Some people also report weight loss, dehydration, and fatigue due to the relentless nature of the vomiting. This is usually accompanied by nausea, abdominal cramps or pain (especially in the upper abdomen), and a loss of appetite. A unique and telling behavior among those suffering from CHS is compulsive hot bathing or showering, which seems to temporarily relieve the symptoms. The vomiting episodes can be so severe that they lead to dehydration, weight loss, and repeated emergency room visits. Cannabinoid Hyperemesis Syndrome (CHS, or Cannabis Hyperemesis Syndrome) is a condition that develops in some people who use cannabis regularly over a long period of time.
Hyperemetic Stage
- Policies promoting a non-judgmental, open discussion about cannabis use in healthcare settings could help overcome this barrier.
- Some people also report weight loss, dehydration, and fatigue due to the relentless nature of the vomiting.
- Treatment of CHS typically occurs during the hyperemetic phase, which often requires hospitalization due to the severity of symptoms.
- Finally, the recovery phase occurs when patients return to their baseline health status, regardless of whether they resume cannabis use.
People who use marijuana long-term — typically for about 10 to 12 years — are at risk of developing CHS. But the main theory is that it may happen due to long-term overstimulation of receptors in your endocannabinoid system (ECS). Hot baths and showers tend to help reduce or curb the symptoms. But not everyone who uses marijuana long-term experiences CHS.
It affects those who have used cannabis for longer durations and use it once a week or more. People have used it for pain management, sleep issues, and, of course, recreationally. People who don’t get their cannabis legally come in concerned it was laced with something like fentanyl. I’ve seen an increase in patients coming in for ingesting too many edibles and experiencing tachycardia and paranoia. As legislation changes and more states legalize marijuana, there has been an uptick in marijuana-related emergency department (ED) visits.
Fluid resuscitation is therefore a cornerstone of treatment during the hyperemetic phase. Warm stimulation is hypothesized to transiently activate transient receptor potential vanilloid-1 (TRPV1) in the hypothalamus which would otherwise be downregulated by chronic cannabis use . As noted earlier, hot baths or showers provide temporary relief for many patients. Treatment of CHS typically occurs during the hyperemetic phase, which often requires hospitalization due to the severity of symptoms.
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Patients have reported smoking again after no cannabis consumption for months and then immediately find themselves back in the throes of CHS. Going on a marijuana “diet” isn’t foolproof either. Often, we see these patients over numerous ED visits with the same presentation before we can identify the cause of their hyperemesis. Assessing the patient and obtaining a medical history can be challenging due to the patient’s condition. When CHS patients arrive in the ED, serious emergencies such as appendicitis, aortic dissection, and pancreatitis need to be ruled out. When the patient presents to the ED, they’re usually doubled over, screaming, dry heaving, and vomiting.
Your stomach may start to hurt, and you may feel fear about vomiting. Nausea without vomiting is the primary symptom of the prodromal stage. Cannabis is also known as marijuana, weed, pot, and hashish. It includes all products containing the cannabinoid tetrahydrocannabinol (THC). As cannabis becomes more potent and widely available, CHS is increasingly prevalent. This includes not only observational studies but also randomized controlled trials to assess potential treatment options for CHS.
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Now, with the widespread availability of cannabis from dispensaries and the potency of available strains, healthcare providers are seeing a rise in the harmful impacts of chronic use. The stigma surrounding cannabis use, especially in populations who consume cannabis regularly, can deter patients from disclosing their usage to healthcare providers. However, it is essential healthcare providers also address the risk of dehydration and electrolyte imbalances, as these conditions are common in CHS patients and may lead to acute renal failure 27,35. Therefore, cultivating a more accepting healthcare environment for patients using cannabis could improve the accuracy of self-reported data and help in the earlier identification of CHS. The hyperemetic phase is marked by severe, intractable nausea and vomiting, accompanied by abdominal pain, which generally does not respond to antiemetic treatments. While it is possible that legalization has made patients more willing to seek emergency care, the burden of managing these cases ultimately falls on healthcare providers.
