Hence, raising the awareness of CHS with an understanding of its pathophysiology and the potential role of therapeutic agents is paramount. A case series from 2010 in the United States described 4 individuals with a history of cannabinoid use who developed episodes of abdominal pain, nausea, and vomiting which could be relieved, in all cases, by bathing in hot water [102]. In all 4 cases, CHS was diagnosed, and patients were counseled to avoid cannabis in the future. Three out of 4 patients resumed marijuana use and presented at the hospital again. One of the patients, a 27-year-old man, said he understood the cause of his symptoms but was “unable” to stop smoking marijuana.

• This material is not a substitute for the advice of a qualified health professional.
• Standard operating procedures (SOP) for detection, diagnosis, treatment and follow up of patients suffering from CVS or CHS (see Attachment 1) provide a valuable method to address this problem in hospitals at low costs [12].
• Quitting cannabis use is the only way to get better if you have CHS.

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Endocannabinoids are arachidonic acid derivatives that are biochemically similar to anandamide and 2-AG and likewise bind to CB1 and CB2 [27, 28]. Once they are activated, anandamide and 2-AG have different pathways for biosynthesis and subsequent degradation, in that anandamide is metabolized mainly by FAAH while 2-AG is metabolized via monoacylglycerol lipase [30]. Endocannabinoids are present in the CNS and enteric nervous systems and are released locally on demand by neuronal signaling; they are released in small amounts and become rapidly inactivated [28]. Understanding the ECS and its effects on the vomiting center of the brain are fundamental to explain the effect of cannabis for this biphasic response [21]. The ECS is composed of ligands, receptors, signaling, and enzymes (its regulators and inhibitors) [22]. The diagnostic criteria for CHS were ill-defined prior to the establishment of the Rome IV criteria of 2016.[20][21] Per the Rome IV criteria, all 3 of the following must be met to be diagnosed with CHS.

Topical Capsaicin Cream

A description of a patient with CHS in Australia revealed that her CHS symptoms exacerbated her anxiety disorder, and she presented to the ED with anxiety plus vomiting [127]. A diagnosis of CHS is confirmed when all symptoms resolve for a long period of time (∼12 months) with the cessation of marijuana [15]. Patients who stop using marijuana but continue to experience cyclic vomiting are more likely to have CVS. It is typical that CHS symptoms resolve in a matter of days once marijuana is stopped; in some case reports, symptoms resolved in hours.

What happens if I stop using cannabis?

Haloperidol may further relieve nausea and vomiting by indirect activity at the CB1 receptors [111, 113]. In a case study of a 27-year-old man who suffered repeated episodes of gastric pain, up to 20 vomiting episodes per day, coupled with severe nausea, multiple diagnostic tests were performed before a CHS diagnosis could be made. During his last hospitalization he was given conventional antiemetic therapy but his symptoms persisted for 2 more days. He consented to IV haloperidol 1 mg which relieved his symptoms and produced no adverse effects; he subsequently received two more IV doses of 2 mg before he was discharged [114].

Preventing a recurrence necessitates complete abstinence to facilitate recovery. As the utilization of cannabis transcends traditional boundaries, encompassing medical treatments, recreational indulgence, and wellness pursuits, the profound impact of THC and cannabinoids on gastrointestinal physiology is coming to light. The literature contains a wealth of case studies and case reports on patients suffering from CHS; these case reports come from around the world but have striking similarities.

Incidence and Prevalence

Indeed, with any syndrome that results in frequent vomiting, there is a concern for a disorder of electrolytes and fluid balance in the body. Patients who fail to respond to antiemetic therapy are at high risk for dehydration and resulting in nutritional deficiencies. Other known complications of forceful cannabinoid hyperemesis syndrome and uncontrolled vomiting include aspiration and subsequent pneumonitis or aspiration pneumonia as well as injury to the esophageal wall such as Boerhaave’s syndrome. When you use marijuana for many years, it can start to slowly change how the receptors in your body respond to the cannabinoid chemicals.

• The third phase is the recovery phase, which is a return to normal behavior.
• Patients with CVS also have times where they are feeling sick to the stomach and can also throw up for between 12 hours to about a week.
• In fact, the authors know of no reports in the literature of a CHS patient who continued to experience symptoms after marijuana was discontinued.
• The patient’s urine drug screen (UDS) was positive for tetrahydrocannabinol (THC).
• But a 2019 study concluded that it potentially accounts for up to 6 percent of emergency room visits for recurrent vomiting.

Some important questions for patients to better and more rapidly diagnose CHS are shown in Table ​Table11. In America, 22.2 million Americans reportedly used some form of cannabinoids in the past month [3]. The Drug Abuse Warning Network (DAWN) states that marijuana mentions (the number of times “marijuana” is mentioned in a medical record) have increased 21% from 2009 to 2011 [3]. Since 2009, the rate of persistent vomiting has increased significantly and continues to increase at about 8% a year [5]. This suggests that this once “rare” condition is going to emerge as an increasingly common presentation in emergency departments (ED) and clinics. CHS is not trivial; there are fatal cases of CHS (as cause of death or contributing to death) reported in the literature.

Overall, our understanding of it is limited by marijuana’s legal status, experts tell Inverse. The patient’s urine drug screen (UDS) was positive for tetrahydrocannabinol (THC). A computed tomography (CT) scan of his abdomen and pelvis with contrast was unremarkable.

It should be noted that in the case of CHS, compulsive showering in hot water is not an anxiety disorder but rather a learned behavior that the patient develops to relieve symptoms [94]. Similar to hot water, capsaicin provides symptomatic relief of CHS [95, 96, 97] but not other vomiting disorders. Topical capsaicin has been advocated for use as a diagnostic tool for CHS to differentiate it from other vomiting syndromes [36]. Multiple studies report pathological frequent and prolonged hot shower behaviors with CHS. Hot showers have been reported to assist in stabilizing the hypothalamic thermostat, frequently altered by chronic cannabis use [51]. Accordingly, they have been reported as one of the therapeutic modalities for the management of the CHS.

• Most CHS patients discover the symptomatic relief of hot showers on their own and use this method to control symptoms [1].
• Research suggests that CHS is a permanent condition that can only be effectively treated by quitting cannabis.
• As the utilization of cannabis transcends traditional boundaries, encompassing medical treatments, recreational indulgence, and wellness pursuits, the profound impact of THC and cannabinoids on gastrointestinal physiology is coming to light.
• Cannabinoid hyperemesis syndrome (CHS) happens when you have cycles of nausea, vomiting and abdominal pain after using cannabis (marijuana) for a long time.
• In a case study from Texas, a 27-year-old male patient with CHS reported he found relief in hot showers but over time, he became refractory to the hot water and ended up having to visit the ED [105].
• If you’re interested, reach out to a mental health professional like a licensed psychologist or therapist.

It would seem that persistent use of marijuana should provoke persistent or at least protracted symptoms, but nearly all CHS patients report long asymptomatic breaks between relatively short symptomatic episodes while they continue to use marijuana. Another puzzling question is why CHS symptoms in many patients resolve completely in a very short period of time − even hours − when marijuana use is discontinued. The serum levels of psychiatric drugs may be reduced in patients suffering from CHS or other vomiting syndrome. A vicious cycle can occur in which CHS patients taking psychiatric medications suffer nausea and vomiting, increase their use of marijuana to manage those symptoms, and exacerbate their mental health condition. For patients on psychiatric pharmacological regimens, CHS can have a destabilizing effect on the patient [126]. Furthermore, the distressing and relentless symptoms of CHS can worsen the patient’s mental health as well.