Cannabinoid Hyperemesis Syndrome

Cannabinoid Hyperemesis Syndrome (CHS) is a condition that leads to repeated and severe bouts of vomiting. It is rare and only occurs in daily long-term users of marijuana.

Your digestive tract also has a number of molecules that bind to THC and related substances. So marijuana also affects the digestive tract. For example, the drug can change the time it takes the stomach to empty. It also affects the esophageal sphincter. That’s the tight band of muscle that opens and closes to let food from the esophagus into the stomach. Long-term marijuana use can change the way the affected molecules respond and lead to the symptoms of CHS.

Cannabinoid Hyperemesis Syndrome
National Center for Biotechnology Information, 2022, July 4

Cannabinoid hyperemesis syndrome (CHS) is a condition in which a patient experiences cyclical nausea, vomiting, and abdominal pain after using cannabis. This disorder is characterized by 1) several years of preceding cannabis use, predating the onset of illness; 2) a cyclical pattern of hyperemesis every few weeks to months, at which time the patient is still using cannabis and 3) resolution of the symptoms after cessation of cannabis use, confirmed by a negative urine drug screen. The almost pathognomic aspect of a patient’s presenting history is that their symptoms are relieved by hot baths or shower. This activity introduces the pathophysiology, clinical manifestation, and management of cannabis hyperemesis…

Recurring vomiting, skin discolouration: the easily overlooked thermal element of cannabinoid hyperemesis syndrome
BMJ Case Reports, 2021, March

A 27-year-old woman presented with a 1-week history of intractable nausea and vomiting. These had been recurring symptoms over an 18-month period. The patient hesitantly revealed a long-standing history of daily recreational marijuana use. Medical records from her initial presentation with surgical intervention and various hospitalisations revealed urine drug screen positive for cannabinoid on various occasions. She was diagnosed with cannabinoid hyperemesis syndrome (CHS) and chronic abdominal burns secondary to heat therapy and advised that marijuana-use cessation is paramount in resolution of her symptoms…

Changes in Emergency Department Encounters for Vomiting After Cannabis Legalization in Colorado
George Sam Wang, MD; Christine Buttorff, PhD; Asa Wilks, MAS; et al 2021, September 17

Results  Vomiting-related ED health care encounters increased from 119 312 in 2013 to 153 699 in 2018 (29% increase). Additional recreational dispensaries were associated with increased vomiting-related ED visits but counties with high baseline medical dispensary exposure experienced smaller increases in vomiting-related ED visits than counties with no baseline medical dispensary exposure. Counties with a high number of medical marijuana dispensaries had increases at a 5.8% slower rate than counties with none. Conclusions and Relevance  The findings of this study suggest that cannabis legalization in Colorado is associated with an increase in annual vomiting-related health care encounters with regard to exposure to these markets. It may be useful for health care clinicians to be aware of cannabis hyperemesis syndrome and inquire about cannabis use when appropriate…

Cannabinoid Hyperemesis Syndrome, An Update for Primary Care Providers
Virginia Lee Stinnett, MSN, FNP-C, and Kristin L. Kuhlmann, PhD, FNP-BC, 2018, March 08

Cannabis is the most commonly used recreational drug worldwide. Crossbreeding and genetic modification techniques have dramatically increased the delta-9- tetrahydrocannabinol content, with resultant increased rates of cannabis use disorders and other toxic effects among users. Cannabinoid hyperemesis syndrome (CHS) is a recently identified disorder and should be considered as a differential diagnosis in patients exhibiting recurrent symptoms of abdominal pain, weight loss, intractable vomiting, and compulsive bathing. Treatment includes vigorous rehydration with intravenous fluids, antiemetics, proton pump inhibitor administration, weight monitoring, and cannabis use cessation. Awareness of CHS symptomology and clinical management strategies can prevent extensive diagnostic workups and unnecessary hospitalizations…

Cannabinoid Hyperemesis Syndrome: Public Health Implications and a Novel Model Treatment Guideline
National Center for Biotechnology Information, 2018 March

Cannabinoid hyperemesis syndrome (CHS) is an entity associated with cannabinoid overuse. CHS typically presents with cyclical vomiting, diffuse abdominal pain, and relief with hot showers. Patients often present to the emergency department (ED) repeatedly and undergo extensive evaluations including laboratory examination, advanced imaging, and in some cases unnecessary procedures. They are exposed to an array of pharmacologic interventions including opioids that not only lack evidence, but may also be harmful. This paper presents a novel treatment guideline that highlights the identification and diagnosis of CHS and summarizes treatment strategies aimed at resolution of symptoms, avoidance of unnecessary opioids, and ensuring patient safety…

The Prevalence of Cannabinoid Hyperemesis Syndrome Among Regular Marijuana Smokers in an Urban Public Hospital,
Joseph Habboushe, Ada Rubin, Haoming Liu, Robert S. Hoffman, 2017 March 21

This study suggests that approximately one-third of patients in our large, urban Emergency Department reporting heavy marijuana use experience symptoms of CHS. In our study population, the condition appears to be most common in 18- to 29-year-olds, although there was no significant difference in gender, race, ethnicity, education level or employment status between frequent marijuana users with CHS and those without…

Cannabinoid hyperemesis and the cyclic vomiting syndrome in adults: recognition, diagnosis, acute and long-term treatment
National Center for Biotechnology Information 2017 March 21

The cannabinoid hyperemesis syndrome (CHS) and the cyclic vomiting syndrome in adults (CVS) are both characterized by recurrent episodes of heavy nausea, vomiting and frequently abdominal pain. Both syndromes are barely known among physicians. Literature is inconsistent concerning clinical features which enable differentiation between CVS and CHS.