Symptoms of Cannabinoid Hyperemesis Syndrome
Since marijuana has long been used as a means to control nausea and vomiting, it seems counterintuitive that it can also be the cause. Before legalization, marijuana had long been used for those undergoing chemotherapy to combat nausea, vomiting, and the inability to eat. For severe nausea, typical antiemetic drugs may have limited effect, so doctors often use, as mentioned, haloperidol or similar medications to stop the vomiting. The exact prevalence of CHS is unknown, but one hospital study found roughly one-third of people who use cannabis daily had CHS symptoms. CHS was first reported in 2004 (Allen et al.), when doctors linked cyclic vomiting in several patients to long-term cannabis use.
Timeline of CHS Syndrome
For patients and healthcare providers alike, awareness of CHS is essential. If you think 5 key differences between crack and cocaine you have CHS or cannabis use disorder, talk to a healthcare provider. If you need help quitting, speak to a healthcare provider or connect with your local addiction treatment services. When patients are told that chronic cannabis use is the root cause of their violent vomiting and abdominal pain, they are reluctant to believe it or vehemently disagree with the diagnosis.
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Until the past decade, marijuana, specifically THC, had been largely illegal to possess and use, and its legalization has prompted new medical insights into its effects, both positive and negative. This article summarizes the symptoms, pathogenesis, treatments for CHS, and differential diagnoses to further increase our understanding of this condition. Misdiagnosis of this condition is extremely common, and it is often confused with cyclic vomiting syndrome (CVS). If you’re ready to feel like yourself again—without the cycle of nausea, pain, and confusion—we’re here to walk the journey with you. Long-term recovery, however, may require a more comprehensive approach, especially if you’re struggling with withdrawal symptoms or the emotional side of quitting. We offer medical guidance, emotional support, and structured care to help you move forward without relying on substances that are doing more harm than good.
This effect is thought to be mediated through capsaicin’s interaction with the TRPV-1 receptor, which plays a role in the endocannabinoid system and may modulate nausea and vomiting pathways . Furthermore, in cases where patients resumed cannabis use after a period of abstinence, the same symptoms reemerged . In contrast, patients who continued using cannabis experienced persistent symptoms.
- If you experience symptoms related to cannabinoid hyperemesis syndrome, you should immediately stop using cannabis.
- These can last months or years before the severe vomiting phase.
- Chronic cannabis use and its health complications could impact an individual’s long-term productivity, education, and career, leading to a broader economic burden on society.
- CHS is a disorder that paradoxically causes abdominal pain, nausea, and uncontrollable vomiting in long-term cannabis users rather than alleviating pain and reducing nausea.
- During this stage, hot showers and baths can help with symptoms.
Many people take a lot of hot showers during the day. Some people also develop a fear of vomiting. That may cause the repeated bouts of vomiting found in people with CHS. The drug is also good at stopping such symptoms in people having chemotherapy.
The Three Stages of CHS Symptoms
One such adverse effect is cannabinoid hyperemesis syndrome (CHS), a condition characterized by recurrent nausea, vomiting, and abdominal pain. CHS is a disorder that paradoxically causes abdominal pain, nausea, and uncontrollable vomiting in long-term cannabis users rather than alleviating pain and reducing nausea. Despite its widespread reputation for alleviating nausea and stimulating appetite, chronic cannabis use has been linked to a paradoxical condition known as cannabinoid hyperemesis syndrome (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. This comprehensive review explores the epidemiology, pathophysiology, diagnosis, treatment, and public health implications of CHS, aiming to bridge knowledge gaps and provide directions for future research. However, as cannabis use has increased, particularly in regions with legalized markets, CHS has become an emerging public health concern.
Other cannabinoids, such as CBD and cannabigerol (CBG), may also contribute to the development of CHS. The half-life of THC ranges from 20 to 30 hours, though this can vary depending on the cannabis product . These cannabinoids bind to cannabinoid receptors type 1 (CB1) and type 2 (CB2), which are distributed throughout the body. Cannabis contains over 100 different cannabinoids, with delta-9-THC and CBD being the primary compounds. Emerging research highlights the potential involvement of mutations in the cytochrome P450 (CYP) enzymes, which affect cannabinoid metabolism. Beyond cannabis use, genetic predisposition plays a crucial role in CHS development.
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