Cannabis Hyperemesis Syndrome

Overview

What is cannabis hyperemesis syndrome?

Cannabis hyperemesis syndrome (CHS) is a condition caused by long-term cannabis (marijuana) use. People who have CHS experience reoccurring episodes of nausea, vomiting, dehydration and abdominal pain, with frequent visits to the emergency department.

Hyperemesis means severe vomiting. Another name for CHS is cannabinoid hyperemesis syndrome. Cannabinoids are compounds found in the cannabis plant that bind to cannabinoid receptors found in our brains, gastrointestinal tracts and immune cells. The most studied exogenous cannabinoids are tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabigerol (CBG).

CHS is more than just a side effect of marijuana. It is a condition that can lead to health complications if left untreated.

Who might get cannabis hyperemesis syndrome?

People who use cannabis chronically are at risk of developing CHS. It tends to occur in people who use cannabis at least once a week and occurs more often in adults who have been using cannabis since their adolescent years. Typically, there is a delay of several years in the onset of symptoms preceded by chronic marijuana misuse in nearly all cases.

How common is cannabinoid hyperemesis syndrome?

Only a small portion of people who regularly use cannabis develop CHS. Because CHS is a newly discovered condition, many people may have it and not report it or are misdiagnosed. One study found that up to 6% of people who visited the emergency room for vomiting had CHS.

Symptoms and Causes

What causes cannabis hyperemesis syndrome?

Experts don’t know exactly what causes cannabis hyperemesis syndrome. Some researchers suspect genetics may play a role. Others believe CHS may occur due to overstimulation of your endocannabinoid system (ECS). The ECS is a network of receptors in your body that respond to compounds in cannabis.

What are the symptoms of CHS?

The primary symptoms of CHS are intense and persistent nausea and vomiting. People with this condition vomit extensively, often without warning, and can vomit up to five times per hour. They may also experience diffused abdominal pain, often report weight loss, and appear dehydrated.

People with CHS self-learn to take hot showers, which helps reduce or curb some nausea they experience. Many people with CHS will compulsively shower or bathe — often for hours every day — to relieve cannabis hyperemesis syndrome symptoms.

There are three phases of cannabis hyperemesis syndrome. Slightly different symptoms occur in each stage:

  • Prodromal phase: This phase is most common in adults who have used cannabis since they were teenagers. You may have abdominal pain or morning nausea. You may also fear throwing up but never actually vomit.
  • Hyperemetic phase: Usually lasting 24 to 48 hours, people in this phase have overwhelming, recurrent vomiting and nausea. You may start compulsively bathing, and avoid certain foods or purposefully restrict your food intake.
  • Recovery phase: During recovery, people stop using cannabis (even in small amounts). When you are in the recovery phase, symptoms lessen over a few days or months. Eventually, they completely disappear.

Diagnosis and Tests

How is cannabis hyperemesis syndrome diagnosed?

Your healthcare provider diagnoses CHS based on your symptoms. If you are vomiting frequently, tell your provider about all substance use, including cannabis. Your provider may ask you:

  • How often you use cannabis.
  • How long you have used cannabis.
  • When you vomit or feel nauseated.
  • If other factors, such as certain foods, lead to vomiting.
  • Whether you have lost weight for no known reason.
  • If you take hot baths or showers to try to relieve symptoms.

You may also have blood tests, a CT scan or MRI to rule out other causes of nausea and vomiting. You may also take a pregnancy test if pregnancy is a possibility.

Management and Treatment

Is there a cannabis hyperemesis syndrome cure?

The only known treatment to permanently get rid of CHS is to stop cannabis use completely. You may have symptoms and side effects of CHS for a few weeks after quitting cannabis. Over time, symptoms will disappear.

Can I treat CHS symptoms at home?

The only cure for CHS is to stop using cannabis. Hot baths may relieve the nausea temporarily, but they don’t cure CHS. Taking too many hot baths can increase dehydration due to sweating.

You may use home treatments to relieve CHS symptoms immediately after quitting cannabis. These remedies are not effective long-term, but they can help you transition to the recovery phase.

Your healthcare provider may recommend:

  • Antihistamines such as diphenhydramine (Benadryl®).
  • Antipsychotic medications such as haloperidol (Haldol®) or olanzapine (Zyprexa®).
  • Capsaicin cream (Zostrix®) to relieve pain.
  • Intravenous (IV) hydration if you become severely dehydrated from vomiting.
  • Pain relievers such as ibuprofen (Advil®, Motrin®) or acetaminophen (Tylenol®).

How soon after cannabis hyperemesis syndrome treatment will I feel better?

Most people with CHS who stop using cannabis have relief from symptoms within 10 days. But it may take a few months to feel fully recovered. As you recover, you begin to resume your usual eating and bathing habits.

Prevention

How can I prevent cannabis hyperemesis syndrome?

The only proven way to prevent cannabis hyperemesis syndrome is to avoid cannabis.

If you need help quitting cannabis, you should speak to your primary care provider or connect with your local addiction treatment services. You can also call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800.662.HELP (4357). This free, confidential, 24/7, 365-day-a-year service provides treatment referral and information in English and Spanish.

Outlook / Prognosis

Does cannabis hyperemesis syndrome have long-term effects?

Research about the long-term effects of CHS is ongoing. However, recurrent vomiting can lead to health complications, including:

  • Dehydration.
  • Esophagitis (inflammation in your esophagus).
  • Malnutrition.
  • Mallory-Weiss syndrome (tears in your esophagus).
  • Tooth decay.

Living With

When should I go to the ER?

CHS can increase your risks for severe dehydration. Call 911 or go to your nearest emergency center if you have any dehydration symptoms, including:

A note from Cleveland Clinic

Cannabis hyperemesis syndrome is a rare condition in people who use cannabis. It causes recurrent, severe vomiting and nausea. People with CHS often bathe or shower compulsively to try to relieve symptoms. You may take some medications to decrease nausea. However, the only way to cure CHS is to stop using marijuana.

Last reviewed by a Cleveland Clinic medical professional on 07/25/2021.

References

  • Chocron Y, Zuber JP, Vaucher J. Cannabinoid hyperemesis syndrome. (https://www.bmj.com/content/366/bmj.l4336) BMJ 2019: 366. Accessed 8/30/2021.
  • National Center for Complementary and Integrative Health. Cannabis (Marijuana) and Cannabinoids: What You Need To Know. (https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know) Accessed 8/30/2021.
  • Sallaberry CA, Astern L. The Endocannabinoid System, Our Universal Regulator. (https://www.jyi.org/2018-june/2018/6/1/the-endocannabinoid-system-our-universal-regulator) Journal of Young Investigators. 2018 June; 34(6): 48-55. Accessed 8/30/2021.
  • Sorensen CJ, DeSanto K, et al. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330965/) J Med Toxicol. 2017 Mar; 13(1): 71-87. Accessed 8/30/2021.

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