Cannabinoid Hyperemesis Syndrome (CHS) and Marijuana Use

Anna Giorgi
·10 min read
6

Medically reviewed by Femi Aremu, PharmD

Cannabinoid hyperemesis syndrome (CHS) is a rare problem that causes constant vomiting. It is linked with the long-term use of cannabis (marijuana).

The exact reason that this problem occurs is not clear. It happens after years of using cannabis many times a week. Symptoms evolve in phases. They can begin as mild problems that make you feel sick in the morning. Belly pain and a sense that you are going to vomit are also common.

With the continued use of cannabis and a lack of treatment, symptoms become more intense. Problems with keeping food and water down can lead to dehydration. This leads to a risk of more severe organ problems. The only treatment known to cure CHS is to stop using cannabis and not resume its use.

This article describes the causes, symptoms, and stages of CHS. It also describes how CHS is diagnosed and treated.

<p>Alexandre Morin-Laprise / Getty Images</p>

Alexandre Morin-Laprise / Getty Images

What Causes Cannabinoid Hyperemesis Syndrome (CHS)?

Since there are so many active chemicals in cannabis, the exact cause of cannabinoid hyperemesis syndrome is unknown. Substances like THC (tetrahydrocannabinol) and other chemicals in cannabis bind to molecules in your brain to trigger the "high" that can occur when using cannabis products.

THC and other chemicals in cannabis also bind to molecules in your digestive tract. These chemicals can change the time it takes your stomach to empty food.

At low doses, the effect of cannabis on your brain can have an antiemetic effect that suppresses nausea and vomiting. However, with repeated use in some people, it can have the opposite effect on the digestive tract. This results in the persistent vomiting and nausea characteristic of CHS.

Learn More: How Is Marijuana Used?

How Common Is CHS?

CHS is considered rare. It is often described as a syndrome that affects only a small portion of people who are heavy, chronic cannabis users. However, research suggests that it could be far more prevalent and may continue to increase due to factors like the legalization of marijuana and the increased use of medical marijuana.

In one study of frequent cannabis users with potential CHS symptoms, 33% of participants met the definition of CHS. When expanded to the general U.S. population, research indicates that about 2.75 million Americans annually may experience CHS.

Since CHS is a fairly new syndromel first described in 2004, it often remains unrecognized during a clinical diagnosis. This further complicates the process of identifying how commonly CHS occurs. For some people, it can take up to nine years to diagnose CHS from the onset of symptoms.

Learn More: What Are Cannabinoids?

CHS Symptoms

CHS symptoms typically occur in chronic, frequent cannabis users. These symptoms generally involve the following conditions:

  • Episodes of cyclic vomiting that can increase up to 20 times per day

  • Uncontrollable nausea

  • Periods of feeling normal without symptoms

  • Abdominal pain

  • Resistant to traditional antiemetic therapy

  • Unintentional weight loss over time

  • Symptoms that are relieved with hot showers or baths

Learn More: Marijuana Abuse and Addiction: Know the Signs

The Three Stages of CHS

Symptoms of CHS are usually spread over three phases. They start mild then become worse over time, usually within the following phases:

Prodromal Phase

The prodromal phase of CHS can involve mild symptoms that last for months or years. During this time, people may increase cannabis use as a means to treat the recurring nausea. The main symptoms during this phase include the following:

  • Early morning nausea and abdominal pain

  • A fear of vomiting

  • Normal eating patterns

  • Anxiety

  • Restlessness

  • Minimal interference in eating and weight

Hyperemetic Phase

The hyperemetic phase of CHS involves symptoms that continue from the prodromal phase and worsen. People with CHS will most likely seek medical care for their symptoms during this phase. The most common symptoms during the hypermetric phase include the following:

  • Ongoing nausea

  • Periods of 24 to 28 hours of repeated, intense vomiting, with vomiting occurring as often as four or more times per hour

  • Abdominal pain

  • Sweating or flushing

  • Reduction of food intake and weight loss

  • Symptoms of fluid loss (dehydration)

People in the hyperemetic phase can take up to 12 hot showers or baths during the day to relieve symptoms. The practice may become compulsive. The hot temperatures may provide some relief as they affect your hypothalamus, the part of your brain that regulates both vomiting and your internal body temperature.

Recovery Phase

During the recovery phase of CHS, your body begins to return to normal. This phase is triggered by stopping cannabis use. The recovery phase can last for days or months and lead to the following:

  • Normal eating

  • Weight gain

  • Cessation of compulsive bathing or showering

While it is possible to return to feeling normal during the recovery phase, research indicates that symptoms recur if cannabis use resumes.

How CHS Is Diagnosed

There is no diagnostic test to confirm CHS. Since its symptoms are easily confused with other conditions, it can take about one to two years before people who seek medical help with CHS get an accurate diagnosis.

People diagnosed with CHS tend to be in their late teens or 20s. The diagnostic criteria for cannabinoid hyperemesis syndrome include the following:

  • Episodic vomiting resembling cyclic vomiting syndrome (CVS)

  • Presentation of symptoms after prolonged excessive use of cannabis

  • Lack of response to antiemetics

  • Relief of vomiting episodes by sustained cessation of cannabis use

Compulsive hot showering or bathing may be critical in distinguishing CHS from CVS and other conditions with similar symptoms. Studies show that between 90% to 100% of people with CHS use hot showering or bathing to relieve symptoms. Researchers have proposed that this behavior may be included in the diagnostic criteria for CHS.

