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The CULTA Blog

What's Cannabinoid Hyperemesis Syndrome?

We all know that medicinal cannabis offers many benefits to patients. Per the Maryland Medical Cannabis Commission (MMCC), it can provide relief from chronic pain, help manage seizures, can treat PTSD, and increase appetite. However, like any medication, some people may react negatively to cannabis. In rare cases, frequent cannabis users may develop a condition called cannabinoid hyperemesis syndrome.

Cannabinoid hyperemesis syndrome, also known as CHS, consists of episodes of severe vomiting and intestinal distress. Health experts first identified CHS in 2004 when they discovered that a subset of patients suffering from prolonged bouts of vomiting all reported heavy cannabis use. 

Although generally considered rare, it’s unknown how often CHS truly occurs among cannabis users. Researchers believe that many cases of CHS are misdiagnosed as other digestive problems, or go undiagnosed entirely, because patients are reluctant to report their cannabis use -- especially in states where cannabis isn’t legal. But the Cleveland Clinic estimates that up to 6% of patients in the ER for severe vomiting suffered from CHS.

For most people, using cannabis may help reduce nausea, vomiting, and other digestive ailments. However, if you are a heavy user of medical cannabis and find yourself suffering from unexpected symptoms, you may be experiencing CHS. 

Learn about the symptoms, health risks, and causes of cannabinoid hyperemesis syndrome, and how to treat CHS if it happens to you or a cannabis patient you know.

Symptoms of cannabinoid hyperemesis syndrome

“Hyperemesis'' is the medical term for severe nausea and vomiting. In cannabinoid hyperemesis syndrome or CHS, this is the most prominent symptom. CHS sufferers may experience episodes of intense hyperemesis, followed by periods with no symptoms. Medical experts have divided other symptoms into three phases:

Phase 1. The prodromal phase

During the prodromal phase of CHS, people commonly experience abdominal pain and nausea when they first wake up. The symptoms are very similar to what pregnant women experience as morning sickness. For some, the prodromal phase also induces a fear or revulsion of vomiting. This phase may occur over weeks or months.

Phase 2. The hyperemetic phase

After the prodromal phase, people with CHS begin experiencing intense nausea, severe vomiting, and dry-heaving. They may also suffer from:

  • Severe abdominal pain
  • Decreased appetite
  • Weight loss
  • Dehydration

Episodes of hyperemesis may last until cannabis use ceases. Phase 2 is when patients are most likely to seek medical attention for CHS.

Phase 3. The recovery phase

When the sufferer stops using cannabis, their hyperemesis ends. Nausea and abdominal pain also cease, and eventually the person is able to consume normal foods and liquids again. This third phase of CHS will last as long as cannabis is not consumed again.

Risks associated with cannabinoid hyperemesis syndrome

Like many medical conditions, CHS is associated with numerous risks and complications. Because it is characterized by severe, prolonged vomiting, CHS causes dehydration which can lead to:

  • Electrolyte imbalances
  • Kidney infection or kidney failure
  • Muscle weakness or muscle spasms
  • Heart problems
  • Brain fog
  • Shock

Cannabinoid hyperemesis syndrome can also lead to malnutrition if the patient is unable to consume enough food due to vomiting or nausea. Many individuals also self-treat their CHS by taking excessive hot showers, which can lead to skin problems.

Causes of cannabinoid hyperemesis syndrome

Cannabinoid hyperemesis syndrome is caused by heavy cannabis use. However, not everyone who uses cannabis will develop cannabinoid hyperemesis syndrome. In fact, the condition is believed to be quite rare. 

It’s believed that CHS occurs because the THC in cannabis activates the cannabinoid receptors in our digestive tract. In most people, these receptors are responsible for the positive effects of medical cannabis, such as relieving nausea and stimulating appetite. However, if these receptors are overstimulated, they may lead to the symptoms of CHS.

Some studies suggest that people who suffer from CHS are daily cannabis users who began consuming cannabis at a young age, such as their teens. However, research is still ongoing to determine the exact cause of CHS and whether other factors like genetics may play a role in individual risk.

How to prevent and treat cannabinoid hyperemesis syndrome

The easiest way to prevent cannabinoid hyperemesis syndrome is to avoid using cannabis and cannabis products. You may also be able to lower your risk by cutting back. Some individuals may prevent CHS by using cannabis in smaller doses or using it less often, or both. You may also stop using cannabis after treating your initial medical conditions.

If you or someone you know is suffering from CHS, the only permanent treatment is to stop using cannabis. It’s been reported that individuals with CHS who quit cannabis experience relief from vomiting and symptoms within a few days. Unfortunately, the CHS symptoms will likely return if the individual starts using cannabis again. 

Although medical cannabis can provide patients with significant pain relief, individuals who experience cannabinoid hyperemesis syndrome are advised to stop using cannabis and seek alternative treatments. To learn more about how your body interacts with cannabis, read our blog on the Endocannabinoid System (ECS).