Cannabis has gone mainstream. Prohibition is no longer an option. Patients, families and organizations all around the world are demanding legalization. Countries all over have legalized medical marijuana, with Canada and Uruguay legalizing it even for recreational purposes.

Cannabinoids, the compounds in marijuana, can be used to treat epilepsy, arthritis, chronic pain, multiple sclerosis, and as an anti-inflammatory agent.

There are no reports of cannabis overdose, it produces no dependency and the worst side effect you can get is ordering an extra-large pizza… or two. It appears there is nothing harmful about cannabis. However, recent studies suggest there might be a condition related to long-term use of cannabis. People all around the United States are experiencing nausea, persistent vomiting, abdominal pain, and dehydration. Patients also have a compulsive tendency to take hot showers when symptoms are intense. Strangely, the symptoms stop when cannabis use is suspended. This condition is called Cannabinoid Hyperemesis Syndrome.

There are a lot of questions that patients, users and doctors have about Cannabinoid Hyperemesis Syndrome. Is there enough evidence to support the fact that cannabis produces CHS? If so, why is it that cases are just recently being reported? Why does cannabis treat and at the same time, cause a medical condition? And, if cannabis is the cause, is there any treatment? Let’s find out…

What does research say about Cannabinoid Hyperemesis Syndrome?

Although THC is the cannabinoid responsible for the psychoactive effect of cannabis, it also has medicinal properties. It is widely used in the medical community to help with nausea, vomiting, as well as abdominal pain. Then why is the cure also the cause of these symptoms?

South Australian Research (2004)

Cannabinoid Hyperemesis Syndrome was first mentioned in a 2004 Australian research. Scientists started investigating patients experiencing cyclical vomiting and their symptoms. They found that all 10 patients who were submitted to the test had one thing in common: chronic cannabis use.

The findings were:

  • Cessation of cannabis abuse led to cessation of the cyclical vomiting illness in seven cases.
  • Three cases did not abstain and continued to have recurrent episodes of vomiting.
  • Three cases who had abstained, returned to the habit after a significant period of abstinence and suffered a relapse of the illness.
    • Two of these cases abstained again, and became well again.
    • The third case did not abstain and remained ill.

Researchers also found an interesting pattern. Of the 10 patients, nine of them admitted to having taken hot baths when the symptoms were severe. Patients told researchers this practice would lessen the pain. Australian researchers concluded that: “chronic cannabis abuse was the cause of the cyclical vomiting illness in all cases, including the previously described case of psychogenic vomiting”.

Other reported cases

In 2009, a case study conducted in the United Kingdom, researchers described a 22 year old male with a history of chronic cannabis abuse who suffers from severe and recurrent vomiting, intense nausea and abdominal pain. The patient also reported having hot baths to ease his symptoms. The study concluded that if a patient with regular and chronic cannabis intake presents severe nausea and vomiting, together with abdominal pain, and compulsive hot bathing behavior, “a diagnosis of cannabinoid hyperemesis syndrome should be considered”.

Another study, also published in 2009, reported two cases showing identical symptoms. The first one was a 25-year-old woman who arrived at the ER reporting nausea, vomiting, and abdominal pain that worsened throughout several days. Over the past five years, she had experienced the same symptoms on several occasions. And, what was the only thing that could calm those symptoms? A long, hot bath. After 48 hours in the hospital without consuming cannabis, her symptoms stopped and she was discharged.

The second one was a 23-year-old man who was suffering from nausea, vomiting, and abdominal pain. He decided to go to the hospital after “exhausting all the hot water at home”. The patient reported using marijuana 2 to 3 times a day for the past 9 years. He was treated with regular medication for nausea and vomiting. After a few hours at the hospital and without taking any marijuana, his symptoms resolved and he was discharged.

The 2011 Temple University study

Even though previous studies showed a pattern worth considering, there was no further explanation of the Cannabinoid Hyperemesis Syndrome condition itself. A 2011 study from the Temple University explained in detail the stages of CHS and why regular cannabis intake might be a possible cause. Contrary to previous studies, researchers from Temple University established that “chronic cannabis use” is equivalent to a consumption rate of three to five times per day.

