A clinical overview of cannabinoid hyperemesis syndrome | Research

The takeaway

CHS is a paradoxical condition where chronic cannabis users experience cyclical intractable vomiting, uniquely relieved by hot showers or capsaicin, that resolves only with cannabis cessation.

Chronic cannabis users, emergency physicians, and clinicians unfamiliar with CHS.

CHS resolves with cannabis cessation, sometimes within hours

What the researchers found

CHS presents as cyclical episodes of severe nausea and vomiting in long-term cannabis users, separated by asymptomatic periods. Unlike other cyclic vomiting syndromes, it responds to hot showers and topical capsaicin. Abstinence from cannabinoids causes resolution, sometimes within hours.

Why it matters

Many clinicians and cannabis users are unaware of CHS. Patients often undergo unnecessary tests and procedures before receiving a correct diagnosis. With increasing cannabis legalization, CHS is expected to become more common.

The numbers in context

Symptoms may require hospitalization. Resolution can occur within hours to days of cannabis cessation.

How the study worked

Narrative review of clinical literature on CHS, covering diagnosis, pathophysiology, symptom management, and clinical implications.

What this study cannot tell us

Narrative review without systematic methodology. The exact mechanism of CHS remains unknown.

How to read the evidence

Moderate: narrative review of established clinical literature, but no systematic search or meta-analysis.

When this study was published

Published in 2019.

The bigger picture

Cannabis is widely known for its anti-nausea properties, which makes CHS counterintuitive and contributes to diagnostic delays. As cannabis use normalizes, emergency departments need to consider CHS in the differential for cyclic vomiting.

Questions still open

What makes some chronic users develop CHS while others do not? Could genetic factors determine susceptibility? Why does capsaicin provide relief?

Common questions

Why do hot showers help CHS?

The exact mechanism is unclear, but it may involve TRPV1 receptor activation (the same receptor capsaicin targets), which could counteract the dysregulation caused by chronic cannabinoid exposure in the gut.

Can CHS come back after stopping?

CHS resolves with cessation and does not return as long as the person remains abstinent. However, resuming cannabis use typically triggers the cycle again.

Read the original research

Cannabinoid Hyperemesis.

Medical cannabis and cannabinoids, 1(2), 73-95

View on PubMed ↗Publisher’s paper ↗

Citation

Pergolizzi, Joseph V; LeQuang, Jo Ann; Bisney, John F. (2019). Cannabinoid Hyperemesis.. Medical cannabis and cannabinoids, 1(2), 73-95. https://doi.org/10.1159/000494992