A look at cannabinoid hyperemesis syndrome

Activating neurological cannabinoid receptors may help prevent nausea and vomiting, especially in patients undergoing chemotherapy. Given the common effects of THC and other cannabinoids on receptors in the brain, cannabinoid hyperemesis syndrome (CHS) appears to be a paradoxical condition. Why do some people suffer from this syndrome?

First described in 2004, CHS typically affects long-term cannabis users more than occasional users. It is a condition characterized by chronic cannabis use, cyclical episodes of nausea and vomiting, and excessive bathing or showering with hot water to relieve symptoms and find relief. As more states legalize cannabis for medical and adult recreational use, emergency rooms across the country are seeing an increase in the number of people being diagnosed with cannabinoid hyperemesis syndrome (CHS).

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It has been suggested that in some people the receptors in the brain no longer respond to cannabis as usual. Meanwhile, cannabinoid receptors in the gastrointestinal tract, which appear to have the opposite effect on nausea and vomiting, are still activated. When this happens, gastrointestinal receptors in the brain that are no longer overshadowed by the effects of cannabis lead to abdominal discomfort, pain, and nausea.

CHS is divided into three phases; Prodromal, hyperemetic and recovery phases. In the prodromal phase, sufferers may experience early morning nausea and abdominal pain, although most maintain normal eating habits. Some may increase their cannabis consumption and seek relief from general discomfort. This phase is often misdiagnosed due to non-specific symptoms and can last months to years.

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In the hyperemetic phase, sufferers experience persistent nausea, multiple episodes of vomiting, increased abdominal pain, reduced food intake and weight loss, and dehydration. During this time, hot showers tend to ease the discomfort and nausea. This phase can last until a person stops using cannabis completely. It usually takes one to two days for the hyperemetic phase to subside.

Treatment is palliative in the hyperemetic phase as the endocannabinoid system takes some time to return to an inactivated state. Intravenous fluids are given to prevent or treat dehydration, antiemetics and proton pump inhibitors are given to relieve vomiting and nausea, and capsaicin cream is also applied to the stomach.¹ Eventually, in the recovery period, the person begins to resume their normal eating habits and will stop , suffering from gastrointestinal problems. This phase can last days or weeks, but symptoms may return after consuming cannabis.

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It has been theorized that the recent increase in CHS cases may be due to the increased availability of high-potency THC products.¹ However, a recent Canadian study suggests that other factors may also be at play. Two groups were compared, one with CHS and one consisting of cannabis users who did not. The study found that there was no apparent connection between cannabinoid concentrations in individuals and the occurrence of CHS.4 In any case, further research into the specific cannabinoids and receptors involved will be required to fully understand CHS in the future.