A Guide to Cannabis Hyperemesis Syndrome (CHS)

Cannabis is celebrated for its myriad therapeutic benefits, from alleviating chronic pain to easing anxiety and even helping with nausea. However, there’s a rare condition that can affect long-term, frequent cannabis users: Cannabis Hyperemesis Syndrome (CHS). This paradoxical condition manifests through recurring episodes of severe nausea, vomiting, and abdominal pain. Despite cannabis’s well-known antiemetic properties, CHS presents a unique challenge for some users. By shedding light on CHS, we can empower individuals with the knowledge needed to make informed decisions about their cannabis use and maintain their overall well-being. 

What is Cannabis Hyperemesis Syndrome (CHS)?

Cannabis Hyperemesis Syndrome (CHS) is a rare but important condition that can affect long-term, frequent cannabis users. It manifests through recurrent episodes of severe nausea, vomiting, and abdominal pain. While cannabis is widely recognized for its therapeutic benefits, including its antiemetic (anti-nausea) properties, CHS represents a unique and paradoxical response in a small subset of users. Understanding CHS can help individuals make informed decisions about their cannabis use and maintain their overall well-being.

3 Stages of CHS

1. Prodromal: During the prodromal phase, individuals often experience mild symptoms such as early morning nausea and occasional vomiting. This phase can last for months or even years. Many people continue to use cannabis during this time, believing it helps alleviate their symptoms, unaware that it might actually be contributing to their discomfort. The nausea is typically worse in the morning and can be accompanied by abdominal discomfort and anxiety.
2. Hyperemetic: The hyperemetic phase is characterized by intense and persistent nausea and vomiting. The vomiting can be so severe that it leads to dehydration and significant weight loss. Patients often find relief through compulsive hot showers or baths, which temporarily ease their symptoms. This phase can be debilitating, leading to multiple hospital visits and the need for IV  fluids due to severe dehydration. It is during this phase that many individuals finally recognize the severity of their condition and seek medical help.
3. Recovery: The recovery phase begins once the individual stops using cannabis. Symptoms gradually subside, and normal eating patterns resume. This phase can last for days to months, depending on the duration and intensity of cannabis use prior to cessation. As the body recovers, the nausea and vomiting cease, appetite returns, and any abdominal pain resolves. It is crucial to avoid cannabis use during this phase to prevent a relapse of symptoms.

What Causes Cannabis Hyperemesis Syndrome?

Although the exact mechanisms behind CHS are not fully understood, several potential factors have been identified:

1. Cannabinoid Receptor Overstimulation: Long-term and heavy use of cannabis might overstimulate cannabinoid receptors in the brain and gastrointestinal tract. This overstimulation can lead to dysregulation, causing the paradoxical symptoms of nausea and vomiting in some users.
2. Genetic Predisposition: Some individuals may have a genetic predisposition to developing CHS. Variations in certain genes that affect cannabinoid metabolism and effects could make these individuals more susceptible to the syndrome.
3. Toxic Buildup: Prolonged exposure to high levels of cannabinoids may lead to a buildup of byproducts in the body, contributing to the symptoms of CHS.

How to Tell If It’s Cannabis Hyperemesis Syndrome (CHS)? 

Cannabis Hyperemesis Syndrome (CHS) is a condition that can perplex regular cannabis users, as it presents symptoms that are quite contrary to the usual effects of cannabis. Here’s how to identify if what you’re experiencing might be CHS:

Key Symptoms of CHS

1. Abdominal Cramping and Pain: One of the hallmark symptoms of CHS is severe cramping and pain, typically localized on the left side where the stomach is located.
2. Diminished Antiemetic Effects of Cannabis: Normally, cannabis is known for its antiemetic (anti-nausea) properties. However, in cases of CHS, users often find that cannabis no longer alleviates nausea and may even exacerbate it.
3. Relief from Hot Showers: A distinctive and somewhat peculiar symptom of CHS is the relief of nausea and pain from taking hot showers or baths. Many CHS sufferers find significant temporary relief through this method.
4. Symptom Improvement After Cessation of Cannabis Use: The most telling sign of CHS is the improvement of symptoms after stopping all cannabis use. If the symptoms subside with the cessation of cannabis, it strongly indicates CHS.

For most users, cannabis remains a safe and beneficial therapeutic option. However, being aware of CHS and its symptoms allows users to take proactive steps if they experience any adverse effects. If you or someone you know experiences recurrent nausea and vomiting with regular cannabis use, consulting a healthcare provider and considering a reduction or cessation of cannabis use might be beneficial. Responsible and informed consumption is key to enjoying the many benefits that cannabis has to offer.

Relief Through Heat Therapy and Additional Treatments for CHS

Lots of patients with CHS find relief from heat therapy such as hot showers & baths, a heating pad also works! Although there’s no official reason for why this provides relief for CHS patients, scientists believe that warm temperatures correct the cannabis-induced disequilibrium at the thermoregulatory centers. Heat/hot showers also activates TRPV1 which helps with inhibiting pain signals, resulting in analgesic and antiemetic effects. 

In addition to heat therapy, other treatments have shown promise in alleviating CHS symptoms:

• Prescription Anti-Nausea Medications: Medications like ondansetron (Zofran) and promethazine (Phenergan) can be prescribed to help manage severe nausea and vomiting.
• Topical Capsaicin Cream: Applying capsaicin cream, which is derived from chili peppers, can mimic the effects of heat and provide relief. The cream activates TRPV1 receptors, similar to hot showers, helping to reduce nausea and pain.

Treatment for Cannabis Hyperemesis Syndrome (CHS)

1. Fluid IV
   Due to the severe vomiting associated with CHS, dehydration is a common and serious complication. Administering intravenous (IV) fluids is essential to rehydrate the body, replenish electrolytes, and provide immediate relief from dehydration symptoms.
2. Stop All Cannabis Use
   The most effective treatment for CHS is to stop all use of cannabis products, including CBD, CBN, and THC. Complete cessation of cannabis is crucial to allow the body to recover and prevent further episodes of nausea and vomiting.
3. Visit a Gastroenterologist (GI Doctor)
   Consulting with a gastroenterologist can help in managing CHS effectively. A GI specialist can conduct a thorough evaluation to rule out other potential causes of the symptoms, provide specialized care, and develop a tailored treatment plan.
4. Diagnostic Challenges
   Unfortunately, there is no official test for CHS. Diagnosis is typically made by ruling out other potential causes of the symptoms. Healthcare providers often rely on a combination of patient history, symptom presentation, and the resolution of symptoms after stopping cannabis use to diagnose CHS.

By following these steps and seeking professional medical advice, individuals with CHS can manage their symptoms and work towards a full recovery. If you suspect you have CHS, it’s important to act promptly and consult with healthcare professionals to receive appropriate care.

After a 90-day break from cannabis, it may be possible to reintroduce cannabis slowly and carefully. It’s important to monitor for any recurrence of symptoms and consult with a healthcare provider before resuming use to ensure it’s safe.

Food Recommendations while in the Hyperemetic phase: 

• Apple Juice
• Gatorade
• Apple Sauce
• Plain Crackers 
• Broth & clear soups