according to a systematic review on CHS management.
- It is not known why the syndrome develops in some, but not all, long-term marijuana users and why symptoms take longer to manifest in some patients than others.
- The pathogenesis of CHS is being elucidated and likely involves a prominent role of TRPV1 receptors.
In this article, we describe CHS and discuss the causes, symptoms, diagnosis, and treatment of the condition. As CHS is a newly described condition, many doctors may find it challenging to diagnose and treat. Researchers have tried to explain what causes CHS, but further study is necessary. Research is ongoing on the exact way that cannabis triggers this problem. In the meantime, the best way to relieve CHS symptoms is to stop using the drug. Ceasing and abstaining from the use of cannabis is the only treatment that relieves and prevents symptoms of CHS, according to a systematic review on CHS management.
Daily cannabis use linked to public health burden
Other symptoms may include sweating, flushing, thirst, weight loss, and changes in body temperature. Since marijuana is recommended as an antiemetic to chemotherapy patients, CHS seems paradoxical, but cannabinoids can have both proemetic as well as antiemetic effects. Cannabis Hyperemesis Syndrome is a complex condition that can cause serious health complications, including repeated vomiting, chs symptoms and signs cyclical nausea, and gastrointestinal distress. While the symptoms of CHS are often mistakenly attributed to other disorders, early diagnosis and quitting cannabis are crucial for managing the condition. Patients diagnosed with CHS may require emergency medicine or treatments such as anti-nausea medications, topical capsaicin, or hot water hydrotherapy to relieve symptoms. Mental health services administration may also be involved in managing the psychological impact of cannabis use and the challenges of quitting.
Medical Disclaimer
- This stage typically lasts about 24 to 48 hours but can extend longer, especially if you continue using marijuana.
- While stress and anxiety are common occurrences for many people, there are clear relationships between stress, anxiety, and several nausea and vomiting disorders.
- Of this patient population, 32.9% (95% confidence interval, range 24.5–40.3%) were considered to have met criteria for CHS (chronic cannabis use, episodes of sometimes severe nausea and vomiting, symptomatic relief from hot showers) 72.
- Conditions that qualify under Utah’s medical cannabis law include HIV, Alzheimer’s, ALS, cancer, Crohn’s disease, epilepsy, multiple sclerosis and PTSD.
- However, this example is highly questionable, since THC exposure was extremely low, the patient was on a ketogenic diet with polypharmacy, and emesis episodes were only of 1–2-day duration five times in 6 months and recurred once after discontinuation of Epidiolex.
The patient reported that he got the rash from prolonged exposure to hot water in showers that he took to relieve the symptoms of his CHS 143. Cutaneous problems arise typically from prolonged and excessive amphetamine addiction treatment exposure to very hot water, heating pads, or hot water bottles. CHS may be confused with hyperemesis gravidarum, so an accurate diagnosis is important to avoid costly and time-consuming diagnostic steps and to avoid prolonging the patient’s suffering as these two conditions respond to different treatments 121. Pregnant women may not be forthcoming about their marijuana use, which can complicate diagnosis 121. Maternal cannabinoid use alone does not necessarily mean that hyperemesis is CHS.
How is cannabis hyperemesis syndrome treated?
Another patient in the series, a 31-year-old man, discontinued marijuana for a short time, then resumed and periodically visits the ED to manage symptoms 102. The third patient (20-year-old man) stopped marijuana use for 2 months after CHS diagnosis, but resumed again, which resulted in another hospitalization 102. If that were not sufficiently ominous, observed mutations on the ATP-binding cassette transporter (ABCA1) could increase risks of future abnormal protein deposition in the brain, dementia, coronary artery disease and Type II diabetes (Feher et al., 2018). Thus, early diagnosis with appropriate genetic and health counseling are high priorities upon diagnosis. The commonly encountered resistance of CHS patients makes this recommendation notably challenging. Hyperemesis syndrome is a condition marked by severe and persistent nausea and vomiting, often accompanied by abdominal pain and dehydration.
Hyperemetic phase
An intriguing point to keep in mind is that the Rome IV criteria include the phrase “resembling cyclical vomiting syndrome.” In that regard, it is important to distinguish between the two. Per the Nelson Textbook of Pediatrics, cyclic vomiting syndrome is defined by having sudden onset episodes of vomiting, having at least four bouts of vomiting per hour, and often having 12 to 15 episodes of vomiting per day. These episodes of vomiting are often separated by weeks or months, and there is a return to baseline between episodes. Importantly, for the definition of cyclic vomiting syndrome, these episodes of vomiting cannot be attributed to other disorders.
Medically Reviewed By: Dr. Joshua Yager M.D.
Miriam, for example, got her prescription from a doctor she had never previously met, located in a cannabis medical clinic in the same building as the dispensary. They ask you a few questions, and then they write you a prescription and you walk out the door,” Miriam said. Finally, he suggested that teens who use cannabis for anxiety may shortchange their emotional development. The stress and confusion in youth, he said, is sometimes just part of learning life skills under pressure. Early cannabis use that masks stress may not only damage neural networks but also undercut psychological growth. The patient still uses a moderate cannabis dose for sleep and pain, a careful balance of THC and cannabidiol.
While some patients use cannabis to manage GI symptoms, excessive use can actually worsen vomiting episodes, often resembling Cyclic Vomiting Syndrome (CVS). In a retrospective chart review of 13 patients treated for CHS at one of two centers, 100% of patients experienced relief when topical capsaicin was administered to help control symptoms of vomiting 96. A thin layer of topical capsaicin cream was applied to the abdominal region, chest, or back. Only one CHS patient returned to the ED within 3 days after receiving topical capsaicin; capsaicin was administered again, and the patient reported rapid relief and was discharged without further treatment 96.
Despite its association with the cannabis plant, CHS is frequently misdiagnosed as cyclic vomiting syndrome or other gastrointestinal issues. The condition poses serious health complications, including emergency department visits, dehydration, and in severe cases, kidney failure or brain swelling. Quitting cannabis is the only definitive treatment, yet many marijuana users struggle with cessation. Medical literature, including the Rome IV criteria, outlines diagnostic criteria for CHS, but it remains a challenging condition for both healthcare providers and patients. Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months.
When cannabinoids bind with brain receptors, they tend to prevent nausea and vomiting. Experts think that when you first smoke weed, your brain signals are more important, but after repeated use of the drug, the brain receptors may no longer respond to marijuana in the same way, causing more nausea and vomiting. One 2018 study found that 32.9% of self-reported frequent marijuana users who’d gone to the emergency room (ER) had symptoms of CHS.