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If you think you have CHS or cannabis use disorder, talk to a healthcare provider. The onset of CHS tends to affect people “after years of using marijuana many times a week,” per the American College of Gastroenterology. A patient in his mid-40s presented to the emergency department, where he complained of a 48-hour history of nausea and uncontrollable bilious vomiting with no blood. The patient also reported burning abdominal pain but no diarrhoea or fever. There was a history of similar episodes, the most recent being a year ago, when extensive tests were done with no specific positive findings.
When it comes to medication, Streem said an IV drip of substances such as droperidol and haloperidol are often used in emergency rooms for CHS. Because research on CHS remains thin, it’s hard to determine just how common it is. The cause of CHS – outside of prolonged marijuana use – remains murky because research is limited.
In addition to appropriate antiemetic therapy, fluid resuscitation, and management of the patient’s symptoms, patients must recognize behaviors and exposures that place them at risk for their pathology. For supportive care, a clinician should work together with the pharmacist to see if any medications could contribute to the patient’s presentation. If administering antiemetics, the nursing staff should be familiar with the adverse event profile so they can report any concerns that may arise. Without more research, there is no definitive answer, but doctors have linked the increase in CHS cases to widespread legalization, along with higher tetrahydrocannabinol (THC) content in modern marijuana. The commercial industry that blossomed after legalization “touted its products as beneficial” while focusing on “engineering a quicker, more intense high,” the Times said.
Management and Treatment
Underdiagnosis or misclassification before broader clinical recognition of CHS was proposed as one possible explanation, alongside increased exposure and heightened diagnostic vigilance during and after the pandemic. Survey-weighted probabilities rose from 3.3% in 2019 to 6.9% in 2020 and reached 13.2% in 2021, before decreasing to 9.7% in 2023. CHS was first identified in 2004 in Australia and remains a syndrome with uncertain etiology. Proposed neurophysiological mechanisms include downregulation of cannabinoid 1 receptors, altered transient receptor potential vanilloid 1 signaling, and disrupted hypothalamic thermoregulation.
The condition was most prominent in the West and Northeast compared with the South. Researchers are currently studying several treatment options to manage the hyperemetic phase of CHS. The only known treatment to permanently get rid of CHS is to stop cannabis use completely. You may have symptoms and side effects of CHS for a few weeks after quitting cannabis. Some people call certain symptoms of CHS “scromiting.” The term combines “vomiting” and “screaming.” You may have intense pain, which causes you to scream while you vomit.
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The capsaicin, the compound found in chili peppers, interacts with specific receptors in the skin that may also be involved in the body’s temperature regulation and pain pathways, mimicking the soothing effect of a hot shower. Applying a small amount of a low-concentration cream may help reduce the severity of pain and nausea. Meltzer says it is important for clinicians to advise those with frequent cannabinoid use or hyperemesis about the risks and subsequent disease burden.
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One of the 4 who recovered went back to using marijuana and the vomiting resumed. They may also prescribe antipsychotic medications such as haloperidol (Haldol) or olanzapine (Zyprexa) to help you calm down as you switch to the recovery phase. The only way to end CHS symptoms is to completely stop using all marijuana products. After you quit, you may still have symptoms and side effects for a few days to a few weeks. If you have symptoms, your doctor drug addiction will do a physical exam and ask for your detailed medical history. During this phase, the user may experience increased nausea, abdominal discomfort, and fear of vomiting, though vomiting itself is absent.
- Due to its lipophilic nature, THC accumulates in adipose tissue over time 24.
- This differs from the adult population where nearly 100% of patients experience nausea and vomiting as well as resolution of symptoms with cessation of cannabis use.
- The risk of CHS diagnosis increases with chronic cannabis use, especially daily use.
- To diagnose CHS, a healthcare professional will study your symptoms and ask you questions.
- As of June 2025, nearly half of US residents live in states with legalized recreational cannabis, and policy shifts have expanded adult-use access through legalization, medical programs, and decriminalization.
Frequently used records
While marijuana seems to bring on nausea in the stomach, in the brain it usually has opposite effect. When cannabinoids bind with brain receptors, they tend to prevent nausea and vomiting. Experts think that when you first smoke weed, your brain signals are more important, but after repeated use of the drug, the brain receptors may no longer respond to marijuana in the same way, causing more nausea and vomiting. When you use marijuana for many years, it can start to slowly change how the receptors in your body respond to the cannabinoid chemicals.
Cannabinoid Hyperemesis Syndrome (CHS): Causes, Symptoms, Treatment
If “scromiting” is useful for anything, it’s as a warning label—one that’s hard to ignore once you’ve seen what CHS looks like up close. Those who trivialize the potential downside of unfettered cannabis use do so at their own peril. “It’s very possible, if not likely, that at least in some of these cases, these could be people who are exposed to synthetic cannabis … and simply don’t know any better,” he said. Armentano agreed, adding that toxicology tests of the marijuana patients used before developing CHS would be helpful in understanding a more direct cause. Streem told USA TODAY on Dec. 5 that most emergency department physicians he’s spoken to in the Cleveland, Ohio, area have treated a case of CHS every day for the past five years. Cannabis can be addictive, and people who stop using it can experience symptoms not unlike opioid or alcohol withdrawal, said Dr. Deepak Cyril D’Souza, director of the Yale Center for the Science of Cannabis and Cannabinoids.
For example, if you smoke weed, eat edibles, use tinctures, or dab or vape THC, tell your doctor about any or all of them. Researchers aren’t sure exactly why weed causes CHS symptoms only in some people. Decrease the potency of THC and/or decrease your total daily intake of THC,” she said. It is unclear if anything less than full cessation of cannabis will prevent a recurrence of CHS. While there are ways to treat symptoms of CHS in the short term, the only true cure is to stop using marijuana completely.
Additionally, the prolonged use of certain antiemetics, such as ondansetron, may have limited benefit in CHS, further highlighting the need for individualized management plans. Studies exploring novel treatments, diagnostic criteria, or the pathophysiology of CHS were also prioritized. Patterns revealed distinct trends for cannabis-related diagnoses, cyclic vomiting syndrome, and CHS. Between 2016 and 2022, use disorder visits increased from 1,008 to 1,465 per 100,000 emergency department visits. CHS visits rose from 4.36 to 22.33 per 100,000 visits during that period, peaking at 33.06 per 100,000 in quarter 2 of 2020. Cyclic vomiting syndrome visits declined from 300 to 186 per 100,000 visits, perhaps suggesting a growing clinical awareness of CHS.
After about years of chronic marijuana use, patients begin to have a strong feeling of sickness, throwing up, and belly pain. This is normally when people go see a doctor to find out what is causing these problems. They start to feel better when they stop using marijuana but can feel bad if they use it again. If you use cannabis often and frequently experience vomiting and nausea, you should tell a healthcare professional. CHS is also underdiagnosed because people sometimes use marijuana to suppress nausea and vomiting.
General Health
Further research is required to investigate the gastrointestinal physiology in these patients during both the acute attacks of hyperemesis and between episodes. THC accumulates largely within body fat which serves as a long-term storage site for the drug 20,22. This characteristic partially explains its prolonged elimination half-life.