Cannabinoid hyperemesis syndrome, what is it and how to treat it?

Excessive use of cannabis can lead to negative consequences that can affect some people. Some of the most known consequences are addiction, anxiety, psychotic symptoms or irritability. Although, its consumption causes also diseases but they’re still unknown to the population as well as to professional doctors. Among these is Cannabinoid Hyperemesis Syndrome or CHS, also known as Cannabis Vomiting Disease, discovered in 2004.

What is cannabinoid hyperemesis syndrome?

Cannabinoid hyperemesis syndrome is a condition that produces frequent and intense vomiting and nausea. It is a rare condition that occurs in daily cannabis users.

This is due to THC, which together with other substances sticks to the molecules in the brain. It also affects the digestive tract, emptying the stomach and the esophageal sphincter, the band of muscle that allows food to pass to the stomach.

Generally, this syndrome affects people who have used cannabis for years on a regular basis, at least once a day. However, not all users are affected by this syndrome, and the causes of its occurrence are still a mystery.

Symptoms of cannabinoid hyperemesis

People with CHS suffer from repeated vomiting attacks followed by periods without symptoms. Doctors divide the condition into three stages:

• Pre-emetic phase: The symptoms of this phase are morning nausea and vomiting combined with abdominal pain. The diet continues to be the same and be careful not to increase the dose of THC thinking that its antiemetic properties will reduce the vomiting, this would make the situation worse. This phase can go on for months or even years without a diagnosis; the symptoms evolve without you realising.

• Hyper emetic phase: This phase appears cyclically, lasting 24-48 hours or several days. At this stage, go to the doctor if you experience the following symptoms:
  • Frequent nausea
  • Repeated episodes of vomiting.
  • Abdominal pain.
  • Weight loss.
  • Symptoms of fluid loss (dehydration).

Patients normally take hot water showers to relieve symptoms. A possible cause is that the temperature influences the hypothalamus, which is responsible for controlling temperature and nausea.

• Recovery phase: When the symptoms disappear, the person starts eating normally again; this can last up to months.

What causes this syndrome?

We still don’t know why some users are affected by this syndrome and others are not. Cannabis has two different effects on the body. At the brain level it relieves nausea, and therapeutic cannabis is desirable for people undergoing chemotherapy, but at the digestive tract level it has the opposite effect.

At first, the signals received by the receptors in the brain are more important. But when they stop responding, it can cause vomiting. It is thought that the main difference lies in the genetic factors specific to each individual.

How to diagnose and treat it?

The existence of multiple health problems related to repeated vomiting makes diagnosis complicated. The doctor asks questions about the symptoms and medical history. A physical examination, especially of the abdomen, will usually be necessary to rule out other problems. Usually several tests will be done, including blood and urine tests, abdominal X-ray, endoscopy of the intestinal tract or a pregnancy test.

Due to its recent discovery, doctors often fail to detect this type of condition, and it can take years to occur. It happens to confuse it with cyclic vomiting disorder, a condition with similar symptoms. The following is a list of symptoms indicate the possibility of suffering from CHS:

• Chronic daily use of cannabis.
• Pain in the abdomen.
• Repeated nausea and vomiting.
• Improvement after a hot shower.

The only thing that confirms this diagnosis is a complete improvement after stopping the use of cannabis.

To treat it, it is sometimes necessary to stay in hospital for a few days, taking medication:

• Painkillers and medication for pain.
• Regular hot water showers.
• Medication for anxiety.
• Rubbing the abdomen with capsaicin creams to reduce pain.

The symptoms will disappear completely by stopping using cannabis.

Cannabinoid hyperemesis syndrome can occur in chronic users, going through different phases. However, the reasons why some people have it and others don’t are not yet known; it is important to study this in order to help the medical community to recognise and treat this type of condition.