Psychiatric comorbidities (e.g. panic attacks, depression), history of migraine attacks and rapid gastric emptying may serve as supportive criteria for the diagnosis of CVS. Compulsive bathing behaviour, a clinical observation previously attributed only to CHS patients is equally present in CVS patients.

Long-term follow-up is essential in order to clearly separate CHS from CVS. However, long-term follow-up of CVS and CHS cases is seldom. We provide a standard operating procedure applicable to a broad spectrum of health care facilities which addresses the major issues of CVS and CHS: awareness, diagnosis, treatment, and follow-up...

Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review,
Journal of Medical Toxicology, 2016, December 20

Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic vomiting associated with cannabis use. Our objective is to summarize the available evidence on CHS diagnosis, pathophysiology, and treatment. We performed a systematic review using MEDLINE, Ovid MEDLINE, Embase, Web of Science, and the Cochrane Library from January 2000 through September 24, 2015. Data were abstracted from the articles and case reports and were combined in a cumulative synthesis. The frequency of identified diagnostic characteristics was calculated from the cumulative synthesis and evidence for pathophysiologic hypothesis as well as treatment options were evaluated using the GRADE criteria. CHS is a cyclic vomiting syndrome, preceded by daily to weekly cannabis use, usually accompanied by symptom improvement with hot bathing, and resolution with cessation of cannabis. The pathophysiology underlying CHS is unclear. Cannabis cessation appears to be the best treatment…

Cyclic Vomiting Presentations Following Marijuana Liberalization in Colorado
National Center for Biotechnology Information 2015, April 22

Conclusion: The prevalence of cyclic vomiting presentations nearly doubled after the liberalization of medical marijuana. Patients presenting with cyclic vomiting in the postliberalization period were more likely to endorse marijuana use, although it is unclear whether this was secondary to increased marijuana use, more accurate marijuana reporting, or both…

Cannabinoid Hyperemesis Syndrome,
National Center for Biotechnology Information, 2011 Dec

Coinciding with the increasing rates of cannabis abuse has been the recognition of a new clinical condition known as Cannabinoid Hyperemesis Syndrome. Cannabinoid Hyperemesis Syndrome is characterized by chronic cannabis use, cyclic episodes of nausea and vomiting, and frequent hot bathing. Cannabinoid Hyperemesis Syndrome occurs by an unknown mechanism. Despite the well-established anti-emetic properties of marijuana, there is increasing evidence of its paradoxical effects on the gastrointestinal tract and CNS. Tetrahydrocannabinol, cannabidiol, and cannabigerol are three cannabinoids found in the cannabis plant with opposing effects on the emesis response. The clinical course of Cannabinoid Hyperemesis Syndrome may be divided into three phases: prodromal, hyperemetic, and recovery phase. The hyperemetic phase usually ceases within 48 hours, and treatment involves supportive therapy with fluid resuscitation and anti-emetic medications. Patients often demonstrate the learned behavior of frequent hot bathing, which produces temporary cessation of nausea, vomiting, and abdominal pain. The broad differential diagnosis of nausea and vomiting often leads to delay in the diagnosis of Cannabinoid Hyperemesis Syndrome. Cyclic Vomiting Syndrome shares several similarities with CHS and the two conditions are often confused. Knowledge of the epidemiology, pathophysiology, and natural course of Cannabinoid Hyperemesis Syndrome is limited and requires further investigation…

Cannabinoid-Induced Hyperemesis: A Conundrum—From Clinical Recognition to Basic Science Mechanisms
National Center for Biotechnology Information 2010 July 3

Cannabinoids are used clinically on a subacute basis as prophylactic agonist antiemetics for the prevention of nausea and vomiting caused by chemotherapeutics. Cannabinoids prevent vomiting by inhibition of release of emetic neurotransmitters via stimulation of presynaptic cannabinoid CB1 receptors. Cannabis-induced hyperemesis is a recently recognized syndrome associated with chronic cannabis use. It is characterized by repeated cyclical vomiting and learned compulsive hot water bathing behavior…

Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse
 H Allen, GM de Moore, R Heddle, J C Twartz 2004, October 11

Nineteen patients were identified with chronic cannabis abuse and a cyclical vomiting illness. For legal and ethical reasons, all patients were counselled to cease all cannabis abuse. Follow up was provided with serial urine drug screen analysis and regular clinical consultation to chart the clinical course. Of the 19 patients, five refused consent and were lost to follow up and five were excluded on the basis of confounders. The remaining nine cases are presented here and compared with a published case of psychogenic vomiting. We conclude that chronic cannabis abuse was the cause of the cyclical vomiting illness in all cases, including the previously described case of psychogenic vomiting..