Is Cannabinoid Hyperemesis Syndrome Real?

Cannabinoid Hyperemesis Syndrome is growing as an acceptable diagnosis for the symptoms of chronic vomiting when associated with excessive cannabis use.

The Paradox CHS

The Paradox - CHS

By Michael Greene

New York Daily Weed Report

New York – The human body is a complex system of careful checks and balances.  We must consider that what may work for the body at lower doses harms us, over time, at higher doses.  As more and more people publicly discuss their cannabis use without fear of stigma or reprisal, and more medical professionals can research it, this syndrome seems to be appearing with more frequency and more consistency. Cannabinoid Hyperemesis Syndrome is growing as an acceptable diagnosis for the symptoms of chronic vomiting when associated with excessive cannabis use. But is it real?

The working theory for Cannabinoid hyperemesis syndrome (CHS) is that it is characterised by unrelenting nausea, recurrent vomiting, abdominal pain and compulsive, hot bathing behaviour. The symptoms contrast the traditional effects associated with cannabis use. CHS is an important differential diagnosis to consider in patients with similar symptoms and the distinctive symptom relief in hot water. Early recognition may prevent extensive, unnecessary medical examinations and frequent hospital admissions. Ugeskr Laeger. 2014 Nov 3;176(45). pii: V11120661.

In 2015 researchers summarized the available evidence on CHS diagnosis, pathophysiology, and treatment. The performed a systematic review using MEDLINE, Ovid MEDLINE, Embase, Web of Science, and the Cochrane Library from January 2000 through September 24, 2015.  Data were abstracted from the articles and case reports and were combined in a cumulative synthesis. The frequency of identified diagnostic characteristics was calculated from the cumulative synthesis and evidence for pathophysiologic hypothesis as well as treatment options were evaluated using the GRADE criteria.

According to a recent study at NYU Langone Health, chronic pot smokers (defined as more than 20 days per month) had almost a one out of three chance of developing CHS.  This translates to over 3 million sufferers in the U.S., when you consider the current numbers of chronic pot smokers.

Marijuana has been found to be an effective alternative to opioid use when the pain is chronic and the disease is severe or terminal.

But when it comes to recreational use, how much you are smoking and for how long is apparently becoming an important consideration. Studies have shown that in addition to CHS regular users can develop cognitive and behavioral problems, and an increased risk of anxiety and depression.

Dr. Joe Habboushe, associate professor of emergency medicine at NYU states that the weed-induced vomiting doesn’t respond to routine anti-nausea drugs but only to several hours of hot showers or capsaicin (derived from peppers) cream.  Habboushe stated in an interview to Dr. Marc Siegel, that small amounts of marijuana (containing cannabinoids) suppresses nausea and pain in the brain and nerves, at the same time, too much of it over time may “overstimulate and turn off the very receptors that were suppressing nausea and pain in the first place.” Habboushe added, “Hot showers seem to be able to stimulate the same receptors and turn them back on.”

The only real way to cure the problem is to stop smoking pot altogether says Dr. Habboushe. This works 97 percent of the time, but if you start smoking it again you are at great risk of the problem returning.

Despite the growing number of cases of CHS, many doctors are still not familiar with this condition and may misdiagnose the problem as something else. Patients have had multiple diagnostic tests and even had their gallbladders removed unnecessarily as a result of the symptoms.

With increasing legalization comes increased accessibility.  Too much of a good thing can have bad results. Doctors are increasingly looking for chronic cannabis use as the cause of this syndrome. Truthful disclosure by patients may help avoid unnecessary medications or medical procedures which could lead to more problems than the underlying cause.

Endocannabinoid system illustration