They identified 3 stages of Cannabinoid Hyperemesis Syndrome:

Prodromal Phase

This early stage can begin months before heavy and intense symptoms of nausea and vomiting. In this phase, patients tend to feel morning sickness, mild abdominal pain, and nausea. Researchers found that patients tend to consume more cannabis to relieve nausea.

Hyperemetic Phase

This is where symptoms get serious. Patients star experiencing persistent nausea and vomiting, along with abdominal pain. Patients also suffer from weight loss and dehydration because of loss of appetite. During this phase, people begin taking hot showers compulsively.

Although there is no certain answer to why people suffering from Cannabinoid Hyperemesis Syndrome take hot showers, researchers had a hypothesis: “hot bathing may act by correcting the cannabis-induced equilibrium of the thermoregulatory system of the hypothalamus”

Recovery Phase

The only treatment researchers found to stop CHS is to stop cannabis use. Patients will start to recover in matter or days or weeks.

Researchers concluded that although cannabis is used successfully to treat nausea, vomiting and abdominal pain, there is increasing evidence of its negative effects on the gastrointestinal tract and, therefore, Cannabinoid Hyperemesis Syndrome.

So… does this mean goodbye to cannabis?

Oh, hell no! Cannabis, as other substances like alcohol, has a biphasic effect. Low and high doses have different effects on the body. And every organism reacts differently to cannabis, as well as other substances. Dr. Bonni Goldstein, medical director of Canna-Centers, wrote about this in Project CBD.

He explains that it’s very possible that some people are more predisposed to this condition than others. Only a very small percentage of people who regularly consume high THC strains get this syndrome. He adds that low daily users of low dose THC are “unlikely” to develop CHS. As always, moderation is the way to go.

“In my experience, medical cannabis patients that are thoughtful in their use of THC-rich medicine are at very low risk for developing CHS. I have seen only two cases of CHS in the last decade of practice. That being said, CHS is quite easy to avoid if you are thoughtful about your use of THC and make sure to not over do it”.

And, to add more studies, here’s one to contradict the above. Two years after the 2004 Australian research was published, three fellow countrymen had something to say about it. According to their publication, the study lacks research and biological explanation.

“Cannabis has been consumed for many centuries and is currently used by millions of people in many countries. It is hard to believe that a distinctive syndrome caused by cannabis has never been noted before by users or clinicians”.

Are there other treatments for CHS?

As explained above, patients suffering from symptoms of CHS only find relief with a hot shower. When the pain is extreme, people tend to take hot baths up to six times a day. But there might be a better solution for both your gut and your wallet: red hot chili peppers.

Don’t think that listening to Californication with a hot bath is the only solution. A study published on January 2018 reported the case of a CHS patient whose symptoms improved after applying topical capsaicin (an active component of chili peppers). It appears that the heat produced by the capsaicin has a very similar reaction as the hot water.

Keeping your high low

Nevertheless, the truth is that there is no evidence to support either side of the story. Although there have been documented cases of patients that recover from Cannabinoid Hyperemesis Syndrome by suspending cannabis intake, it is still unclear how or why cannabis can both relieve and cause nausea and vomiting.

According to a doctor at Green Leaf Health Care, quoted on Leafly, the relationship with regular cannabis intake is more a chemical issue: “I’ve traveled through India and Asia extensively and know heavy long-term users without ever having issues regarding hyperemesis. Perhaps long term use and concentrated levels could produce these issues in certain susceptible individuals; however, I feel like it’s more of a chemical issue.”

There’s still a lot of research to be done to understand if there is a direct correlation between CHS symptoms and cannabis. As always, we recommend being responsible with your cannabis intake. Remember that when it comes to cannabis, whether you use it for medical or recreational purposes, less is more.

If you start to experience intense nausea, vomiting and abdominal pain, suspend the use of cannabis and consult your doctor.