What is Cannabinoid Hyperemesis Syndrome (CHS)?

Perhaps you or someone you know has relied on cannabis as a potential natural remedy that helps relieve pain, reduces nausea, and promotes better sleep. However, sometimes too much of a good thing may end up becoming harmful. In many unfortunate cases people experience their worst nightmare, their medicine turns into a poison for their body.

Instead of enjoying the anti-emetic effects of THC and cannabis, imagine if instead it promoted a severe bout of nausea and vomiting. This is called hyperemesis which stems from its Greek roots ‘hyper’ meaning excessive and ‘emesis’ to vomit. When chronic users of cannabis experience a cyclical pattern of bouts of hyperemesis for several weeks or months triggered by cannabis use they may have a condition known as Cannabinoid Hyperemesis Syndrome (CHS). Some may also label this condition as Cannabis Hyperemesis Syndrome however these terms are used interchangeably in research. We understand how awful of a betrayal it is when the solutions you rely on to make life more manageable may no longer be an option. In this blog we will investigate further what CHS is and explore whether CBD may be a viable option for relief for individuals coping with this condition.

Diagnosis for CHS

Researchers have proposed multiple different checklists to better diagnose CHS although the most recent known one is the Rome IV criteria:

• Symptoms shown at minimum for three months with the symptoms first occurring at least 6 months before diagnosis.

• Episodic vomiting resembling cyclical vomiting syndrome in onset, duration and frequency.

• The issue presents itself after prolonged or excessive cannabis use.

• Sustained cessation of cannabis use prevents vomiting.

Given the severity of symptoms such as abdominal pain, nausea and vomiting typically most doctors will investigate other causes by process of elimination for other conditions such as:

• Gastritis

• Gastrointestinal reflux disease (GERD)

• Peptic ulcer disease (PUD)

• Appendicitis

• Diverticulitis

• Sigmoid volvulus

• Biliary colic

• Pancreatitis

• Nephrolithiasis

• Urinary tract infection

• Ectopic pregnancy

• Ovarian torsion

If you do use cannabis it is important knowledge to share with your doctor if you are dealing with these symptoms so they could better assess if you may have CHS.

CHS vs Cyclic Vomiting Syndrome (CVS)

As noted in the Rome IV criteria one of the major symptoms that is prevalent with CHS is episodic vomiting which resembles Cyclical Vomiting Syndrome (CSV). This is the key factor that helps to define the frequency and intensity of vomiting. For individuals struggling with cyclical vomiting syndrome they may be diagnosed by having a sudden onset of episodic vomiting. Typically these episodes may involve at least four bouts of vomiting per hour with about twelve to fifteen episodes per day. These episodes usually are separated by weeks or months with a return to baseline between episodes.

While the episodic frequency of vomiting is similar with both CHS and CVS, the distinguishing factor between them is that for CVS there are no other disorders attributed to cause vomiting whereas with CHS it is suggested to be caused by potential toxicokinetics of cannabis.

Diagram sourced from an online article "Cannabinoid Hyperemesis Syndrome: Quarantine Tom’s Twist" written by McGill University medical student Harrish Gangatharam.

CHS Symptoms and Signs

Although the main and obvious symptom of CHS is vomiting it is important to be mindful of other symptoms such as:

• Persistent nausea that often occurs in the morning.

• Intense abdominal pain or discomfort.

• Fear of throwing up.

• Loss of appetite.

• Headaches/migraines.

• May also be associated with pathologic bathing behavior such as frequently taking hot showers that have been reported to offer relief from symptoms.

What Causes CHS

Some evidence indicates that CHS may be caused by a dysregulation of our Endocannabinoid System (ECS), with the essential function of bringing our body to homeostasis or balance. Naturally occurring endocannabinoids as well as many phyto-cannabinoids coming from the cannabis plant, bind to our cell receptors to signal essential functions. Our CB2 receptors have shown to play a crucial role in controlling inflammation, pain, and intestinal motility. Whereas nausea and vomiting are regulated by the CB1 receptors in the central and peripheral nervous systems. Researchers suggest that some potential causes of CHS may “include influence on the activity of cannabinoid receptors, conversion of cannabis into emetic substances, or contamination with other toxins.”

