Cannabinoid Hyperemesis Syndrome

Anthony Pellegrino
August 5, 2021

The information is provided for informational purposes only and does not relieve readers of their obligation to obtain qualified medical, legal or other professional advice.

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Marijuana legalization has been an ongoing movement in the US for quite some time. In recent years, especially, it has been in full swing. However, something unexpected has emerged in its wake. That is the newly recognized medical condition referred to as "Cannabinoid Hyperemesis Syndrome" (CHS). CHS was first identified by medical professionals in the mid-2000s. However, it has received significant attention in recent years due to legalization. The condition itself is surprising and mysterious to medical scientists, and it also raises interesting questions regarding what many people thought they knew about cannabis use. 

Cannabinoid Hyperemesis Syndrome causes severe nausea and vomiting.

What is Cannabinoid Hyperemesis Syndrome (CHS)?

Cannabinoid Hyperemesis Syndrome is a newly discovered and rare medical condition that follows heavy and regular use of cannabis. It usually takes daily consumption of cannabis over several years for the condition to develop. The syndrome itself is marked by severe and repeated vomiting. The word "emesis" is a medical term that refers to the act of vomiting. As such, the term "hyperemesis" refers to intense spells of vomiting. CHS can do more than elicit vomiting, however. It can also cause severe cramping and abdominal pain.

Sometimes a hot bath or shower will relieve the nausea associated with CHS.

Interestingly enough, patients frequently find that their symptoms are temporarily alleviated by taking a hot shower or bath. However, this is only temporary relief, and symptoms will persist so long as cannabis use continues. If nothing changes, CHS can lead to other health complications such as kidney failure, esophageal erosions, and electrolyte imbalances. 

What Causes Cannabinoid Hyperemesis Syndrome?

According to this 2011 study, CHS “occurs by an unknown mechanism.” Generally speaking, patients need to use cannabis on a regular (daily or weekly) basis for years before CHS will emerge. While the underlying cause is still unknown and unclear, many possibilities have been proposed. Some speculate that the root cause is a dysfunction of the endocannabinoid system. However, we need more research before we can understand its root causes or why it affects some cannabis users and not others.

It can take years of constant cannabis use to trigger CHS.

According to current, very limited research, Cannabinoid Hyperemesis Syndrome appears to be a genetically inherited condition. It has been suggested that a defective LYST gene (also called the CHS1 gene) is responsible for a dysfunctional endocannabinoid system and the development of CHS. The only thing that can be said for sure is that using cannabis to a significant degree for a prolonged period leads to the emergence of CHS in rare cases.

While many people are familiar with the effects and "high" of marijuana use, most probably aren't aware of the underlying mechanics. Cannabinoids like THC, CBD, and CBG bind to the endocannabinoid receptors in your brain. But, as we mentioned, the brain is not the only place where this binding occurs. These cannabinoids bind to the receptors in your digestive tract as well. It's speculated that something can occur over time regarding this digestive binding to cause the emergence of CHS. The 2011 study referred to above found that activation of CB1 receptors in the GI tract produced the following symptoms:

  • Tightening of the esophageal sphincter,
  • A slowing of gastric emptying (the movement of stomach contents into the small intestine)
  • Abdominal pain and inflammation

Symptoms of Cannabinoid Hyperemesis Syndrome

In typical circumstances, cannabis tends to relieve nausea, not cause it. Many medical patients use marijuana to treat nausea and vomiting. Dronabinol, for example, is an FDA-approved drug that contains THC as an active component for chemotherapy-related nausea/vomiting. This means that CHS patients will often make their symptoms worse because they turn to cannabis to relieve their nausea. 

The typical symptoms of Cannabinoid Hyperemesis Syndrome are:

  • Continuous nausea
  • Recurring incidents of vomiting
  • Prolonged Stomach pain
  • Reduced appetite
  • Rapid weight loss
  • Dehydration
CHS sufferers can inadvertently worsen their symptoms by using more cannabis to temporarily relieve their symptoms, creating a vicious cycle.

The Three Phases of CHS

People with CHS suffer three distinct phases of symptoms: the prodromal phase, the hyperemetic phase, and the recovery phase.

The Prodromal Phase

The Prodromal is the first stage of CHS. It is defined by:

  • Nausea in the early morning,
  • Increased anxiety surrounding vomiting
  • Abdominal pain or distress

In most cases, the prodromal phase will clear up within 48 hours. But this phase can also last for months or years and lead to more severe symptoms later on. Unfortunately, these symptoms may cause patients to increase their marijuana use because cannabis normally helps with nausea. Yet, if CHS develops, symptoms will worsen unless cannabis use ceases. This is counterintuitive for most cannabis users.

The Hyperemetic Phase

If cannabis use continues while suffering from CHS, it can worsen into the hyperemetic phase. During this phase, sufferers may experience these symptoms: 

  • Intense, often incapacitating nausea and vomiting
  • Severe abdominal pain and distress
  • Loss of appetite
  • Weight loss
  • Dehydration
  • Compulsive hot showering (Because hot showers and baths can provide immediate relief for CHS symptoms, patients may take an uncharacteristic number of them each day. It can become compulsive because hot showers/baths are only a temporary solution.)

If you believe you have developed CHS that has progressed to the hyperemetic phase, you should immediately stop any cannabis use. Depending on the severity of your symptoms, you should also consider seeking medical attention. You may be dangerously dehydrated and may need your kidneys examined. 