CHS is often confused with cyclic vomiting syndrome (CVS), which causes cycles of nausea and vomiting balanced with periods of feeling normal, similar to CHS. Other conditions that can mimic symptoms of CHS include the following:

  • Elevated intracranial pressure (growing pressure inside your skull)

  • Acute intoxication (a condition caused by the ingestion of a large amount of alcohol)

  • Pancreatitis (inflammation of the pancreas)

  • Ovarian torsion (a condition in which an ovary and a fallopian tube twist around the ligaments that support it, cutting off blood flow to the organ)

  • Testicular torsion (a condition in which a testicle rotates, twisting the spermatic cord that provides it with blood and oxygen)

  • Gastroesophageal dysmotility (disorders that cause difficulty with swallowing, choking, or heartburn after eating)

  • Mitochondrial disorders (a group of metabolic disorders)

  • Acute intermittent porphyria (a rare, inherited disease)

To make a diagnosis, your healthcare provider will conduct a thorough physical examination and ask you about your past health and current symptoms. It's helpful to volunteer your history of cannabis use with your provider if you are not asked about it.

As your healthcare provider seeks a diagnosis for your symptoms, you may have one or more of the following tests:

Learn More: How to Talk to Your Doctor About Marijuana

How Is CHS Treated?

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.

Other treatments can include the following:

  • Restoration of fluids with hydration or intravenous (IV) fluids if you can't keep fluids down

  • Correction of electrolyte imbalances

  • Hot showers or baths

  • Zostrix (topical capsaicin), a cream made from the active ingredient in chili peppers, is applied to the abdominal region, chest, or back

  • Benzodiazepines, such as Haldol (haloperidol)

  • Ativan (lorazepam) to counteract anxiety caused by CHS, along with help treat seizures

  • Substance abuse counseling for cannabis cessation

Can You Treat CHS Symptoms at Home?

Treating CHS symptoms at home is most effective if you stop using marijuana. You may also get temporary relief from the following at-home treatments:

  • Drink plenty of fluids to avoid dehydration. Increase your consumption of water and other clear liquids until symptoms improve.

  • Check with your healthcare provider before increasing fluids if you have kidney, liver, or heart disease.

  • Apply over-the-counter Zostrix (topical capsaicin) to your abdomen.

  • Talk to your healthcare provider about treatment programs that can help you stop using cannabis and cure CHS.

If symptoms persist and you continue to use cannabis, you may experience more severe problems that require hospitalization for treatment.

How Soon After CHS Will I Feel Better?

After stopping cannabis use, symptoms typically start to disappear within one to two days though individual results can vary. However, symptoms almost always return if you resume using marijuana.

What Are the Health Complications of CHS?

The repeated vomiting that occurs with CHS can lead to issues such as dehydration and electrolyte problems in your blood. Without treatment, the vomiting is likely to continue, and these conditions can lead to the following health complications:

Treatment that helps prevent dehydration and loss of electrolytes can help reduce your risk of many of these problems.

Can You Prevent CHS?

The only way to prevent CHS is to avoid using any form of marijuana. This condition develops after several years of cannabis use. It's still possible to develop CHS if you use cannabis for many years without having any problems.

Chronic cannabis use is the primary risk factor for developing CHS. Using cannabis for a prolonged period increases your risk of this condition. While any amount of long-term cannabis use can lead to CHS, daily cannabis use seems to be more likely to cause CHS than using it less often.

Learn More: Is Weed Really a Gateway Drug?

When to Seek Emergency Medical Help

Prolonged, untreated CHS can lead to chronic dehydration that robs your key organs of the fluids and nutrients they need to maintain your well-being. Seek emergency medical help or call 911 if you have any of the following symptoms:

  • Syncope (loss of consciousness)

  • Vomiting blood or a substance that resembles coffee grounds

  • Persistent vomiting that does not stop

  • Inability to keep fluids down

  • New or worsening abdominal pain

  • New or increasing fever

  • Symptoms of dehydration, including confusion and an inability to think clearly, feeling dizzy, light-headed, or you will faint, sunken eyes and a dry mouth, dark urine, or passing just a small amount of urine

Summary

Cannabinoid hyperemesis syndrome (CHS) is a somewhat rare problem that involves severe bouts of vomiting. It is more common among those who use cannabis daily for years. As more states make recreational use of cannabis legal, it is thought that this problem will become more common.

While symptoms begin as mild, they can intensify and increase your risk of severe problems. As a somewhat new problem, CHS is often mistaken for other problems with the same symptoms. When combined with the fact that people may not reveal they use cannabis, getting the right diagnosis can take years.

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. Symptoms can recur if you resume its use.

Contact your healthcare provider if you suspect you have CHS. This can help you avoid more severe problems as your body is robbed of food and water from constant vomiting.

Read the original article on Verywell Health.