Review explores how the endocannabinoid system connects stress, nausea, vomiting, and cannabis hyperemesis

The endocannabinoid system normally regulates nausea, vomiting, and anxiety. Cannabis can have both antiemetic and pro-emetic effects depending on dose and duration. Chronic use may dysregulate the ECS, altering its homeostatic control and potentially contributing to the paradoxical nausea and vomiting seen in cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS).

Narrative review examining the endocannabinoid system's role in stress, nausea, and vomiting regulation, the effects of prolonged cannabis use on ECS function, and the evidence linking ECS dysregulation to CVS and CHS pathophysiology.

Cannabinoid hyperemesis syndrome and cyclic vomiting syndrome can be debilitating conditions that do not respond well to standard antiemetics. Understanding how the ECS becomes dysregulated through chronic cannabis use could lead to better treatments for these increasingly common conditions.

The paradox of cannabis being both a treatment for and cause of nausea highlights the complexity of endocannabinoid signaling. As cannabis use becomes more prevalent and products become more potent, CHS is likely to increase, making understanding of these mechanisms clinically urgent.

Narrative review without systematic methodology. The mechanisms linking ECS dysregulation to CVS and CHS are still largely hypothetical. The distinction between CVS and CHS remains debated in the medical community.