Cannabinoid Hyperemesis Syndrome Is Increasingly Common but Often Missed | Research

The takeaway

As cannabis legalization expands, CHS prevalence is rising, yet many healthcare providers still miss the diagnosis; treatment involves benzodiazepines for acute attacks and amitriptyline (50-200 mg/day) for long-term management.

Emergency physicians, gastroenterologists, and primary care providers

Amitriptyline 50-200 mg/day recommended for long-term CHS prevention

What the researchers found

CHS typically presents with episodic vomiting from chronic daily cannabis use over months to years, with nausea and abdominal pain improved by hot showers. Symptoms resolve with cannabis cessation over 6-12 months. Acute treatment uses parenteral benzodiazepines. Long-term prevention uses amitriptyline 50-200 mg/day, which can be slowly tapered after remission.

Why it matters

CHS remains unrecognized by many providers, leading to repeated ER visits, unnecessary testing, and delayed treatment. As cannabis becomes more widely available, providers need clear diagnostic and treatment frameworks.

The numbers in context

Amitriptyline dose: 50-200 mg/day for prevention. Symptom resolution: 6-12 months after cannabis cessation. In the US, 52.5 million people aged 12+ used cannabis in 2021.

How the study worked

Narrative review of current literature on CHS prevalence, diagnosis, and management in the context of expanding cannabis legalization.

What this study cannot tell us

Narrative review without systematic search methodology. Treatment recommendations are based on limited evidence and clinical experience. The pathophysiology of CHS remains incompletely understood.

How to read the evidence

Narrative review synthesizing clinical evidence and expert recommendations.

When this study was published

2024 review

The bigger picture

CHS represents one of the most concrete health consequences of heavy cannabis use. Its increasing prevalence provides a measurable signal of how expanded access translates to specific health system burden.

Questions still open

Why do only some chronic cannabis users develop CHS? Is the rising prevalence purely due to increased use, or also improved recognition? Are there genetic or other factors that predict CHS susceptibility?

Common questions

How is cannabinoid hyperemesis syndrome treated?

Acute episodes are treated with intravenous benzodiazepines. Long-term prevention uses amitriptyline at 50-200 mg/day. The definitive treatment is cannabis cessation, with symptoms typically resolving over 6-12 months.

Is CHS becoming more common?

Yes. As more states legalize cannabis, CHS prevalence has increased. Many healthcare providers still do not recognize the condition, leading to delayed diagnosis.

Read the original research

Cannabinoid hyperemesis syndrome: prevalence and management in an era of cannabis legalization.

Journal of investigative medicine : the official publication of the American Federation for Clinical Research, 72(2), 171-177

View on PubMed ↗Publisher’s paper ↗

Citation

Stubbs, Justin Joe; McCallum, Richard. (2024). Cannabinoid hyperemesis syndrome: prevalence and management in an era of cannabis legalization.. Journal of investigative medicine : the official publication of the American Federation for Clinical Research, 72(2), 171-177. https://doi.org/10.1177/10815589231217495