Start your free visit for ED treatment. Learn more

Jul 13, 2021
4 min read

Cannabinoid hyperemesis syndrome: signs, symptoms, and causes

Cannabis products are commonly used to treat nausea and vomiting. But for some people, cannabis itself can trigger severe nausea and vomiting, especially with long term use.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Most of the time when we’re sick to our stomachs, we can make an educated guess on the cause. Stomach flu, food poisoning, motion sickness, or too much alcohol are all common culprits.

Some causes aren’t quite as well-known. Cannabinoid hyperemesis syndrome, or CHS for short, is one of them.

Many people seek out cannabis to help with nausea and vomiting associated with cancer treatment. But for some reason, at high doses, marijuana has the opposite effect, causing serious bouts of nausea and vomiting all on its own. Researchers are working hard to understand CHS and what causes it. Here’s what they know so far.

Men’s healthcare, without the waiting room

Connect with a US-licensed healthcare provider about ED, premature ejaculation, hair loss, and more.

Learn more

What is cannabinoid hyperemesis syndrome?

Cannabinoid hyperemesis syndrome (CHS) is quite a mouthful. To break it down, cannabinoids are chemical compounds found in cannabis and emesis is the medical term for vomiting. The condition is characterized by recurring abdominal pain, nausea, and vomiting from marijuana use.

CHS is more common in men, is typically accompanied by abdominal pain, and usually appears in people who use cannabis at least once per week (Sorenson, 2017).

Treatment of severe nausea and vomiting is one of the most widely accepted medical uses for cannabis. Many states have medical marijuana programs for people with qualifying conditions––one being nausea and vomiting.

We also have synthetic forms of cannabis, Marinol and Cesamet, which are approved by the U.S. Food and Drug Administration (FDA) to treat cancer-related nausea and vomiting (AbbVie, 2017; Bausch, 2020). 

So if cannabis treats nausea and vomiting, how can CHS be real? It may seem ironic that a medication used to treat something can also make it worse, but yes, CHS is real and can happen with long-term cannabis use.

What causes cannabinoid hyperemesis syndrome?

Scientists don’t know precisely why CHS happens, but it has to do with the way cannabis acts on our endocannabinoid system (ECS). 

The ECS is a complex biological system that affects many different parts of our body, including our brain and digestive system. At lower doses, cannabis acts on the brain to block the urge to vomit and stimulates your appetite.

But the active substances are stored in fat cells in the body and stress or hunger can stimulate your body to burn fat, releasing large quantities of these chemicals into your bloodstream. That alone or in combination with additional doses can cause a sort of cannabis intoxication that can cause severe (Perisetti, 2020). 

Is cannabinoid hyperemesis syndrome dangerous?

CHS affects everyone differently but an extended period of nausea and vomiting can commonly cause.

Vomiting in particular can also cause serious electrolyte imbalances that require medical attention for treatment. In rare cases, people who experience frequent vomiting can have additional problems in their esophagus or an increased risk of lung infections (Chu, 2021). 

Seek medical attention if vomiting keeps you from eating or drinking for more than 24 hours. It’s important to let your healthcare provider know about your substance use to allow for proper diagnosis and treatment.

Treatment of cannabinoid hyperemesis syndrome

The only known way to cure CHS is to stop cannabis use. Studies have found more than 95% of people with CHS had no more symptoms after stopping cannabis (Sorenson, 2017).

CHS treatment varies from place to place. Most healthcare teams will monitor your vitals and provide supportive care like giving you fluids and nutrients. Prescription drugs that have shown benefits include benzodiazepines, antidepressants, anti-seizure medications, and antipsychotics (Chu, 2021).

To help alleviate symptoms at home, try a hot shower or bath.  Many people report that a hot bath alone is enough to relieve their symptoms temporarily. Research has also found that capsaicin cream, which is derived from chili peppers, can also alleviate symptoms of CHS (Richards, 2017). 

Can you still smoke with cannabinoid hyperemesis syndrome?

As weeks pass with no abdominal discomfort or vomiting, you might wonder if you’re in the clear to resume cannabis use. Unfortunately, the only known way to ensure CHS symptoms don’t return is abstaining from cannabis. This includes smoking, vaping, edibles, and tinctures (Chu, 2021). 

Not using cannabis can be especially difficult for those who take it for medical conditions or for people with a history of chronic cannabis abuse. But current guidance warns against its use (Perisetti, 2020).

Can CBD cause cannabinoid hyperemesis syndrome? 

There are two main active substances in cannabis: THC (tetrahydrocannabinol) and CBD (cannabidiol). THC is the psychoactive component that makes you feel “high.”

And while CBD is more famous for its purported anti-anxiety and calming effects, both substances have been found to contribute to the development of CHS, especially at high doses (Galli, 2011).

The medical world is working hard to learn more about the uses of cannabis and understand its side effects. Currently, the only way to avoid recurrent vomiting from cannabis is to stop using any form of cannabis.

Stopping can be difficult. Don’t feel like you have to do it on your own. Joining a support group and speaking with a healthcare professional about treatment options to help you stop can be effective.

References

  1. AbbVie Inc. (2017) Marinol: Highlights of prescribing information. North Chicago, IL: Author. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018651s029lbl.pdf

    Bausch Health US, LLC. (2020) Cesamet: Package insert. Bridgewater, NJ: Author. Retrieved from https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=83c7ac15-ece9-47de-b83c-d575544fa449&type=display

    Chu, F., & Cascella, M. (2021). Cannabinoid Hyperemesis Syndrome. In StatPearls. StatPearls Publishing. Retrieved May 13, 2021 from https://pubmed.ncbi.nlm.nih.gov/31751105/

    Galli, J. A., Sawaya, R. A., & Friedenberg, F. K. (2011). Cannabinoid hyperemesis syndrome. Current Drug Abuse Reviews, 4(4), 241–249. doi: 10.2174/1874473711104040241. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22150623/

    Lee, M., Silverman, S. M., Hansen, H., Patel, V. B., & Manchikanti, L. (2011). A comprehensive review of opioid-induced hyperalgesia. Pain Physician, 14(2), 145–161. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21412369/

    Perisetti, A., Gajendran, M., Dasari, C. S., Bansal, P., Aziz, M., Inamdar, S., Tharian, B., & Goyal, H. (2020). Cannabis hyperemesis syndrome: an update on the pathophysiology and management. Annals of Gastroenterology, 33(6), 571–578. doi: 10.20524/aog.2020.0528. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33162734/

    Richards, J. R., Gordon, B. K., Danielson, A. R., & Moulin, A. K. (2017). Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review. Pharmacotherapy, 37(6), 725–734. doi: 10.1002/phar.1931. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28370228/

    Sorensen, C. J., DeSanto, K., Borgelt, L., Phillips, K. T., & Monte, A. A. (2017). Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review. Journal of Medical Toxicology, 13(1), 71–87. doi: 10.1007/s13181-016-0595-z. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28000146/

    U.S. Department of Justice Drug Enforcement Administration. (n.d.). Controlled Substance Schedules. Diversion Control Division. Retrieved May 14, 2021 from  https://www.deadiversion.usdoj.gov/schedules/