Have you been partaking in the sticky icky daily for more than five years or use the plant medicinally to combat nausea or stomach pain? You may be surprised to learn about cannabis hyperemesis syndrome (CHS). While this article will give you a great summary of CHS, please speak with a medical professional if you think that you or someone you know is suffering from CHS.
Cannabis hyperemesis syndrome: Is it serious?
Cannabis hyperemesis syndrome, also referred to as cannabinoid hyperemesis syndrome or CHS for short, is a somewhat rare condition that can occur with long-term, heavy cannabis use. Cannabinoids are chemical compounds naturally produced within the cannabis plant (though it can also be produced synthetically) that attach to the cannabinoid receptors in the body. The most well known of these compounds are tetrahydrocannabinol (THC) and cannabidiol (CBD), but there are over 100 documented cannabinoids, most of which do not produce any psychoactive effects. The word hyperemesis means severe or extended vomiting, which is the most common symptom of CHS.
Cannabis hyperemesis syndrome is a newly discovered condition, with the first scientific report published in 2004. Researchers found a correlation between chronic cannabis use and cyclical vomiting and it was concluded that “chronic cannabis abuse was the cause of the cyclical vomiting illness in all cases....” Since it is a fairly new syndrome, much more research is needed. CHS is not common, with one study estimating that 6% of all emergency room visits for recurring vomiting are actually due to CHS. However, if left untreated and undiagnosed, cannabinoid hyperemesis syndrome can lead to dehydration, malnutrition, tooth decay, esophagitis, and Mallory-Weiss syndrome (esophagus tears) and become life-threatening. There have been three reported fatalities associated with CHS; two where CHS was documented as the cause of death, and one where CHS was noted, but not the official cause of death.
What triggers cannabinoid hyperemesis?
CHS is caused by naturally produced or synthetic cannabinoids and the method of consumption doesn’t matter, so heavy users of dabs, flower, edibles, or vaping are all susceptible. THC seems to be the culprit and those who partake in other cannabinoids like CBD alone, do not seem to develop CHS. More studies are needed to understand cannabis hyperemesis syndrome and why it’s triggered in some people and not others, but scientists have a few theories:
- A buildup of cannabinoids in the body or an effect of cannabinoid toxicity once a person becomes dose-dependent.
- A trigger of the cannabinoid receptors in the hypothalamus (brain), which is in charge of regulating body temperature and digestion.
- Cannabinoid receptors in the digestive system are being directly stimulated.
- Possible genetic predisposition to metabolizing cannabinoids in an atypical way, making certain individuals more susceptible than others.
- Cannabigerol, a cannabinoid, may be an antagonist to certain cannabinoid and serotonin receptors in the body, reversing or blocking the typical anti-vomiting/anti-nausea effects of CBD that is related to certain effects on the body’s serotonin.
- It may be related to the fact that THC is fat-soluble. THC builds up in fat stores and can be released into the bloodstream when those fat stores are used.
How long does it take for cannabinoid hyperemesis to start?
First, not all pot lovers will get CHS and it is still considered a fairly rare condition. The syndrome affects heavy cannabis users who have been partaking for many years. Some medical experts say CHS can occur after just five years of heavy use, but others define long-term use as about 10 to 12 years. A study of patients who visited the ER found that of those who smoke cannabis 20 or more days each month, 32.9% had symptoms of CHS. This is a great reason to give your body a break and do a complete cannabis detox every now and again.
When to get medical attention
If you believe you have CHS, the syndrome can be reversed simply by stopping all cannabis use and there is no need for a doctor’s visit. However, most times, smokers have no idea that herb is the cause or that cannabis hyperemesis syndrome even exists. If you are a heavy cannabis user and you are combating recurring nausea and vomiting, see your medical provider and mention the possibility of CHS. One of the most dangerous aspects of this syndrome is dehydration caused by consistent vomiting. If you have any symptoms of dehydration such as dark urine, delirium, dizziness, fainting, or unexplained fatigue, go to the emergency room immediately.
CHS symptoms and treatment: Three stages of CHS
The symptoms of CHS typically begin as a belly ache, morning sickness, or nausea, but will progressively get worse if cannabis use is not ceased. These symptoms may sound familiar as cannabis is often used medically to treat nausea and digestion issues. Oftentimes, this leads medical patients to take higher doses of cannabis with the belief that it will relieve their condition, when in actuality, cannabis is the culprit. As cannabinoid hyperemesis syndrome progresses, patients will develop cyclical vomiting episodes up to five times per hour, abdominal pain, and severe nausea. Those with CHS often exhibit compulsive behavior when it comes to taking hot showers and baths as these are the only things that provide some relief. CHS symptoms are broken down into three stages:
Prodromal phaseThe first phase of CHS is categorized by the onset of symptoms that will slowly progress in severity as the patient continues to partake in cannabis. While it depends on each person, the prodromal phase of CHS can last anywhere from several months to years. Cannabis smokers in this phase are having nausea, morning sickness, and stomach pain, but are not vomiting, so are still able to eat and drink as usual. Indicators of the prodromal phase are:
- Morning sickness and nausea
- Belly pain and abdominal discomfort
- Fear of vomiting
If a person doesn’t stop using cannabis or increases use due to their symptoms, they can move into the hyperemetic phase of CHS. This phase is described as an intensification of the symptoms felt during the prodromal phase to the point of being debilitating with patients unable to go about their daily lives. If left untreated in the hyperemetic phase for a prolonged time, symptoms can become life threatening. Patients will typically visit the ER at some point during this phase and will often be misdiagnosed with dehydration since there are many illnesses that share these symptoms and lab tests return negative. Patients will begin to lose weight and feel the effects of dehydration and malnutrition from constant vomiting and retching. This is when patients begin compulsive showering and bathing to temporarily relieve their symptoms. The hyperemetic phase is categorized by:
- Strong, cyclical nausea, and vomiting without warning
- Recurrent retching attacks
- Abdominal pain
- Dehydration
- Weight loss and malnutrition
- Tooth decay
- Frequent showering or bathing
Quitting smoking, vaping, and edibles is the only cannabis hyperemesis syndrome treatment and it is an effective one. As the name suggests, the recovery phase begins once cannabis use is ceased and symptoms begin to subside. This phase can be just a couple of days or a few months, depending on the individual. Traces of cannabis can remain in the body for quite a long time, especially for every day smokers, so it typically takes at least three weeks of no use for symptoms to go away entirely. CHS will return if cannabis use resumes.
How long does cannabinoid hyperemesis syndrome last?
This is the last thing you want to hear, but if you develop CHS, you will probably have to quit consuming cannabis for good. Cannabis hyperemesis syndrome will progressively get worse if a patient doesn’t stop using cannabis. In most cases, CHS symptoms will return if the patient resumes cannabis consumption, even after years of being symptom-free.
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