Cannabinoid Hyperemesis Syndrome: An Emerging Medical Enigma

Cannabis, or marijuana, a plant-based substance with a storied history of medicinal, recreational, and illicit usage, has grown in social acceptance and legal recognition over the past few decades. As of September 2021, it was legalized for medicinal use in many countries and recreational use in many jurisdictions. However, as with any pharmacologically active substance, its use can lead to unforeseen complications. One such complication is Cannabinoid Hyperemesis Syndrome (CHS), a relatively new and somewhat mysterious condition that has emerged in the medical literature in the 21st century.

CHS was first identified in 2004 in a small case series, and research into this syndrome has steadily grown. CHS is characterized by cyclic episodes of debilitating nausea, vomiting, and abdominal pain in patients with a history of chronic cannabis use. Despite being widely unrecognized and underdiagnosed, it has increasingly become a concern among healthcare providers, particularly in regions where cannabis usage is widespread. It's worth noting that a 2019 study published in "Basic & Clinical Pharmacology & Toxicology" estimated that CHS may be present in around 2.75% of cannabis users.

What Triggers Cannabinoid Hyperemesis?

Although the exact pathophysiology of CHS is not fully understood, a widely accepted theory attributes the syndrome to the interaction between cannabinoids and the cannabinoid receptor type 1 (CB1) present in the brain and the digestive system. Cannabis has over 100 cannabinoids, with Delta-9-tetrahydrocannabinol (THC) being the most potent and best studied. THC acts on CB1 receptors, resulting in anti-emetic effects in the short term, but chronic stimulation of these receptors seems to induce paradoxical hyperemesis.

Chronic cannabis use can lead to slowed gastric emptying (gastroparesis), which in turn could provoke the symptoms of nausea and vomiting seen in CHS. Moreover, the thermoregulatory function of the hypothalamus can be disrupted by chronic cannabis use, explaining the characteristic symptom of CHS patients finding relief from hot baths or showers.

What Are The First Signs of Cannabinoid Hyperemesis Syndrome?

CHS typically manifests after a few years of regular, heavy cannabis use. Initial symptoms include the development of mild nausea and fear of vomiting (emetophobia), often dismissed by the patient as being unrelated to cannabis use. There may also be abdominal discomfort or pain and diminished eating ability.

These early symptoms are typically followed by more frequent episodes of intense nausea and vomiting. The vomiting can be so severe and prolonged that it may lead to complications such as dehydration, electrolyte imbalance, and weight loss. A unique feature of CHS is the learned behavior of frequent hot bathing, which seems to provide temporary symptomatic relief.

What Are The Three Stages of Cannabinoid Hyperemesis Syndrome?

CHS is usually divided into three stages: the prodromal phase, the hyperemetic phase, and the recovery phase.

Prodromal Phase: This is the early stage of the syndrome, where the patient experiences initial symptoms such as mild nausea, abdominal discomfort, and fear of vomiting. Patients may increase their cannabis use during this phase, mistakenly believing it will help with nausea. This stage can last for months or even years.

Hyperemetic Phase: The hallmark of this phase is intense and persistent nausea and vomiting, which can occur several times an hour, leading to severe complications like dehydration and weight loss. Patients may also experience abdominal pain and continue to use hot baths or showers for symptom relief. This stage requires medical intervention for rehydration and symptom management.

Recovery Phase: This phase begins once the patient abstains from cannabis use. Symptoms start to decrease, and the patient's normal eating patterns, weight, and bathing habits are restored. This phase can last days to months, but the syndrome may recur if cannabis use is resumed.

How To Prevent It?

The only known definitive prevention and treatment for CHS is abstaining from cannabis. While this might sound simple, it can be challenging for people who depend on cannabis for its therapeutic effects or for those with substance use disorders.

Other preventive measures include spreading awareness about CHS among regular cannabis users and healthcare providers. Early recognition and diagnosis are essential for preventing the syndrome's progression to more severe stages.

Healthcare providers can also consider recommending alternative treatments or medications for patients using medical cannabis, particularly those at risk or showing early signs of CHS. Counseling and support for cannabis cessation might be necessary for some individuals.

Living with Cannabinoid Hyperemesis Syndrome

In the midst of medical descriptions, statistics, and treatment strategies, the personal experiences of those living with CHS often get overshadowed.

Imagine the pervasive aroma of cannabis that once signified relaxation and tranquility now acting as a harbinger of unrelenting nausea and pain. This is the stark reality for many CHS patients, who report a drastic shift in their relationship with cannabis. What was once an ally morphs into a foe, a cruel twist of fate that is often hard to comprehend and accept. 

Living with CHS can be a lonely and confusing journey. Misdiagnosis is common due to the syndrome's relatively recent recognition, leading to a lengthy and often frustrating process to determine the cause of symptoms. And while the cure—abstaining from cannabis—may seem simple on paper, the reality is far more complicated. 

However, abstaining from cannabis has greatly enhanced the quality of life for many people with CHS. This can lead to a time of introspection and development, during which more constructive methods of dealing with stress and taking care of oneself are adopted. It proves that the human spirit can overcome great adversity and serves as a reminder that happiness may be found even in the darkest times.

CHS's psychological and emotional effects must be recognized and addressed to gain a complete understanding of the condition and effectively combat it. This two-pronged strategy is crucial for providing a more thorough, compassionate, and efficient response to this new medical syndrome.

Bottom Line

Even though cannabis is now widely used in both recreational and medical settings, there are still dangers associated with its consumption that should not be ignored. CHS is a recently identified syndrome that may become more widespread as cannabis use increases. Understanding the causes and progression of this illness is important for healthcare providers as well as patients. The only surefire remedy is to stop using cannabis altogether, so using this ancient and powerful plant with caution and moderation is important. For more information, visit our FAQ page or book an appointment by clicking the link below.