Another argument is that THC may be directly responsible rather than cannabis as a whole. THC has been shown to have biphasic effects where at lower doses it tends to reduce nausea, while at high doses may induce vomiting. In a recent 2024 study the researchers underline that “At high doses or with chronic cannabis use, CB1 receptor activation can paradoxically trigger the symptoms of CHS. This dual effect is partly attributed to receptor desensitization, internalization, and dysregulated signaling. These processes could reduce the effectiveness of endocannabinoid feedback inhibition, leading to increased excitatory activity in the brainstem or gastrointestinal system, thereby resulting in hyperemesis.”

CHS Theories

Based on anecdotal stories, most cases we hear of people dealing with CHS happen when the primary method of consumption for THC was dabbing or smoking concentrates. Some theories that stem from this common story is that the intensive THC content was much more than their body could handle. Some concentrates, waxes, or shatter may test upwards to 80-90% THC in a single gram which far surpasses the average percentages available when smoking it in the flower that usually ranges from around 15-30% depending on the cultivar. Another popular theory is that the other harsh chemicals used for extraction or to heat up the concentrates such as butane may be negatively impacting the user’s health. However these are currently just theories and more research is needed to better assess the direct root causes of CHS.

Treatment For CHS

Generally research indicates that the most effective cure for CHS is to abstain from cannabis use altogether as it may be the main leading factor causing the condition. However some studies are examining other potential remedies for those dealing with CHS.

Short Term Relief

For the short term many people with CHS report that taking hot showers and baths alleviated symptoms temporarily. Others have found that Capsaicin products (the compound that makes peppers ‘spicy’) offer some relief when applied topically on the skin.

Both of these techniques for short term relief are supported in research to be potentially effective due to “transient receptor potential vanilloid-1 nociceptor system becomes activated by both acidic pH and high temperatures, which use sodium and calcium channels to regulate the release of substance P, a mediator involved in the perception of pain, and hence may undergo modulation through the use of topical capsaicin as well as exposure to hot water.”

Long Term Solutions

Unfortunately research has only determined one main solution for CHS and that would be to quit using cannabis altogether. However difficult it might be for a chronic user to quit and deal with withdrawal symptoms, it may be the silver bullet necessary for the endocannabinoid system to reset.

Can you use CBD if you have CHS?

With a condition called Cannabinoid Hyperemesis Syndrome, it would seem obvious that any cannabinoid including CBD may trigger another bout of vomiting. However the research is still unclear what specifically causes CHS and there seems to be little to no studies examining whether CBD can be used for patients dealing with CHS. It is important to note that there are several cases reported that even CBD oil with trace amounts of THC resulted in CHS.

However we do often see other side as well where people who don’t respond well to THC find that they can still gain the potential benefits using CBD instead. We have had several customers come to our shop and share that CBD has been the substitute for their THC use and normally these customers lean towards a fully THC free option. An example would be an Isolate CBD product that pure CBD completely removed from the rest of the plant. Alternatively there is Broad Spectrum CBD which uses the full hemp extract except with the THC removed. One common approach these people take is to try using an alternative method of consumption. So for example if they previously mostly smoked for its fast absorption, then trying a CBD oil under the tongue could be another fast and efficient method to consider.

Ultimately it is still a risk to consider as in some cases people who struggle with CHS still react to CBD the same way as it would any other cannabinoid or use of cannabis. If you are considering if CBD may be an option for you it is best to consult your doctor first.

There is a whole realm to explore in the world of cannabinoids and we are always happy to be your guide to help you discover the potential benefits. If you have any questions or concerns, please feel free to chat with us online, stop by your local CBD store , or give us a call at 719-666-7219.