Symptoms, patients often eat well, maintain weight, and remain functional at work. The patients continue using cannabis in this phase, believing in its anti-nausea effects. The chemoreceptor trigger zone sends signals via the efferent vagus nerve, triggering responses in the parasympathetic and sympathetic nervous systems. This activation leads to the emetic reflex, which includes increased salivation, deep breathing, glottis closure, pyloric sphincter relaxation, retroperistalsis, and abdominal muscle contraction.
Cannabinoid hyperemesis syndrome
Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months. Cannabinoids are often utilized for their drug addiction antiemetic properties, so CHS can be a puzzling condition, and the diagnosis of CHS may be disputed by patients. Unlike other cyclic vomiting syndromes, CHS can be relieved by hot showers or topical capsaicin. Abstinence from cannabinoids causes CHS to resolve, sometimes in a matter of days or hours.
Dysregulated stress response in nausea and vomiting
Although there were very few case studies involving CHS patients with eating disorders, bulimia might present in such a way that it could be confused with CHS. About 35% of individuals with some form of substance use disorder have an eating disorder (which typically precedes the substance use disorder) versus 5% of the general population 174. A recent, published in 2016, case report describes the first use in the literature of propranolol to treat CHS 117. A 37-year-old man in profound distress suffering hyperemesis presents at the ED, stating he had similar experiences in the past which could be relieved with hot showers, but this time hot water provided no relief. The patient admitted he had smoked marijuana on a daily basis for the past 20 years. In the ED, the physician treated him with IV propranolol 1 mg as this had been effective in cases of CVS.
What does cannabinoid hyperemesis syndrome feel like?
- This antagonism reverses the anti-emetic actions of low-dose CBD, which likely occurs at the 5-HT1A receptor 33.
- Although laboratory examinations and advanced imaging studies (e.g., CT scans, ultrasounds) are often negative, they play a crucial role in ruling out other conditions.
- TRPV1, PPARα, GRP55, and GRP119 are the other receptors influenced by cannabinoids 27.
Antipsychotics including haloperidol and olanzapine have been reported to provide complete symptom relief in limited case studies. Conventional antiemetics including antihistamines, serotonin antagonists, dopamine antagonists and benzodiazepines may have limited effectiveness. Emergency physicians should avoid opioids if the diagnosis of CHS is certain and educate patients that cannabis cessation is the only intervention that will provide complete symptom relief. The onset of symptoms was reported in 13 of those cases at a median of 9 years (range 3–25 years). In the limited subset of cases where data were available, it appeared that it took a mean of 2.6 years (range 1 day to 9 years) to get a CHS diagnosis.
- With many states legalizing the use of both medical and nonmedical marijuana and increasingly favorable public opinion emphasizing the benefits marijuana, it is reasonable to expect its use will become more frequent and widespread.
- While pesticides can lead to adverse health problems, this is likely not the cause of CHS.
- Cannabis hyperemesis syndrome (CHS) is a gut–brain axis disorder characterized by recurring nausea and vomiting intensified by excessive cannabis consumption.
- In contrast, patients who continued using cannabis experienced persistent symptoms.
How Does Cannabinoid Hyperemesis Syndrome Affect Mental Health?
The FDA approves its use for chemotherapy-induced nausea and vomiting when other anti-emetic treatments fail. Cannabis broadly affects the gastrointestinal system, affecting its secretions, appetite, inflammation, and motility 13,14,15. Cannabis has over 100 cannabinoids in it and has varied effects and toxicity dependent on the THC-to-other-cannabinoids ratio 16.
Because of this possible complication, it’s important to use caution with marijuana and other cannabis products. If you think you have CHS or cannabis use disorder, talk to a healthcare provider. If patients present after a protracted course of nausea and vomiting, there may be electrolyte derangements, ketonuria, or other signs of dehydration.
While several treatments provide symptom relief, it what is chs weed is important to be cautious with certain medications. Narcotic pain medications, for instance, should generally be avoided in CHS patients. Opioids may exacerbate CHS symptoms due to their association with bowel dysfunction, and they could also potentially lead to opioid dependence in chronic users 47. Additionally, the prolonged use of certain antiemetics, such as ondansetron, may have limited benefit in CHS, further highlighting the need for individualized management plans. The studies included focused on individuals diagnosed with CHS, as well as those with comparable conditions such as CVS, and chronic cannabis users exhibiting symptoms similar to CHS. A key focus was on studies that included detailed demographic information such as age, gender, and cannabis usage patterns, as well as data regarding co-morbidities, substance use history, and prior treatments.
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- Cannabinoid Hyperemesis Syndrome (CHS), first described in 2004,2 is characterized by cyclic vomiting that occurs in the context of chronic daily or near-daily cannabis use.
- Receptor activation leads to inhibitory effects on the release of growth hormone, thyroid hormone, prolactin, and luteinizing hormone 38.
- This can sometimes take several weeks, even 2-3 months to fully take effect.
However, reliable data on the incidence and prevalence of CHS are not known. Of this patient population, 32.9% (95% confidence interval, range 24.5–40.3%) were considered to have met criteria for CHS (chronic cannabis use, episodes of sometimes severe nausea and vomiting, symptomatic relief from hot showers) 72. If these results are applied to the general population of regular marijuana users in the US, it is possible that 2.75 million Americans (range 2.13–3.38 million) suffer from CHS 72. It is likely many are not even aware that their symptoms relate to their cannabinoid use.
Activating CB1 receptors reduces gastric motility, resulting in delayed gastric emptying in murine 49, 50 https://ecosoberhouse.com/ and human studies 51, 52. The delay in gastric emptying seems as if it would be promote emesis 53, yet this delay often occurs with the antiemetic benefits of THC, possibly because those antiemetic effects override the effects of delayed intestinal motility 13. This applies not just to botanical marijuana; dronabinol (delta-9-tetrahydrocannabinol) slows gastric emptying and decreases colonic tone as well 54. The objective of our research was to establish a clinically meaningful description of CHS and its presentation, to evaluate diagnostic challenges in identifying this syndrome, and to describe effective treatment options.
As CHS is a new diagnosis, the manufacturers of these drugs did not design them for treating CHS, but a doctor may opt to prescribe them for this use. As CHS is a newly described condition, many doctors may find it challenging to diagnose and treat. Researchers have tried to explain what causes CHS, but further study is necessary. CHS is a relatively new disorder that is not only difficult to diagnose but to manage. Theara Coleman has worked as a staff writer at The Week since September 2022.
Cannabis Hyperemesis Syndrome is a complex condition that can cause serious health complications, including repeated vomiting, cyclical nausea, and gastrointestinal distress. While the symptoms of CHS are often mistakenly attributed to other disorders, early diagnosis and quitting cannabis are crucial for managing the condition. Patients diagnosed with CHS may require emergency medicine or treatments such as anti-nausea medications, topical capsaicin, or hot water hydrotherapy to relieve symptoms.