The Recovery Phase

The final stage of CHS is the recovery phase. It can take several weeks or even months to fully recover from CHS. Usually, no special treatments are necessary besides the complete cessation of cannabis use and maintenance of a normal eating pattern. Still, it's essential to maintain medical appointments after the initial diagnosis because other issues can crop up. During this phase, patients should find themselves gaining back the weight they lost along with the return of a more typical bathing schedule. 

Diagnosing Cannabinoid Hyperemesis Syndrome 

Because Cannabinoid Hyperemesis Syndrome has symptoms shared by many other medical conditions, it's often a difficult diagnosis for medical practitioners. The condition is so rare that it usually doesn't occur to a diagnostician till other conditions are ruled out. CHS patients are frequently misdiagnosed as having Cyclic Vomiting Syndrome

CHS sufferers are at risk of kidney failure due to dehydration.

There are no specified tests for CHS, unfortunately. This means that the first step in diagnosing CHS involves ruling out all other potential gastrointestinal issues that may be causing symptoms. Those who go to the hospital or urgent care for a CHS diagnosis can expect some of the following tests:

  • Blood tests to rule out infection or anemia
  • Electrolyte measurements
  • Tests for pancreas and liver enzymes
  • Pregnancy test
  • Urine analysis
  • Drug screening
  • X-rays and CT scans of the intestinal area to rule out blockages or other abdominal complications
  • Upper endoscopy, to inspect the stomach and esophagus
  • A CT scan of the brain to rule out a neurological or nervous system-related cause of symptoms


Treating Cannabinoid Hyperemesis Syndrome

For the symptoms of CHS to clear up entirely, patients must ultimately stop using cannabis altogether. Patients may find that it takes up to two weeks or more for symptoms to clear up completely. Treatment of CHS and its symptoms is ordinarily supportive and usually focused on alleviating symptoms of vomiting. Some studies suggest that rubbing capsaicin cream on the stomach during episodes of vomiting can also be helpful. But the only definitive treatment for CHS is the total cessation of cannabis consumption. 

If the symptoms of CHS are severe or last long enough to cause dehydration, medical attention is necessary. As is the case for many conditions that cause intense, prolonged vomiting, IV fluid replacement is often utilized to treat dehydration. In addition, patients may also receive medications to treat nausea, pain, stomach inflammation, and the anxiety that may naturally come with symptoms of CHS. 

Ceasing cannabis use is the only known way to treat CHS.

Frequently Asked Questions About CHS

Why does Cannabinoid Hyperemesis Syndrome happen?

Cannabinoid Hyperemesis Syndrome (CHS) is a medical condition that can develop following the heavy use of cannabis over a long period--usually years. CHS is a newly described and still largely unrecognized medical condition. More clinical research is necessary to discover the exact mechanisms responsible for CHD development. 

Can you still smoke weed if you have Cannabinoid Hyperemesis Syndrome?

No. The medical community generally agrees that patients should not continue using or smoking cannabis after a CHS diagnosis, as this will only worsen symptoms.

Is Cannabinoid Hyperemesis Syndrome permanent?

No, CHS is not a permanent medical condition if it's treated correctly and not ignored. Symptoms of CHS can vary from person to person and timeframe to recovery can vary.

Is there a cure for Cannabinoid Hyperemesis Syndrome?

Unfortunately, the only way to treat and cure CHS is through the cessation of cannabis use. Some patients may need to quit using cannabis indefinitely, as their CHS symptoms can return if cannabis use is reintroduced.  

Can CHS cause death?

CHS has led to death in extreme cases, but it's incredibly rare. Only a few fatal cases have been identified. The life-threatening complications arise because of severe and prolonged dehydration due to repeated vomiting. 

If nothing is done, this dehydration can lead to kidney failure (specifically, cannabinoid hyperemesis acute renal failure). Needless to say, both kidney failure and dehydration can be life-threatening if left untreated. 

Can you smoke CBD if you have CHS?

No, as tempting as it may be, you should not smoke CBD products either if you have been diagnosed with CHS. CBD is still a cannabinoid. CHS is thought to be caused by cannabinoids in general and not just THC. Therefore, even CBD and CBG might increase the symptoms of CHS.

Is CHS a genetic condition?

While the current knowledge surrounding CHS is still limited, it does appear as though CHS can be genetically inherited. 

How long does it take for cannabinoid receptors to return to normal?

Generally speaking, the cannabinoid receptors in your brain (CB1 receptors) need at least two days of cessation to begin to return to normal. Completely normal CB1 function will require four weeks of marijuana cessation. However, when it comes to CHS patients, their cannabinoid receptors may need significantly longer to return to normal. 

Does CHS Produce Anxiety?

CHS, in itself, is not associated with anxiety directly. Consuming too large a dose of THC, on the other hand, often causes anxiety. Nevertheless, the symptoms of CHS can easily be severe or uncomfortable enough to cause anxiety.

Anthony Pellegrino
Anthony Pellegrino is a freelance journalist, writer, and content marketing strategist. He is currently studying to get his B.A. in philosophy at Fort Hays State University. He is a content creator for several marketing agencies, brands, and tech startups. His writing is focused on content marketing, technology, philosophy of mind, metaphysics, politics, career planning, and of course, cannabis. Academically, Anthony is focused on A.I., Consciousness, Social Sciences, and Philosophy.

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