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A doctor confirmed that Brittany’s years of cannabis use had manifested in CHS. Your doctor probably should send you to see a stomach doctor, who knows more about your problem and can help you feel better. Most people end up having an abdominal ultrasound, upper scope, and a test to see how fast stuff gets out of the stomach before we figure out that their problem is CVS or CHS.
Cannabinoid hyperemesis syndrome (CHS) is a new and underrecognized clinical syndrome
In animal models, CB1 receptor activation in the dorsal vagal complex of the brainstem mediates this effect 35,36. Dronabinol (synthetic THC) and nabilone (a CB1 receptor agonist) are two commercially available cannabinoids for the treatment of chemotherapy-induced nausea and vomiting 37. Cannabigerol (CBG) is a non-psychotropic cannabinoid that behaves as an antagonist at both the CB1 and 5-HT1A receptors 32. This antagonism reverses the anti-emetic actions of low-dose CBD, which likely occurs at the 5-HT1A receptor 33.
Causes of CHS
Other organs where CB1 receptors have been identified are the spleen, heart, liver, uterus, bladder, and vas deferens 10. In the gastrointestinal system, CB2 receptors are expressed by lamina propria plasma cells and activated macrophages, as well as by the myenteric and submucosal plexus ganglia in human ileum 9,12,13. CB2 receptors are likely involved in the inhibition of inflammation, visceral pain, and intestinal motility in the inflamed gut 9,14. In summary, a suggested approach includes an initial evaluation with a comprehensive metabolic panel, ECG, and urine drug screen. Initiate IV fluid hydration and first-line medications such as lorazepam and capsaicin followed by second-line medications haloperidol, aprepitant, or amitriptyline if needed. Discharge criteria include tolerating a regular diet with good pain control.
- Intense cycles of abdominal pain and vomiting typically start within 24 hours of the last cannabis use and can last for days.
- The first reports came from doctors treating regular users of marijuana for nausea and vomiting in South Australia.
- Scromiting was earlier identified in 2004 by Australian researchers who studied about 19 chronic marijuana users battling episodes of abdominal pain and retching.
Emergency room doctors can stabilize the patient and help alleviate the acute symptoms but the only known way to stop the episodes of excruciating abdominal pain and repeated vomiting is to stop using cannabis, Meltzer says. Severe nausea, vomiting, and stomach pain are the hallmark symptoms of cannabinoid hyperemesis syndrome (CHS). The word “cannabinoid” refers to compounds uniquely found in cannabis, and “hyperemesis” means severe vomiting. If you are experiencing severe vomiting or other concerning symptoms, contact your health care provider.
What Does It Mean To Have a Substance Abuse Problem?
Preventing dehydration and stopping nausea and vomiting are the treatment goals during the hyperemesis stage of the condition. When you use weed, these compounds bind to Sobriety cannabinoid receptors found in your brain, digestive tract (gut), and certain cells in your body. Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main cannabinoids in marijuana products. THC is what’s responsible for the “high” most people feel when they use marijuana.
You’re more likely to get CHS if you use marijuana at least once a week and have been doing so since you were a teenager. «Cannabinoid» refers to cannabis (marijuana) and «hyperemesis» is a word meaning «prolonged vomiting.» Intense cycles of abdominal pain and vomiting typically start within 24 hours of the last cannabis use and can last for days. A recent study of more than 1,000 people who have had CHS found that 85% had had at least one emergency department visit and 44% reported at least one hospitalization. Public health responses to CHS are hampered by a lack of comprehensive data and research. The rapid expansion of cannabis legalization has outpaced the research into its health impacts, particularly regarding conditions like CHS.
Getting relief by taking hot showers is a sign that you could have this health problem. Two distinct cannabinoid receptors, CB1 and CB2, have been identified in human and animal models. The CB1 and CB2 receptors function as G-protein coupled receptors that act by inhibiting adenylate cyclase 7. In the brain, CB1 receptors are localized to the cerebral cortex, hypothalamus, anterior cingulate gyrus, hippocampus, cerebellum, and basal ganglia 8. In the gastrointestinal system, CB1 receptors are found on both intrinsic and extrinsic neurons, with the enteric nervous system serving as the major site of action 9.
- Fluid resuscitation is therefore a cornerstone of treatment during the hyperemetic phase.
- The onset of CHS tends to affect people «after years of using marijuana many times a week,» per the American College of Gastroenterology.
- While the overall prevalence of marijuana use has remained stable in the United States at 4%, the prevalence of cannabis use disorders (i.e. cannabis dependence, cannabis abuse) has continued to rise 4.
- In nearly all cases there is a delay of several years in the onset of symptoms preceded by chronic marijuana abuse 6.
- They’ll also examine your abdomen and may order tests to rule out other causes of vomiting.
How common is cannabinoid hyperemesis syndrome?
This buildup is thought to eventually overstimulate the endocannabinoid system, leading to a paradoxical reaction where the drug, which usually suppresses nausea, begins to cause it. Experts also aren’t clear on what causes CHS, or why some people develop it while others don’t. Since it was first identified in 2004 in Australia, researchers have looked at the effects of cannabis on the vomiting centers of the brain. Doctors at the hospital ran tests and ordered scans but could not name the source of her unrelenting nausea and vomiting. It was so bad she thought it might be a recurrence of her severe pancreatitis, the illness for which she once had been hospitalized and put on life support.
Hospitals and emergency departments, especially in regions with high cannabis use, are likely to see a rise in patients presenting with the characteristic symptoms of CHS. The challenge of diagnosing and managing CHS, coupled with the resource strain of frequent hospital visits, may exacerbate the pressure on healthcare facilities. Adequate training and resources should be provided to healthcare professionals to ensure that CHS is correctly identified and treated, and also to help manage the increased patient load. The most effective treatment during the hyperemetic phase of CHS is the use of hot showers by patients. The effects of this learned behavior are temperature-dependent 6, fast acting 6, but short-lived 6,56,62.
Vomiting Syndrome Linked to Cannabis Is on The Rise in The US
Researchers have identified two receptors called CB1 and CB2 to which marijuana molecules attach. Receptors are specialized cells that respond to specific stimuli or changes in the environment. One study looking at Reddit posts on the subject found that spicy food, greasy food, coffee, black tea, and alcohol were frequently mentioned as CHS triggers. These foods/beverages are mostly acidic, but relationships between them and CHS have not been studied scientifically, although the co-use of weed and alcohol is well-known, the study authors said. Your doctor may ask you questions, like how long you’ve been using cannabis and what type of products you normally use.
Patients with CHS frequently appear in emergency departments and are often tested unnecessarily for a wide variety of conditions, misdiagnosed with cyclic vomiting syndrome or assigned nonspecific gastrointestinal conditions. As of June 2025, nearly half of US residents live in states with legalized recreational cannabis, and policy shifts have expanded adult-use access through legalization, medical programs, and decriminalization. Among cannabis-related harms, cannabinoid hyperemesis syndrome (CHS) has been described as a growing concern in clinical and public health settings. They should also have the freedom and empowerment to speak up to other team members if they feel that this may be getting overlooked in the diagnostic picture.