Cannabis is a widely used psychotropic drug that young adults and adolescents commonly use. According to J Emerg Med (2018), nearly 183 million (4% of the population) are cannabis users.
Since cannabis is legalized in several states, individuals use it for recreational and medical purposes. Its adverse effects due to chronic and acute usage are becoming more prevalent.
One of the aftermaths of using frequent cannabis is cyclic vomiting – also known as cannabinoid hyperemesis syndrome (CHS).
So what is CHS, and how do we treat it? If you are curious to know, let’s get familiar with this topic.
What is Cannabinoid Hyperemesis Syndrome?
Cannabis hyperemesis syndrome (CHS) is a rare consequence of long-term (usually 10-plus years), heavy, daily cannabis use, characterized by nausea, vomiting and abdominal pain. The symptoms are often temporarily relieved by hot baths or showers, or in the long term, by stopping use altogether.
CHS is a newly discovered condition, and several medical practitioners find it challenging to diagnose it.
However, research conducted over the years stated that individuals with CHS usually use cannabis for an extended period. The chronic use of cannabis causes people to experience episodes of vomiting.
In short, cannabinoid hyperemesis syndrome is a condition that causes repeated and severe nausea and vomiting. It is a rare syndrome, and it usually occurs among individuals who use cannabis daily for a long-term.
CHS symptoms are often confused with cyclic vomiting syndrome (CVS), which usually affects children. The two conditions are related, but CHS goes away after cessation of cannabis use.
What are the Symptoms of Cannabinoid Hyperemesis Syndrome?
The literal translation of ‘hyperemesis’ is ‘hyper-vomiting’. This is the primary symptom. It manifests as prolonged periods of violent nausea and vomiting which last one or more days per week. Severe abdominal pain accompanies the sickness.
CHS subjects go through cyclic vomiting, and in between these episodes, there is a time in which they do not show any symptoms. A study cited in Curr Drug Abuse Rev. (2011) showed that the CHS symptoms have three stages.
The researchers divided these symptoms as:
- Prodromal phase
- Hyperemetic phase
- Recovery phase
In this stage, individuals typically experience:
- Early morning nausea
- Abdominal pain
- An urge to vomit
This stage tends to last for months or years. Since cannabis has antiemetic properties and antinausea effects, several people use more cannabis at this time.
Moreover, several people follow a regular eating pattern, but they typically become terrified of vomiting due to their symptoms.
At this stage, people usually go through:
- Abdominal discomfort
- Ongoing nausea
- Recurrent episodes of vomiting
- Decreased hunger
- Weight loss
Vomiting and nausea in this phase are usually persistent and intense. Several people prefer taking frequent showers and baths because it helps them to relieve their nausea.
How do hot showers ease nausea? Hypothalamus is a part of our brain that is affected by hot temperature. When you take a hot bath, the hypothalamus regulates your body temperature and alleviates vomiting.
Furthermore, several people often seek medical help in the hyperemesis stage. Plus, the symptoms might continue if the person does not completely stop using cannabis.
The symptoms gradually fade away in this stage, and they can last for about days to months. Individuals in the recovery phase:
- Have normal eating patterns
- They feel better
- Their showering frequency becomes normal
We talked about the symptoms in every phase, but what about its diagnosis? How will you be able to diagnose whether it is CHS or not?
Since CHS diagnosis guidelines do not currently exist, the doctors will diagnose by asking about your symptoms and past health. Furthermore, a healthcare practitioner may perform a physical exam.
A review published in Hosp. Pharm (2013) provided CHS symptoms diagnostic criteria by breaking them into three categories.
Crucial for Diagnosis
- Long-term cannabis use: exceeding one year
Major CHS Features
- Severe bouts of vomiting and nausea
- Weekly cannabis use
- Abdominal pain
- cannabis cessation subsides symptoms
- Alleviates symptoms with hot baths and showers
Other Supportive CHS Features
- Age below fifty years
- Vomiting and nausea in the morning
- Over five kg weight loss during hyperemesis phase
- No change in bowel habits
- Negative endoscopic, radiographic, and laboratory test results
What’s more, your healthcare provider may ask you to perform other tests to verify that vomiting is due to CHS. These tests include:
- Electrolyte test
- Infection and anemia blood tests
- Liver and pancreas enzyme tests
- Urine analysis
- Drug screening
- Belly X-ray
- Upper endoscopy
- Abdominal CT scan
Currently, there is no single test available to confirm CHS diagnosis. If the doctors see improvement after quitting cannabis, this proves that a person had CHS.
