Marijuana Use and Nausea: It May Be Cannabis Hyperemesis Syndrome

People who regularly use marijuana might not know the drug can cause severe stomach pain, nausea, and vomiting episodes — a condition known as cannabis hyperemesis syndrome.

Cannabis has long been controversial, with opinions divided on its medical benefits and recreational use. However, a relatively new condition has emerged amidst the debates — cannabis hyperemesis syndrome (CHS).

This perplexing medical phenomenon has caught the attention of health professionals and researchers, driving them to unravel the mysteries surrounding its causes, symptoms, and potential treatments.

What is CHS?

CHS is a health condition that can occur in long-term or frequent cannabis users. The syndrome manifests in recurring episodes of intense nausea, relentless vomiting, and abdominal pain.

Unlike other adverse reactions to cannabis, which tend to resolve after the effects of the drug wear off, CHS symptoms can persist for hours to days, leading to severe dehydration, weight loss, and a significantly reduced quality of life.

The history of CHS dates back to the early 2000s when researchers first documented cases of patients experiencing persistent vomiting due to cannabis use. Since then, similar cases have been reported worldwide, particularly in regions where marijuana has become more socially accepted.

In a 2018 study, researchers estimated that as of 2014, approximately 2.1 to 3.3 million people in the United States have experienced CHS. However, the scientists say the syndrome's prevalence is likely higher due to current trends in cannabis use.

Diagnosing CHS can be challenging due to its similarity to other gastrointestinal conditions. Medical professionals often exclude other potential causes through tests and examinations before arriving at a CHS diagnosis — especially if the person doesn't reveal their cannabis use.

Unfortunately, the lack of awareness and knowledge surrounding CHS may lead to misdiagnosis, delays in treatment, and unnecessary suffering for people experiencing the syndrome.

What's it like to have cannabis hyperemesis syndrome?

Jason, a 29-year-old man from the upper Midwest recently diagnosed with CHS, told Healthnews that his stomach symptoms began to emerge in 2020.

"I had been smoking in the mornings and throughout the day. However, if I went to work, I would smoke in the morning and then not really all day," he explained. "But then when I would get home, I would smoke all night too."

Then Jason started to experience vague symptoms which he couldn't pinpoint to any known cause. For example, he began to have blood with bowel movements, stomach pain, headaches, and generally felt unwell.

Then, the symptoms began to get worse.

"I'd have stomach pain in the morning and just not really be able to eat anything, and it would take me down with headaches and other symptoms," Jason said. "And then it would eventually build towards throwing up for a day or a few days at a time."

Though Jason was honest with healthcare providers about his cannabis use, they ordered a colonoscopy, endoscopy, and other tests to search for the cause of his symptoms. However, these tests did not result in a diagnosis.

Then, on a car trip, Jason's symptoms worsened. "Six hours into the trip, I started feeling super sick," he explained.

However, this time, once the vomiting episode started, it lasted for 11 days.

"I went to the ER, and that's when the doctor told me — CHS," Jason said. "And I had been dealing with my doctor for the past six months. I had gotten a colonoscopy, I've done all these things, and nobody had mentioned anything."

Jason said that for over a year, he thought he had a potentially lifelong illness like Crohn's disease, IBS, or worse. But when the doctor mentioned CHS, he was relieved.

"I went 11 days with throwing up, and when that doctor talked to me about it finally — I'm like, done [with cannabis], easy," Jason explained. "I thought I had a disease."

That's when he decided to take a break from cannabis. "After dealing with something like that, it was an easy decision to make," he said.

Notably, some people who have CHS may deny they have the condition, which can hamper diagnosis and treatment.

"When I went back for my final checkup, [the doctor] said about three or four other patients have been dealing with this for about a year. One is very serious and has been [vomiting] for about a week. And none of the patients believe it's from THC or cannabis use," Jason explained.

Treating CHS

Currently, there are no specific medications designed specifically for treating CHS. Instead, the focus is on managing symptoms.

Anti-nausea medications, intravenous fluids to combat dehydration, and electrolyte replacements are among the supportive measures used to help patients through CHS episodes.

The most effective treatment for CHS is to cease all cannabis use. This means abstaining from any form of cannabis product, including low-potency products such as gummies.

- Harsh Sheth, a surgical gastroenterologist in Mumbai, India

Harsh also says it's critical to seek medical attention if symptoms persist.

"In some cases, antiemetic medications or hot baths may also be prescribed by a healthcare professional in order to help alleviate the symptoms," Harsh explained.

Jason agrees that hot baths and showers can be helpful during CHS episodes. His healthcare provider also recommended applying capsaicin cream, a substance derived from red-hot chili peppers, to the abdomen, which helped combat some of the symptoms.

While the cornerstone of CHS management is discontinuing cannabis use, for individuals with a dependency on cannabis, this can be a daunting challenge. However, support from healthcare providers, counselors, and support groups may help people overcome cannabis misuse and find alternative coping mechanisms.

Still, two weeks after Jason stopped using cannabis, he noticed significant changes, including less stomach pain.

Within four weeks, I had no stomach pain, felt less anxiety, less paranoia. I think that a lot of weed smokers don't really see that until they take a multi-month-long break.

- Jason

Why are cases of CHS increasing?

Harsh says that the incidences of CHS are likely increasing due to the potency of cannabis products and an increase in regular and frequent use.

He explains that cannabis products are becoming more potent due to advances in cultivation and extraction techniques, resulting in higher concentrations of THC. Additionally, new trends such as vaping and edibles have allowed for greater access to these high-potency cannabis products.

"Generally speaking, high-potency cannabis products such as vape pens, waxes, and shatter are more likely to cause CHS than lower-potency products such as gummies," Harsh explains. "However, it is still possible for any form of cannabis use to trigger a CHS episode."

A recent case report published on August 21 describes CHS as having three phases:

1. Prodromal phase
2. Hyperemesis phase
3. Postdrome phase

In the first phase, there may be some abdominal discomfort and nausea, but patients are able to continue normal eating habits. In the second phase, people continuously vomit. In the third phase, vomiting may last up to two days with abdominal pain persisting for 10 days.

Even though cannabis is used for chemotherapy patients in order to alleviate nausea and vomiting, THC may interact with receptors in the gastrointestinal system. Researchers believe that higher doses and use repeatedly over a prolonged amount of time may induce CHS.

Therefore, as time creeps on, more people may be diagnosed with CHS.

Still, the mechanisms behind CHS remain unclear. However, some experts believe long-term exposure to the psychoactive compound in cannabis, delta-9-tetrahydrocannabinol (THC), may lead to alterations in the endocannabinoid system, disrupting its balance. This disruption may trigger the development of CHS symptoms.

Moving forward after a CHS diagnosis

Currently, Jason says he still uses cannabis sparingly, but paying attention to stomach symptoms helps him realize when he might be using too much or too often.

Though everyone experiences being cannabis-free differently, Jason says, "I would say it's good to take breaks. That was the biggest thing I learned."

He adds, "I think if you can get someone to go on that break, once they reach that one month, two-month point, [of being cannabis free], they're going to be like, 'Oh my gosh, my life is so much more stress-free, my anxiety levels, my paranoia, my getting work done in general has [improved].'"