Cannabis hyperemesis syndrome appeared after a chronic user stopped cannabis while traveling to a country with stricter laws | Research

The takeaway

A 33-year-old daily cannabis user developed severe cannabis hyperemesis syndrome about a week after stopping use due to travel, with symptoms overlapping withdrawal and resolving within 10 days on a combination of tramadol, promethazine, and mirtazapine.

Emergency medicine physicians evaluating recurrent vomiting; gastroenterologists seeing patients with unexplained abdominal pain.

CHS emerged after cessation, not during active use

What the researchers found

CHS symptoms (severe vomiting, abdominal pain, fever) emerged approximately one week after cessation of daily cannabis use, with standard anti-emetics (ondansetron) failing. The patient also had anxiety, depression, and brain fog consistent with cannabis withdrawal. A combination of tramadol, promethazine, and mirtazapine as outpatient treatment led to full recovery within 10 days.

Why it matters

This case highlights that CHS can emerge after cannabis cessation, not just during active use, and can overlap with withdrawal symptoms. The successful treatment combination offers an alternative when standard anti-emetics fail.

The numbers in context

33-year-old male. Daily cannabis user for several years. Symptoms began approximately 1 week after stopping. Ondansetron was ineffective. Full recovery within 10 days on tramadol, promethazine, and mirtazapine.

How the study worked

Single case report of a 33-year-old male chronic daily cannabis user who stopped using due to travel to a country with stricter cannabis laws.

What this study cannot tell us

Single case report. Cannot generalize treatment response to other patients. Patient also used tobacco and alcohol, which were continued. Exact cannabis doses and duration not quantified.

How to read the evidence

Single case report. Illustrative but cannot establish treatment efficacy or generalizability.

When this study was published

2024 study

The bigger picture

The overlap between CHS and cannabis withdrawal suggests these may be related manifestations of the same underlying dysregulation, and clinicians should consider both diagnoses when chronic cannabis users present with GI symptoms after cessation.

Questions still open

How often does CHS present during cessation rather than active use? Is the tramadol-promethazine-mirtazapine combination effective in other CHS cases?

Common questions

Can CHS happen after stopping cannabis?

This case and others suggest yes. While CHS is typically associated with active chronic use, symptoms can emerge or worsen shortly after cessation, possibly overlapping with the withdrawal syndrome.

Why did standard anti-nausea medication not work?

CHS is notoriously resistant to conventional anti-emetics like ondansetron. The mechanism of CHS-related vomiting differs from typical nausea and may involve cannabinoid receptor dysregulation in the gut and brain that these medications do not address.

Read the original research

Cannabis Hyperemesis Syndrome in a Recently Abstinent Chronic User: Assessment and Intervention.

Consortium psychiatricum, 5(1), 27-32

View on PubMed ↗Publisher’s paper ↗

Citation

Ei Sherif, Yasmine; Gouher, Sariah; Abualhab, Mutaz Mohsin; El-Khoury, Joseph. (2024). Cannabis Hyperemesis Syndrome in a Recently Abstinent Chronic User: Assessment and Intervention.. Consortium psychiatricum, 5(1), 27-32. https://doi.org/10.17816/CP15473