CHS is an acronym for Cannabinoid Hyperemesis syndrome. It's also known as cannabis Hyperemesis syndrome, and both words relate to the same condition. Cannabinoid Hyperemesis Syndrome (CHS) is a disorder that can occur due to long-term marijuana usage. The condition causes severe vomiting and nausea regularly. Many doctors may find it challenging to identify and treat CHS because it is a newly characterized illness. Researchers have tried to figure out what causes CHS, but more research is needed.

The body develops resistance to the effects of the plant's active components over time. Marijuana usage can cause a significant rise in nausea and vomiting, stomach discomfort, dehydration, disorientation, and various other side effects. Stopping using marijuana is the only known treatment for CHS. Symptoms generally disappear after two days of quitting, although, in some people, it might take months. We still don't know what causes it or which Cannabinoids are involved. Thus, this disease is still poorly understood.


Phases of CHS:

There are three stages of Cannabinoid Hyperemesis syndrome, which are described below:


Prodromal phase:

The first is known as the "Prodromal phase," during which patients feel general morning sickness as well as stomach discomfort or pain. Because these effects are minor and can happen after years of cannabis usage, many people continue to smoke marijuana or even increase their use in the hopes that it would help them feel better.


Hyperemesis Phase:

The "hypermetric phase," which is the acute phase of cannabis Hyperemesis syndrome, is the next step. The effects of CHS are intensified in this setting; patients have chronic nausea and may retch and vomit for hours at a time. The discomfort in the abdomen becomes painful, and the intensity of the symptoms causes patients to lose weight and become dehydrated.


Recovery Phase:

It might take a few days to move from the Hyperemesis to the healing phase after stopping marijuana. When this happens, nausea and vomiting symptoms fade away over time, and appetite returns.


Patients feel forced to take hot showers or baths as a side effect of this component of CHS, sometimes even waking up amid the night to do so. Researchers have shown that high temperatures help to reduce nausea and vomiting associated with CHS. It's thought that Hyperemesis and other side effects interfere with the brain's capacity to control the body's core temperature and that hot baths help to alleviate this. This impact, however, is very brief, and patients report feeling nauseous again shortly after exiting the bath or shower.


The Causes of CHS

Marijuana has a wide range of physiological impacts. Experts are still attempting to figure out why some people get CHS. Marijuana has the opposite impact on the brain as CHS. It aids in the prevention of nausea and vomiting. In patients who are undergoing chemotherapy, the medication is also effective at alleviating these symptoms. Marijuana, on the other hand, appears to have the opposite impact on the digestive tract. It increases your chances of nausea and vomiting. The signals from the brain may be more relevant while using marijuana for the first time. Initially, this may have anti-nausea effects. However, with frequent marijuana use, specific brain receptors may stop reacting to the substance in the same way. This might explain why patients with CHS have frequent bouts of vomiting. It's still unclear why some people who use a lot of marijuana acquire the condition while others don't.


The Diagnostic approach:

Patients with recurrent stomach discomfort, nausea, and vomiting with a normal CBC, basic metabolic panel, and liver function tests should be suspected of CHS. Patients should be asked explicitly about their marijuana usage and if hot baths help them feel better. A toxicological test should be done. Different workouts of patients who use marijuana and take hot showers regularly should be evaded. Marijuana usage should be discouraged among patients. It can be difficult if marijuana is used as a taste drug or alleviates chemotherapy-induced illness and vomiting.


How is CHS treated?

Doctors are unfamiliar with CHS, making it challenging to identify patients who have it. People are frequently misdiagnosed for years, causing the therapy to be delayed. People with CHS can only get treatments that help them rehydrate and manage their nausea and vomiting. The use of benzodiazepines, such as lorazepam to reduce nausea and vomiting is one possible therapeutic approach. Benzodiazepines are restricted drugs that anybody should use with caution, especially those with a history of drug abuse. 


The producers of these medications did not develop them for treating CHS because it is a novel diagnosis, but a doctor may choose to prescribe them for this purpose. During the Hyperemesis stage of the illness, these supportive therapies can assist, but recovery depends on the individual ceasing to consume marijuana. If they keep using this medication, their symptoms may reappear. Because more individuals will have legal access to marijuana as the rules around its possession and usage alter, CHS may become more prevalent.


Treatment of CHS:

Treatment recommendations for CHS management are currently unavailable to doctors. Published case reports provide the vast majority of evidence for effective therapy and management. There is a lack of understanding regarding patients with CHS during the Prodromal stage since people with CHS frequently only visit their doctors during the Hyperemesis stage. First and foremost, doctors who treat CHS patients urge them to abstain from smoking marijuana. Doctors focus on avoiding dehydration and alleviating nausea and vomiting symptoms during the Hyperemesis period. If a person cannot tolerate oral fluids, doctors can administer hydration using intravenous (IV) solutions. If abdominal discomfort is present, some patients with CHS may need pain medications. Some doctors may suggest the following to relieve nausea and vomiting symptoms:

  • Vitamin B-6
  • Ondansetron
  • Metoclopramide 
  • Dexamethasone
  • Famotidine
  • Droperidol
  • Promethazine 

Many specialists, however, believe that these treatments are unhelpful in treating nausea and vomiting in patients with CHS.



Cannabinoid Hyperemesis Syndrome is a relatively new and under-appreciated medical condition. Although its frequency is unclear, several publications have confirmed its distinct clinical features. In individuals with recurrent, persistent vomiting and a history of cannabis usage, CHS should be considered a viable diagnosis. Despite marijuana's well-known anti-emetic benefits, there is mounting evidence of its perplexing effects on the gastrointestinal tract and the central nervous system. More research is needed to figure out how common this illness is and it’s other epidemiological features, natural history, and pathogenesis. Furthermore, treatments are required, and attempts to stop abusing cannabis are critical.


Marijuana plant at outdoor cannabis farm field.