Long-term marijuana use can lead to an illness called cannabinoid hyperemesis syndrome, or CHS.

This syndrome is classified by bouts of extreme nausea and vomiting, often combined with significant abdominal pain and a suppressed appetite, a desire to take hot showers or baths, and periods of no symptoms.

Cannabinoid hyperemesis syndrome can lead to weight loss, dehydration, and serious complications. It is unclear how many people may struggle with CHS, which is often mistaken for cyclic vomiting syndrome (CVS).

Long-term and chronic use of cannabis can lead to CHS.

Cannabinoid hyperemesis syndrome is best treated by stopping cannabis use completely. There are some medications and remedies that can help to manage it as well.

Marijuana Use

The National Institute on Drug Abuse (NIDA) reports that marijuana is the most widely used illicit drug in the United States.

The National Survey on Drug Use and Health (NSDUH) reports that in 2016, approximately 24 million Americans were considered to be current users of marijuana.

Marijuana is legal in many states for adult recreational use and in even more states for medicinal purposes.

Marijuana is often used to treat anxiety, pain, and nausea. It can also be given to patients to increase appetite and help with sleep.

Why Cannabinoid Hyperemesis Syndrome Occurs

Marijuana is commonly thought to relieve nausea and vomiting. It can seem paradoxical that regular use of the drug can lead to hyperemesis or extreme bouts of vomiting and nausea.

The journal Current Psychiatry reports that the vast majority of people who suffer from CHS (95 percent) used cannabis heavily on a daily basis for a period of close to 10 years.

Marijuana contains tetrahydrocannabinol (THC), which interacts with CB1 and CB2 receptors in the brain and body. CB1 receptors are found throughout the central nervous system as well as in organs like the heart, liver, spleen, vas deferens, uterus, and bladder. CB2 receptors interact with the immune and gastrointestinal systems.

Regular and repeated use of marijuana can cause disruptions to these organs and receptors, which may reverse the antiemetic properties of cannabis.

Chronic, heavy, and long-term use of marijuana can then lead to the onset of CHS.

Signs and Symptoms

Natural Medicine Journal reports the following as signs of CHS:

  • Cyclic nausea and vomiting
  • History of regular cannabis use for a long period of time
  • Use of cannabis weekly or more
  • Abdominal pain
  • Compulsion to take hot baths or showers to relieve symptoms
  • Relief of symptoms when cannabis use is stopped

Phases of CHS

CHS typically has three main phases: prodromal, hyperemetic, and recovery.

Prodromal Phase

During the prodromal, or pre-emetic phase, individuals may wake up feeling nauseated, suffer from some abdominal pain and be afraid of vomiting. This phase can last for several months or even years with prolonged and continued cannabis use.

Hyperemetic Phase

This phase generally lasts between 24 and 48 hours. It includes severe bouts of uncontrollable and unpredictable vomiting and significant nausea, appetite suppression, and stomach pain. It can lead to significant weight loss.

Frequent hot bathing can become compulsive, as it seems to relieve symptoms temporarily.

The hyperemetic phase can last as long as a week. It can cause severe dehydration and end in a trip to the emergency room.

Symptoms can subside within 12 hours of stopping cannabis use, although a full resolution of symptoms can take up to three weeks.

Recovery Phase

This phase lasts as long as cannabis use is stopped. A return to using can bring on a relapse of the syndrome.

Effective Treatments for CHS

The most effective and safe treatment for cannabinoid hyperemesis syndrome is to stop using cannabis entirely.

The journal Current Drug Abuse Review publishes that the two main modalities of treatment for CHS are therapy for the hyperemetic phase and relapse prevention during the recovery phase.

Hospitalization is typical during the cycles of vomiting, pain, and nausea brought on during the hyperemetic phase. Treatments include rehydration, often through intravenous (IV) fluids and proton pump inhibitors. Anti-emetic medications are commonly introduced, although they are not typically extremely effective for CHS.

One of the safest and most effective symptom-relieving methods is taking hot baths or showers. It is not entirely clear why this works. It perhaps serves to regulate body temperatures that can be disrupted by cannabis use.

Invasive testing can worsen CHS and is not recommended.

The Journal for Nurse Practitioners reports that Haldol (haloperidol) can be an effective medication for treating the hyperemetic phase of CHS.

According to the journal Case Reports in Psychiatry, haloperidol’s effectiveness on reducing vomiting and nausea related to CHS may be due to the way the medication suppresses dopamine interaction in the brain. Haloperidol may have an indirect impact on CB1 receptors and therefore works to minimize symptoms of CHS.

Benzodiazepine drugs may address symptoms of CHS, although these drugs are also addictive and should be used with caution. Opioid drugs for the pain are not recommended.

The topical application of capsaicin to the backs of the arms and stomach can help to alleviate nausea, vomiting, and abdominal pain related to CHS, ALiEM (Academic Life in Emergency Medicine) publishes.

Cannabis Cessation

All of the treatments for cannabinoid hyperemesis syndrome include stopping cannabis use in addition to pharmacological or other methods. As soon as marijuana or cannabis use is started again, the symptoms of CHS can return.

NIDA states that marijuana is indeed an addictive drug. Close to a third of people who use it struggle with addiction involving the drug.

Treatment methods for CHS should include addiction treatment services as well. Addiction treatment programs include services like:

  • Group and individual counseling
  • Behavioral therapies
  • Support groups
  • Relapse prevention workshops
  • Skills training

Addiction treatment is one of the safest and most effective methods for treating cannabinoid hyperemesis syndrome. It is often combined with additional supportive and pharmacological methods during the hyperemetic phase.

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