CHS Remains Frequently Misdiagnosed Despite Being Treatable with Hot Showers and Cannabis Cessation | Research

The takeaway

A review of cannabinoid hyperemesis syndrome finds it is frequently misdiagnosed, standard antiemetics are typically ineffective, and hot water bathing provides characteristic symptomatic relief.

emergency medicine clinicians, gastroenterologists, chronic cannabis users

What the researchers found

CHS is characterized by cyclical vomiting in chronic cannabis users, is frequently misdiagnosed leading to extensive investigations and delayed treatment, and standard antiemetics are typically ineffective. Hot water bathing/showering is a hallmark symptomatic relief. No standardized treatment protocol exists. Little is known about risk factors for developing CHS.

Why it matters

CHS awareness is growing but misdiagnosis remains common, leading to unnecessary testing, repeated ED visits, and patient suffering. Understanding its unique features can reduce diagnostic delays.

The numbers in context

Prevalence: probably rare but uncertain. Hot water bathing: characteristic relief. Standard antiemetics: typically ineffective. Cannabis cessation: essential for resolution. No standardized treatment protocol exists.

How the study worked

Narrative review of CHS diagnosis, management, and research gaps.

What this study cannot tell us

Narrative review format. CHS prevalence is uncertain. Based largely on case reports. No randomized treatment trials exist. The mechanism of CHS remains poorly understood.

How to read the evidence

Narrative review synthesizing case-based evidence without systematic methodology provides preliminary evidence.

When this study was published

Contemporary review of CHS literature.

The bigger picture

As cannabis use increases, CHS recognition becomes more important for clinicians. The lack of a predictive model for who will develop CHS means all chronic users are potentially at risk.

Questions still open

What determines who develops CHS among chronic cannabis users?
Could biomarkers help predict CHS risk?

Common questions

How do you know if it's CHS and not something else?

CHS has distinctive features: cyclical vomiting in chronic cannabis users, relief from hot showers or baths, and failure of standard anti-nausea medications. The diagnosis is often missed because cannabis is not considered as a cause.

Does CHS go away?

Yes, with cannabis cessation. However, symptoms can return if cannabis use resumes. There is currently no way to predict who will develop CHS or how to prevent it.

Read the original research

Rare but relevant: Cannabinoid hyperemesis syndrome.

Addiction (Abingdon, England), 120(2), 380-384

View on PubMed ↗Publisher’s paper ↗

Citation

Stjepanović, Daniel; Kirkman, Julia; Hall, Wayne. (2025). Rare but relevant: Cannabinoid hyperemesis syndrome.. Addiction (Abingdon, England), 120(2), 380-384. https://doi.org/10.1111/add.16693