Cannabinoid Hyperemesis Syndrome May Be Caused by Cannabis Disrupting the Stress and Autonomic Nervous Systems

Medical hypothesis paper reviewing existing literature on the endocannabinoid system, HPA axis, sympathetic nervous system, and clinical features of CHS to propose a unifying mechanistic explanation.

CHS has been recognized clinically for over a decade but its pathophysiology remains poorly understood. A coherent mechanistic framework could guide treatment development beyond the current approach of symptom management. Understanding CHS as an autonomic disorder rather than a simple gastrointestinal problem reframes how clinicians should approach these patients.

CHS is a paradox: cannabis is widely used as an antiemetic, yet in some chronic heavy users it causes severe vomiting. This hypothesis paper attempts to resolve that paradox by distinguishing between acute cannabinoid effects (antiemetic) and chronic overstimulation effects (endocannabinoid system dysfunction leading to autonomic instability and vomiting).

This is a hypothesis paper, not an experimental study. The proposed mechanism has not been directly tested. The author draws on circumstantial evidence and physiological reasoning rather than new data. Alternative mechanisms (including direct effects on gut motility via CB1 receptors in the gastrointestinal tract) are not fully addressed.