Cannabinoid hyperemesis syndrome: what doctors need to know about cannabis-related cyclic vomiting | Research

The takeaway

Cannabinoid hyperemesis syndrome (CHS) is an under-diagnosed condition in chronic cannabis users characterized by cyclic vomiting, abdominal pain, and relief from hot showers, with complete cannabis cessation as the only cure.

Cannabis users experiencing unexplained nausea or vomiting, and anyone interested in potential adverse effects of chronic cannabis use.

Diagnostic delay for CHS is typically several years despite distinctive symptoms

What the researchers found

CHS manifests as incoercible cyclical vomiting, diffuse abdominal pain, and compulsive hot showering in chronic cannabis users. Patients typically experience years of diagnostic delay, repeated emergency visits, and unnecessary invasive examinations before correct diagnosis.

Why it matters

As cannabis use increases, more people may develop CHS without being correctly diagnosed. Physicians unfamiliar with the condition subject patients to years of expensive, invasive testing when the clinical presentation is actually distinctive and recognizable.

The numbers in context

Literature spans 2004-2019. Diagnostic delay is typically several years. Patients make frequent emergency department visits before correct diagnosis.

How the study worked

Literature review of scientific articles published between 2004 and 2019 from Cochrane, Medline, PubMed, and PsycInfo databases using keywords "hyperemesis," "cannabis," and "cannabinoid."

What this study cannot tell us

This is a narrative literature review, not a systematic review with defined quality assessment. Prevalence data for CHS are limited. The pathophysiology of CHS, including why hot showers provide relief, remains poorly understood.

How to read the evidence

Moderate: literature review covering 15 years of published cases, though prevalence data are limited.

When this study was published

Published in 2019.

The bigger picture

CHS challenges the perception that cannabis is entirely benign. As legalization expands and use increases, healthcare systems need to train clinicians to recognize this condition early, saving patients from unnecessary suffering and the healthcare system from avoidable costs.

Questions still open

Why do only some chronic cannabis users develop CHS? What is the mechanism behind hot shower relief? Is there a genetic predisposition? Could any treatment besides complete cessation provide lasting relief?

Common questions

What is cannabinoid hyperemesis syndrome?

CHS is a condition in chronic cannabis users characterized by episodes of severe cyclic vomiting, abdominal pain, and a compulsive need to take hot showers. Symptoms resolve completely when cannabis use stops.

Why does it take so long to diagnose CHS?

Many physicians are unfamiliar with CHS, so patients undergo extensive testing for other causes of vomiting. The connection to cannabis use is often overlooked because cannabis is widely perceived as an anti-nausea agent.

Read the original research

Cannabinoid hyperemesis syndrome: a review of the literature.

Psychiatria Danubina, 31(Suppl 3), 390-394

View on PubMed ↗

Citation

Deceuninck, Eleonore; Jacques, Denis. (2019). Cannabinoid hyperemesis syndrome: a review of the literature.. Psychiatria Danubina, 31(Suppl 3), 390-394.