Cannabis Hyperemesis Syndrome (CHS)

What is cannabinoid hyperemesis syndrome?

Cannabinoid hyperemesis syndrome (CHS) happens when you have cycles of nausea, vomiting and abdominal pain after using cannabis (marijuana) for a long time. People with CHS often find temporary relief from these symptoms by taking hot baths and showers.

“Hyperemesis” means severe vomiting. Cannabinoids are compounds in the Cannabis sativa plant that bind to cannabinoid receptors in your brain, spinal cord, gastrointestinal tract and other body tissues. Examples of cannabinoids include tetrahydrocannabinol (THC) and cannabidiol (CBD).

CHS is more than just a side effect of marijuana use. It’s a condition that can lead to serious health complications if you don’t get treatment for it.

How common is cannabinoid hyperemesis syndrome?

It’s difficult for researchers to know how common CHS is. Not everyone with the condition seeks medical help or tells their provider that they use marijuana.

One study found that 32.9% of self-reported frequent marijuana users who came to an emergency department for care met the criteria for CHS. With the widespread use, increased potency and legalization of marijuana in multiple states in the U.S., CHS may be becoming increasingly common.

What are the symptoms of cannabinoid hyperemesis syndrome?

Symptoms of CHS typically come on several years after the start of chronic marijuana use. But not everyone who uses marijuana long-term experiences CHS.

Common symptoms of cannabinoid hyperemesis syndrome include:

• Persistent nausea — often in the morning.
• Repeated vomiting and retching (making the sound and movement of vomiting). This can happen up to five times an hour.
• Intense abdominal discomfort or pain.
• Fear of throwing up.
• Loss of appetite.

Hot baths and showers tend to help reduce or curb the symptoms. Many people with CHS will compulsively shower or bathe — often for hours every day — to relieve CHS symptoms.

Symptoms of CHS and their severity depend on the phase of the syndrome:

• 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. This phase can last for months or years.
• Hyperemetic phase: This is the characteristic phase of CHS. It usually lasts 24 to 48 hours and involves overwhelming, recurrent vomiting and nausea. You may start compulsively bathing and avoid certain foods or purposefully restrict your food intake.
• Recovery phase: During recovery, you stop using cannabis (even in small amounts). When you’re in the recovery phase, symptoms lessen over a few days or months. Eventually, they completely disappear.

What is scromiting?

Some people call certain symptoms of CHS “scromiting.” The term combines “vomiting” and “screaming.” You may have intense pain, which causes you to scream while you vomit.

What causes cannabinoid hyperemesis syndrome?

Scientists don’t yet know the exact cause of CHS. But the main theory is that it may happen due to long-term overstimulation of receptors in your endocannabinoid system (ECS). This may lead to issues with your body’s natural control of nausea and vomiting.

What are the risk factors for cannabinoid hyperemesis syndrome?

People who use marijuana long-term — typically for about 10 to 12 years — are at risk of developing CHS. But not every person who uses marijuana, even long-term use, develops CHS.

It tends to affect people who use cannabis at least once a week and happens more often in adults who’ve been using cannabis since their adolescent years.

How is cannabinoid hyperemesis syndrome diagnosed?

Healthcare providers mainly diagnose CHS based on your symptoms, medical history and history of substance use. Your provider will do a physical exam and may ask you:

• How often you use cannabis (marijuana).
• How long you’ve used cannabis.
• When you vomit or feel nauseated.
• If other factors, like 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.

It’s important to be honest about your marijuana use if you have symptoms of CHS. Without knowing this background, providers often misdiagnose CHS as other conditions, like cyclic vomiting syndrome (CVS).

Providers typically use the following criteria to diagnose CHS:

• Long-term, frequent marijuana use (more than one year).
• Severe cyclic vomiting episodes.
• Abdominal pain.
• Symptoms stop with sustained abstinence from marijuana use.
• Compulsive bathing in hot water.

Your provider may recommend certain tests to rule out other causes of nausea and vomiting, like:

• Blood tests.
• Urinalysis.
• Imaging tests, like a CT scan or MRI.

What is the treatment for cannabinoid hyperemesis treatment?

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.

If you have cannabis use disorder and need help quitting, professional treatment is available. Talk to your healthcare provider or an addiction counselor.

Researchers are currently studying several treatment options to manage the hyperemetic phase of CHS. But there are currently no therapies approved by the U.S. Food and Drug Administration (FDA) for CHS.

You may need to go to the hospital for severe CHS. There, healthcare providers may give you:

• IV fluids and electrolytes if you become dehydrated from vomiting.
• Antiemetics, though these often aren’t effective at relieving vomiting in CHS.
• Other alternative therapies for symptom relief, like capsaicin cream to relieve pain.

How do you stop cannabinoid hyperemesis syndrome?

The only cure for CHS is to stop using cannabis. Hot baths may relieve the nausea for a while, 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 may help you feel better while you transition to the recovery phase. Your healthcare provider may recommend:

• Antihistamines, like diphenhydramine (Benadryl®).
• Capsaicin cream to relieve pain.
• Pain relievers like ibuprofen (Advil®, Motrin®) or acetaminophen (Tylenol®).
• Prescription medications, including benzodiazepines (like lorazepam), antipsychotic medications (like haloperidol) or tricyclic antidepressants.

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.

How can I prevent cannabinoid hyperemesis syndrome?

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

Quitting marijuana use can be hard. If you need help quitting, speak to a healthcare 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 1.800.662.4357. It’s a free, confidential service that’s open 24/7, 365 days a year. They provide treatment referrals and information in English and Spanish.

What are the possible complications of cannabinoid hyperemesis syndrome?

There are several possible complications of CHS, including:

• Dehydration.
• Electrolyte imbalance.
• Malnutrition.
• Weight loss.
• Tooth decay.
• Choking, pneumonitis and/or aspiration pneumonia.
• Injury to your esophagus, like Boerhaave’s syndrome or Mallory Weiss tear.
• Scald burns from using very hot water to try to manage symptoms.

When should I go to the ER for cannabinoid hyperemesis syndrome?

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

• Dark or very little pee.
• Delirium (sudden confusion).
• Dizziness.
• Fatigue or unexplained sleepiness.
• Quickened heart rate.
• Rapid breathing.
• Syncope (fainting).