Plus, doctors can use the criteria mentioned above to diagnose this syndrome instantly. Once CHS is confirmed, treatment can begin to cater to nausea, vomiting, and dehydration.
What Causes Cannabinoid Hyperemesis Syndrome?
Cannabis is a complex herbaceous plant with several compounds. Plus, it has complex effects on our bodies. Therefore, experts are still trying to learn what triggers CHS.
A review published in J Med Toxicol (2017) highlights the causes of CHS. Cyclic vomiting can occur due to genetics, or cannabis effects can alter with long-term use.
Researchers, while conducting a study, identified CB1 and CB2 receptors. Cannabis molecules attach themselves to these receptors.
CB1 receptors are typically present in the brain, but they are also found in other organs. cannabis, when it affects our brain, usually prevents nausea and vomiting. However, when it affects the gastrointestinal tract, it triggers nausea and vomiting.
A piece of evidence suggests that these CB1 receptors are responsible for regulating the cannabis effects on the digestive system.
Moreover, episodes of vomiting usually occur when the receptors that bind cannabis’s different compounds have become altered. A few receptors can become highly active while others may stop working. These changes can provoke CHS symptoms.
Not to mention, experts do not have much knowledge about CB2 receptor function. Plus, the evidence that supports these theories still lacks.
How Do You Treat Cannabinoid Hyperemesis Syndrome?
Currently, there are no specific treatment guidelines to manage CHS symptoms. Doctors usually provide treatment options and manage CHS symptoms through published case reports.
Individuals usually consult their doctors during their hyperemesis stage; therefore, there are no suitable treatment options for people who are in their prodromal phase.
People experiencing CHS are advised to stop using cannabis and are usually admitted to the hospital because of severe vomiting. They are generally treated with:
- IV (intravenous) solution to prevent dehydration
- Antiemetic medications for stopping vomiting
- Pain-relieving medications
- PPI (proton-pump inhibitors) for treating stomach inflammation
- Multiple hot showers in a day
- Capsaicin cream for reducing nausea and pain
Besides these interventions, doctors also recommend prescription drugs such as:
- Xanax or Valium
- Vitamin B-6
If people do not use cannabis, their symptoms usually subside after a day or two. It is necessary to participate in rehab programs to get entirely better.
Is Cannabinoid Hyperemesis Syndrome Permanent?
CHS has three stages, as mentioned above, and when an individual reaches the recovery phase, its symptoms usually die down.
Since an individual is not consuming cannabis anymore, cyclic vomiting and other symptoms subside.
Moreover, healthcare practitioners believe that the best way to stop CHS from happening again is to stop smoking cannabis.
In short, CHS is not a permanent condition, and its symptoms fade away when a person stops cannabis use.
Can You Die From Cannabinoid Hyperemesis Syndrome?
CHS is responsible for causing vomiting, nausea, and abdominal pain. Since a person is frequently vomiting, dehydration is inevitable.
It can lead to kidney failure, and experts classify it as cannabinoid hyperemesis acute renal failure. If the condition becomes severe and interventions are not taken on time, it can result in death.
The Journal of Forensic Sciences (2019) highlights the death of a 31-year-old male, 27-year-old male, and 27-year-old female due to CHS in Canada.
Moreover, according to US today (2019), severe vomiting due to CHS is thought to play a vital role in the death of a 17-year-old boy Brian Smith Jr.
Therefore, it demonstrates that it is crucial to recognize CHS symptoms among cannabinoid users. If the condition becomes severe, it can be fatal.
Medical Professionals Are Still Skeptical on Cannabinoid Hyperemesis Syndrome
The proposals and theories put forth by researchers are compelling, but some medical professionals remain skeptical.
Authors of a 2006 review out of Australia criticize the original 2004 research that defined cannabinoid hyperemesis syndrome for poor study design and for misattributing increases in cannabis use to liberalized laws.
“Cannabis has been consumed for many centuries and is currently used by millions of people in many countries,” the authors wrote. “It is hard to believe that a distinctive syndrome caused by cannabis has never been noted before by users or clinicians.”
Why Was There No CHS Before?
An article cited in Family Council (2019) highlights that several healthcare professionals are not 100% sure about what causes this condition.
However, they suspect that this syndrome is becoming prevalent because cannabis is available in more potent THC concentrations.
The article further stated that in the 1970s, cannabis’s THC concentration was around 7%. Now the mean concentration has increased up to 15% to 30%. Plus, it has now become possible to make cannabis extracts from 99% THC.
In a nutshell they believe, cannabinoid hyperemesis syndrome has increased in the previous years because cannabis strains has become more potent.
Could Neem Oil Cause Cannabinoid Hyperemesis Syndrome?
