People with suspected cannabinoid hyperemesis syndrome remain skeptical about the diagnosis | Research

The takeaway

Interviews with 24 chronic cannabis users with cyclic vomiting found many remained uncertain that cannabis caused their symptoms, and felt clinical recommendations to simply quit failed to address the complexity of stopping.

Emergency medicine physicians, gastroenterologists, addiction counselors

Many patients attributed vomiting to food, stress, or GI issues rather than cannabis

What the researchers found

Twenty-four participants with chronic cannabis use and cyclic vomiting attributed their symptoms to food, alcohol, stress, and GI issues rather than cannabis. Many relied on at-home internet research to understand their condition. Clinical treatment focused on cannabis cessation, but patients felt this failed to acknowledge the difficulty of quitting and the therapeutic benefits they perceived from cannabis.

Why it matters

CHS diagnosis requires accepting that a substance many use for nausea relief is actually causing nausea. Understanding patient skepticism can help clinicians communicate more effectively and develop support strategies beyond simple cessation advice.

The numbers in context

24 participants interviewed; recruited from Rhode Island ED prospective cohort; many attributed symptoms to food, alcohol, stress rather than cannabis

How the study worked

Semi-structured interviews with 24 participants recruited from a prospective cohort of patients presenting to Rhode Island emergency departments with cyclic vomiting and chronic cannabis use. Thematic analysis using NVivo.

What this study cannot tell us

Small qualitative sample from one state. Participants may not have had confirmed CHS (diagnosis was clinical). Self-selection may have favored those more willing to discuss cannabis use.

How to read the evidence

Qualitative study with thematic analysis providing patient perspective, but small single-site sample with unconfirmed CHS diagnoses.

When this study was published

Published 2023

The bigger picture

The disconnect between clinical understanding of CHS and patient experience highlights the need for patient-centered approaches that acknowledge the complexity of chronic cannabis use while providing evidence about the condition.

Questions still open

Would gradual dose reduction instead of cessation be acceptable to CHS patients? Are there biomarkers that could help patients accept the cannabis-symptom connection?

Common questions

Do people with CHS believe cannabis is causing their symptoms?

Many do not. In this study, participants with chronic cannabis use and cyclic vomiting often attributed symptoms to food, alcohol, stress, or GI issues, and remained uncertain about the cannabis connection.

Why is quitting cannabis hard for CHS patients?

Patients reported that cessation recommendations failed to consider the chronicity of their use, the therapeutic benefits they perceived (like anxiety relief), and the challenge of stopping a deeply embedded habit.

Read the original research

"I still partly think this is bullshit": A qualitative analysis of cannabinoid hyperemesis syndrome perceptions among people with chronic cannabis use and cyclic vomiting.

Drug and alcohol dependence, 246, 109853

View on PubMed ↗Publisher’s paper ↗

Citation

Collins, Alexandra B; Beaudoin, Francesca L; Metrik, Jane; Wightman, Rachel S. (2023). "I still partly think this is bullshit": A qualitative analysis of cannabinoid hyperemesis syndrome perceptions among people with chronic cannabis use and cyclic vomiting.. Drug and alcohol dependence, 246, 109853. https://doi.org/10.1016/j.drugalcdep.2023.109853