Cannabinoid hyperemesis syndrome (CHS), or cannabis hyperemesis syndrome, is still a relatively recent discovery. The first known case of it occurred in 2004.
CHS produces repeated cyclical vomiting in some people who have a history of long-term marijuana use. Not much is known about this syndrome, but recovery is possible through stopping cannabis use.
What Is Cannabinoid Hyperemesis Syndrome?
Because CHS has only recently been identified, there is still a lot that is not known about it. However, cases of it have increased since the legalization of marijuana in several states.
CHS is believed to come about as a result of long-term and excessive marijuana use, specifically prolonged exposure to tetrahydrocannabinol (THC), the compound that produces the “high.”
One of the ironies of CHS is that its symptoms are centered around the digestive tract. Marijuana is often medically used to help with severe nausea and to stimulate appetite in cancer patients.
It is believed that it is the overstimulation of cannabinoid receptors in the endocannabinoid system through the long-term or heavy use of marijuana that leads to CHS.
Symptoms Of CHS
The symptoms of CHS center around the abdomen and include abdominal pain, persistent severe vomiting, and repeated episodes of vomiting due to stomach inflammation.
This means that a person experiencing CHS can have 12 to 15 episodes of vomiting a day. A person may vomit four or five times during each episode.
The symptoms of CHS often follow three phases:
- the prodromal phase, which consists of abdominal pain and morning nausea
- the hyperemetic phase, which consists of persistent nausea, repeated bouts of vomiting, and ongoing stomach pain
- the recovery phase, in which symptoms stop because the use of marijuana has stopped
How Is Cannabinoid Hyperemesis Syndrome Diagnosed?
CHS is difficult to diagnose because the pathophysiology of severe and episodic vomiting can resemble many other health issues.
One example, and the most likely alternative diagnosis, is cyclic vomiting syndrome. In fact, the commonly used diagnostic criteria for CHS include “stereotypical episodic vomiting resembling cyclical vomiting syndrome in onset, duration, and frequency.”
Diagnosis of CHS is usually made by:
- the diagnostic criteria called the Roman IV criteria
- the elimination of other possibilities through a pregnancy test, endoscopy, CT scan, and blood tests by a healthcare provider, often done in the emergency department
- drug screenings following cessation of symptoms coinciding with the cessation of marijuana use
Treatment Of Cannabinoid Hyperemesis Syndrome
Treatment involves symptomatic care until the determination of the condition can be made. This usually includes anti-nausea and antiemetic medication.
Unfortunately, transitional antiemetic medications such as ondansetron are typically ineffective.
Doctors may elect to prescribe one or more of the following medications:
- antipsychotic medication such as haloperidol
- benzodiazepines (short-term)
- capsaicin cream
Many people who have been diagnosed with CHS report that they got symptomatic relief from hot showers or hot baths.
Complications From CHS
CHS is not, in and of itself, dangerous. However, complications can arise from it that can be harmful, namely dehydration and electrolyte depletion requiring IV fluids.
Prolonged dehydration, which can be caused by repeated bouts of vomiting, can lead to urinary tract infections and kidney failure.
People with persistent symptoms of cannabinoid hyperemesis syndrome can also experience weight loss.
Treatment For Marijuana Addiction
The only effective treatment for CHS is to stop using cannabis. Since the chronic and excessive use of marijuana is what instigates CHS, people with symptoms of CHS may require addiction treatment.
Marijuana does have a few medical uses, but abuse of the drug can lead to negative side effects similar to other forms of drug abuse.
Marijuana abuse can negatively impact mental health by causing:
- damage to the central nervous system (of which CHS is considered one result)
- psychotic symptoms
- impaired coordination
- mood disorders
People who have abused cannabis may experience withdrawal and need help sorting through the mental health issues or past trauma that led to addiction.
Treatment options for marijuana substance abuse include behavioral therapy at group and individual levels, peer recovery support, and more.
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- The BMJ — Cannabinoid hyperemesis syndrome
- Healthline — How is Cannabinoid Hyperemesis Syndrome Treated?
- Mayo Clinic - Dehydration
- MedlinePlus - Promethazine
- National Center for Biotechnology Information — Cannabinoid Hyperemesis Syndrome
- University Hospital Southampton — Cannabinoid hyperemesis syndrome (CHS)