Cannabinoid hyperemesis syndrome (CHS) is a rare digestive condition causing severe and recurrent episodes of vomiting in people who have used marijuana daily for a long time.
The cause is the reaction generated by some of the 400 active substances in marijuana. When they bind to receptors in the brain, it causes a calm high. Doing the same in the digestive tract causes delays in critical functions like gastric emptying and a worsening of others including reflux.
Because CHS is a relatively new diagnosis – the first cases were only described in medical literature about a decade ago – it’s easily undiagnosed or misdiagnosed for years. For a quick diagnosis, it’s key to see experienced specialists like those at the Neurogastroenterology & Motility Center.
The largest population of patients currently at risk of CHS are young adults who have been among the largest consumers of marijuana since it was legalized in many states.
Symptoms & Diagnosis
CHS can also be a challenge to diagnose because it often mimics other motility disorders. We conduct a careful, detailed medical history and physical exam with each patient to hopefully reach an accurate diagnosis quickly.
The most common symptoms of CHS are:
- Recurrent bouts of vomiting
- Gagging
- Retching
Patients with CHS fall into one of these three progressively more serious phases:
- Prodromal Phase. Patients experience early morning nausea and abdominal pain but no change in appetite. Many might increase marijuana use to control the nausea, but that is usually ineffective.
- Hyperemetic Phase. Patients experience almost constant nausea and severe episodes of vomiting, with significant abdominal pain, poor appetite, weight loss and dehydration. During this phase, hot baths and showers seem to help ease symptoms.
- Recovery Phase. Symptoms ease or resolve and patients can start eating almost normally. However, ongoing marijuana use will trigger repeat cycles of attacks.
Having CHS can also lead to complications related to the severe vomiting. Stomach acid generated while vomiting can irritate the lining of the esophagus and cause tooth decay. You can also become chronically dehydrated, which can lead to some degree of renal failure, low blood pressure, muscle cramps, dizziness and fainting.
Treatment Options
The only reliable way to treat CHS is to stop using marijuana. This can sometimes take weeks to months to realize the full effect in your digestive tract. During that time, we can prescribe medicines and supplements to reduce the severity of attacks and help you manage symptoms. Cognitive behavioral therapy can also help you stop using marijuana. When use stops, the symptoms do not usually return.