What Is Cannabinoid Hyperemesis Syndrome?

What Is Cannabinoid Hyperemesis Syndrome (CHS)?

Cannabinoid hyperemesis syndrome (CHS) is a disease of the stomach or intestine that occurs among frequent or chronic users of marijuana (cannabis). It is characterized by the sudden development of frequent severe nausea and vomiting accompanied by abdominal pain lasting less than one week.

CHS patients experience the above-mentioned symptoms shortly after their last cannabis intake. Symptoms may be temporarily reduced by hot baths and showers. However, quitting cannabis is the only treatment for CHS.

How Common Is CHS?

Based on studies conducted in emergency rooms, it is believed that approximately 2.75 million Americans suffer from CHS each year, while the precise number is unknown. In the US and Canada, CHS ER visits increased between 2017 and 2021, with males aged 16 to 34 accounting for the majority of these visits.

Legalization of cannabis for recreational use and increases in the amount of delta-9-tetrahydrocannabinol (THC) in cannabis products are correlated with an increase in CHS.

What Are the Symptoms of Cannabinoid Hyperemesis Syndrome?

CHS symptoms normally appear some years after the commencement of chronic cannabis consumption. However, all long-term users of the drug develop CHS.

Symptoms associated with CHS include:

• Nausea that tends to persist, particularly in the morning hours.

• Multiple vomiting and retching occur up to five times an hour.

• Severe abdominal discomfort and pain.

• Poor appetite.

• "Scromiting" is a combination of two words, namely, “screaming” and “vomiting.” You scream because of the unbearable pain while vomiting.

What Are the Three Phases of CHS?

Prodromal Phase:

• This is the first stage of cannabinoid hyperemesis syndrome (CHS).

• A person may often feel sick in the morning or have stomach pain after using cannabis for a long time.

• They may feel like they are going to vomit, but they usually do not actually throw up.

• This stage can continue for many months or even years.

Hyperemetic Phase:

• This is the most serious stage of CHS.

• The person starts having very bad nausea and vomits many times a day. They may also have strong stomach pain and may not feel like eating or drinking anything.

• Some people take frequent hot showers or baths because it helps them feel a little better.

• This phase usually lasts for one or two days, but sometimes it can last longer.

Recovery Phase:

• This stage begins when the person completely stops using cannabis. Slowly, the nausea, vomiting, and stomach pain start getting better.

• The person can eat normally again and begins to feel healthy.

• Recovery may take a few days, weeks, or even months, but the CHS symptoms usually go away completely if cannabis use is stopped.

What Causes Cannabinoid Hyperemesis Syndrome?

Doctors still do not know the exact cause of cannabinoid hyperemesis syndrome (CHS). However, experts believe it may happen because long-term and heavy cannabis use overstimulates the body’s endocannabinoid system (ECS), which helps control functions such as nausea, vomiting, mood, and digestion.

Cannabis can affect the body in different ways. In the brain, it may help reduce nausea and vomiting, which is why it is sometimes used in people receiving chemotherapy. But cannabis can also affect the stomach and intestines. In some people, repeated use may irritate the digestive system and increase feelings of nausea and vomiting instead of reducing them.

At first, cannabis may make a person feel better. However, with long-term use, certain receptors in the brain may stop responding normally to the drug. When this happens, the body may react differently, and symptoms of CHS, such as severe nausea, vomiting, and stomach pain, can develop.

Scientists are still studying why CHS happens in some people who use cannabis regularly, while others never develop the condition. The exact reason is still not fully understood.

Who Is at Risk of Developing CHS?

Those who consume marijuana (cannabis) on a regular basis for around 10 to 12 years are susceptible to the development of CHS. However, all those who consume marijuana regularly do not suffer from CHS. The disease usually strikes individuals who consume marijuana at least once a week, and it is more common among adults who have used marijuana since their teenage years.

Cannabinoid Hyperemesis Syndrome Trigger Foods

• Coffee, black tea, and alcohol may make symptoms worse.

• Hot peppers, spicy sauces, and strong spices like black pepper can upset the stomach.

• Tomatoes, citrus fruits, and creamy or cheesy foods may increase nausea or stomach discomfort.

• Greasy fast food, fried items, and fatty meats can be hard to digest and may worsen symptoms.

• Chocolate and cocoa products may trigger symptoms in some people.