Neem oil is a natural pesticide which is certified for organic use in the US. The growth of the legal cannabis industry in the US, together with the eagerness of many licensed cultivators to produce an organic product, has led to an increase in the use of products containing azadirachtin, the substance derived from the neem tree which kills pests.
Symptoms of neem oil poisoning are somewhat similar to symptoms of CHS – and abate in the same way when the exposure to neem oil and its derivatives ceases. This hypothesis has mainly been raised by cannabis aficionados rather than doctors, and it is possible that conventional science just doesn’t know enough about how cannabis is grown to make the connection. There are currently 139 products containing neem oil that are registered with the Organic Materials Review Institute and available in the US.
Cannabinoid Hyperemesis Syndrome The Takeaway
Since this syndrome is a new condition, doctors are not fully aware of it. That is why it makes it challenging to identify people with this condition.
Individuals usually misdiagnose it, and that delays the treatment. Plus, there are no clinical guidelines available, and the doctors typically rely on published case reports to treat CHS subjects.
Several studies and quite a few news reports have said that CHS is on the rise, and linked this to the increasing number of places where cannabis is legal for recreational and medicinal use. However, this is as yet unproven.
The first case of cannabis hyperemesis in the Netherlands was reported in 2005 despite cannabis having been decriminalised there since the early 70s, and it certainly isn’t an epidemic. There are no reported cases in Portugal (decriminalised 2001), nor Uruguay (legalised in 2017).
It could be simply that there are more reported cases, specifically in the US, because more people now feel able to tell doctors about their cannabis use without fear of repercussions.
Since Cannabis hyperemesis syndrome is so rare, I’d also be careful of misdiagnosis. Other gastrointestinal problems may be at play, and cannabis could be either helpful or hindering in such cases. As with so many potential issues with long-term cannabis use, we just don’t have enough data to draw any hard conclusions.
Cannabinoid Hyperemesis Syndrome F.A.Q
What are the chances of getting CHS?
We know it is associated with heavy, chronic cannabis use, and my recent study has shown that about 1 in 3 daily or near daily (20 days per month, self-reported) users develop at least some symptoms of CHS.
Can you still smoke with cannabinoid hyperemesis syndrome?
Is cannabinoid hyperemesis syndrome permanent? It’s not necessarily clear, but doctors think the best way to ensure that CHS does not recur is to stop smoking cannabis altogether. In most instances, symptoms will abate within a few days.
How long does it take to recover from cannabinoid hyperemesis syndrome?
Once the nausea and vomiting subside, usually within 48 hours, the patient enters the recovery phase. Recovery may range from days to months and is associated with cessation of cannabis use. If the patient reinitiates cannabis, symptoms usually return.
How do you test for CHS?
Diagnostic approach and management. CHS should be suspected in patients coming in with recurrent symptoms of abdominal pain, nausea and vomiting, and who have normal CBC, basic metabolic panel, lipase, and liver function tests.
Is CHS genetic?
What Causes CHS? CHS is an inherited condition caused by a defect in the LYST gene (also called the CHS1 gene). The LYST gene gives the body instructions on how to make the protein that’s responsible for transporting certain materials to your lysosomes.
How do you know if you have cyclic vomiting syndrome?
The symptoms of cyclic vomiting syndrome often begin in the morning. Signs and symptoms include: Three or more recurrent episodes of vomiting that start around the same time and last for a similar length of time. Varying intervals of generally normal health without nausea between episodes.
Is diarrhea a symptom of CHS?
Other conditions, like food poisoning, can cause very similar symptoms, although those are often accompanied by diarrhea, whereas CHS usually is not.
How long of at break should you take?
Like anything else, your body builds up a tolerance: you need more to get high. A t-break could help you save money and also keep balance. The hard news is that if you partake most days, a true t-break should be at least 21 days long, since it takes around three weeks or more for THC to leave your system.
Does CHS cause anxiety?
Cannabis use is associated with several short- and long-term side effects such as changes in mood, impaired memory, impaired attention, depression, and anxiety and it is correlated with schizophrenia [1, 2].
Is CHS reversible?
All respondents who previously indicated they were employed prior to diagnosis were able to return to work. These data reaffirm that both these entities are responsive to appropriate treatment, and CHS is essentially reversible and ‘curable’ over time when marijuana is minimized or stopped.
Does Benadryl help with CHS?
Pareek et al. (2007) reviewed literature of case studies related to CHS and determined that treatment of CHS should include either ondansetron (Zofran) 4 mg intravenously or promethazine (Phenergan) 25 mg intravenously with diphenhydramine (Benadryl) 25–50 mg intravenously.