Eight US patients with cannabinoid hyperemesis averaged 19 years of cannabis use before symptoms developed | Research

The takeaway

Eight cannabinoid hyperemesis patients averaged 19 years from first cannabis use to symptom onset, had 7 ER visits on average, and four of five who quit cannabis recovered completely.

Read this if you want to know more about cannabinoid hyperemesis syndrome and how long it takes to develop.

19 years average from first cannabis use to CHS symptom onset

What the researchers found

Eight patients with cannabinoid hyperemesis syndrome (CHS) were identified at a single US hospital between January and August 2009. The syndrome had previously been described mainly in Australian patients.

Patients averaged 32.4 years old, and the mean interval between first cannabis use and development of recurrent vomiting was 19 years. The burden on healthcare was substantial: patients averaged 7.1 emergency room visits, 5 clinic visits, and 3.1 hospital admissions for this syndrome. All had visited at least one other hospital.

All patients experienced vomiting every 3 hours on average, took about 5 baths or showers per day (totaling 5 hours of bathing daily), and had abdominal pain. Seven took hot baths and seven experienced excessive thirst.

Four of five patients who stopped cannabis recovered. The three who continued using despite medical advice continued to have symptoms. One recovered patient who resumed cannabis experienced symptom recurrence.

Why it matters

This US case series confirmed that CHS was not limited to Australian populations and documented the extensive healthcare utilization and long latency period before symptom onset.

The numbers in context

8 patients, mean age 32.4 years. Mean 19 years from first cannabis use to symptoms. Mean 7.1 ER visits, 5.0 clinic visits, 3.1 admissions. Vomiting every 3 hours. 5 baths/showers per day (5 hours total). 4/5 who quit recovered.

How the study worked

Retrospective case series of 8 patients identified at William Beaumont Hospital (Michigan) from January to August 2009 based on chronic cannabis use, unexplained recurrent vomiting, and compulsive bathing. Chart review with follow-up from subsequent visits and patient interviews.

What this study cannot tell us

Small case series from a single hospital. Retrospective design with potential recall bias. No comparison group or prevalence estimate. Self-reported cannabis use history.

How to read the evidence

Case series of 8 patients from a single center with follow-up data on cannabis cessation outcomes.

When this study was published

Published in 2010. CHS has since been widely recognized in emergency departments across the US.

The bigger picture

The long latency period (nearly two decades) between cannabis use initiation and CHS onset suggested that the syndrome was not simply a dose-response phenomenon and that chronic neuroadaptive changes likely contributed.

Questions still open

Why does CHS take an average of 19 years to develop? What biological changes occur over decades of cannabis use that eventually trigger the hyperemesis syndrome?

Common questions

How long does it take for cannabinoid hyperemesis to develop?

In this case series, patients averaged 19 years of cannabis use before developing symptoms. This long latency period suggests the syndrome develops from cumulative, chronic effects.

Does quitting cannabis cure cannabinoid hyperemesis?

Four of five patients who stopped cannabis use recovered completely. One patient who resumed cannabis experienced symptom recurrence, confirming the causal relationship.

Read the original research

The cannabis hyperemesis syndrome characterized by persistent nausea and vomiting, abdominal pain, and compulsive bathing associated with chronic marijuana use: a report of eight cases in the United States.

Digestive diseases and sciences, 55(11), 3113-9

View on PubMed ↗Publisher’s paper ↗

Citation

Soriano-Co, Maria; Batke, Mihaela; Cappell, Mitchell S. (2010). The cannabis hyperemesis syndrome characterized by persistent nausea and vomiting, abdominal pain, and compulsive bathing associated with chronic marijuana use: a report of eight cases in the United States.. Digestive diseases and sciences, 55(11), 3113-9. https://doi.org/10.1007/s10620-010-1131-7