• Some people may also feel worse after eating foods like echinacea, kava, cloves, black truffles, broccoli, or collard greens because they contain plant compounds similar to cannabinoids.

How Is CHS Diagnosed?

Many health conditions can cause repeated vomiting, so doctors first try to rule out other possible causes. Your doctor will ask about:

• Your symptoms.

• How long have you been using cannabis?

• How often do you use it?

• Your past medical history.

They will also do a physical exam, especially checking your stomach area.

Tests That May Be Done

Your doctor may order tests to make sure another illness is not causing the vomiting. These tests may include:

• Blood Tests: To check for infection, anemia, or dehydration.

• Electrolyte Tests: To see if repeated vomiting has affected body salts and fluids.

• Liver and Pancreas Tests: To check how these organs are working properly.

• Urine Test: To look for infection or other urinary problems.

• Drug Screening: To check for drug-related causes.

• Upper Endoscopy: A small camera test to examine the stomach and the food pipe.

There is no single test that confirms CHS. One common clue is that symptoms improve after taking a hot shower.

The best way to confirm the CHS diagnosis is if symptoms improve after completely stopping cannabis use. Being honest with your doctor about marijuana use helps with proper diagnosis and treatment.

Why Is CHS Hard to Diagnose?

CHS is a relatively newly recognized condition, so some doctors may not identify it right away. It is often mistaken for cyclic vomiting syndrome because both conditions have similar symptoms. A digestive specialist called a gastroenterologist may help diagnose CHS.

How Is Cannabinoid Hyperemesis Syndrome Treated?

The only proven way to completely stop CHS is to stop using cannabis entirely. Even after quitting, symptoms may continue for a few days or weeks, but they usually go away over time.

Some people may find it difficult to stop using cannabis. If needed, a doctor, counselor, or addiction specialist can help with treatment and support.

Treatment During Severe Symptoms

There is currently no specific FDA-approved medicine for CHS. Doctors are still researching better treatment options. If symptoms become severe, hospital treatment may be needed. Treatment may include:

• IV Fluids and Electrolytes: To treat dehydration caused by repeated vomiting

• Medicines for Nausea and Vomiting: These may help some people, although they do not always work well in CHS

• Pain Relief Treatments: Some people may feel better using capsaicin cream on the skin

• Rest and Monitoring: Doctors may monitor the patient until vomiting and dehydration improve

Stopping cannabis use completely is the most important step for recovery and preventing symptoms from coming back.

How Long Does It Take to Recover From Cannabinoid Hyperemesis Syndrome?

Recovery times differ for everyone. The majority of individuals experience an improvement in their condition after days to weeks after discontinuing cannabis use. In some instances, the symptoms can take a few months to fade away. The symptoms will only reappear in case of a relapse in cannabis consumption.

What Complications Can CHS Cause?

Vomiting frequently during CHS results in the following issues:

• Dehydration is a result of fluid loss.

• Disturbance in electrolyte balance.

• Malnutrition due to weight loss.

• Esophageal damage due to continuous vomiting.

• Kidney damage arising from extreme dehydration.

• Recurrent hospitalization due to uncontrolled nausea and vomiting.

Serious complications are quite rare if the condition is detected and addressed early enough.

Can CHS Be Prevented?

Avoiding cannabis (marijuana) is the only method of preventing cannabis hyperemesis syndrome. It can be challenging to stop using marijuana. Consult a healthcare professional or get in touch with your local addiction treatment programs if you need assistance stopping.

Conclusion

Cannabinoid hyperemesis syndrome (CHS) causes recurrent episodes of vomiting, nausea, and stomach pains among individuals who have been using cannabis consistently over an extended period of time. The exact causative agent is unknown; however, discontinuing cannabis consumption remains the sole method of treating CHS.

If you experience constant nausea, uncontrolled vomiting, and stomach pains, and you are a regular user of cannabis, take caution. Seek immediate medical advice from a health care professional to make sure that you receive the best care possible.

Key Takeaways

• CHS is associated with the prolonged and regular use of cannabis.

• It is marked by intense nausea, vomiting, and abdominal pain.

• For many CHS patients, one of the short-term remedies is the use of a hot shower or bath.

• CHS is not diagnosed through a specific test but rather depends on the symptoms, cannabis use history, and exclusion of any other medical condition.

• Complete abstinence from cannabis use is the only effective remedy.

• Patients usually get cured upon ceasing the use of cannabis, although it takes some time for recovery.