Cannabis Use Linked to Rise in Cannabinoid Syndrome
Key takeaways
CHS is a real and rising condition linked to regular, long-term cannabis use. It causes cycles of vomiting and abdominal pain, and many patients seek relief with very hot showers. Stronger products and wider access likely contribute to more cases. Diagnosis rests on a history of heavy use, hot-water relief, and improvement after stopping cannabis. Acute care treats dehydration and nausea; the most reliable long-term fix is abstinence. Awareness by users and clinicians can reduce repeat ER visits and prevent complications.
Table of Contents
What is cannabinoid hyperemesis syndrome (CHS)?
Cannabinoid hyperemesis syndrome, or CHS, is a condition seen in some people who use cannabis often over long periods. It features cycles of nausea, stomach pain, and repeated vomiting. Episodes can last hours to days. People may go to the emergency room for dehydration or pain relief.
The condition is unusual because cannabis can ease nausea for some medical patients, yet in these cases it appears to trigger it. The exact cause is not known. Researchers point to brain–gut pathways and how cannabinoids affect temperature control and stress systems.
Core symptoms
Nausea builds in waves, followed by vomiting and sharp abdominal cramps. Many patients report poor appetite and weight loss during flares. Some feel weak, light-headed, or anxious. Between flares, symptoms can fade, which makes the pattern hard to link to cannabis use at first.
“Hot water” relief
A striking behavior is frequent very hot showers or baths. Heat can give short-term relief from nausea and pain. Creams that activate heat-sensing nerve receptors, such as capsaicin, may also help in the short term. These clues suggest that temperature-regulation circuits in the brain could be involved.
Who appears to be at higher risk?
Most daily cannabis users never develop CHS. The syndrome is linked to frequent, long-term exposure rather than to a single use. People who start using cannabis at a young age, who use concentrated products, or who increase their intake over time may have higher exposure. Stress, poor sleep, and heavy use during the day are common in patient histories. Some scientists suspect a genetic factor that changes how people respond to THC and other cannabinoids, but no single gene has been confirmed.
How common is it?
Reports from hospitals in the United States and Canada suggest that ER visits for CHS have grown in recent years. The rise tracks with wider access to legal cannabis and with the spread of high-potency products. Still, CHS remains a small share of total cannabis users.
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Why might cases be rising?
Several trends may explain the increase. Each adds to overall THC exposure and may heighten risk for a sensitive subset of users.
Potency trends
Average THC levels in plant material have risen over the past two decades. Concentrates, vape oils, and some edibles can deliver far higher doses than dried flower. Regular use of these products can lead to sustained high THC levels in the body.
Legalization and access
Legal markets make cannabis easier to obtain and may reduce perceived risk. As more people use more often, the number of susceptible individuals who develop CHS also rises. Public-health systems now see the pattern more clearly and diagnose it more often.
How is CHS diagnosed?
There is no single lab test for CHS. Clinicians first rule out other causes of vomiting and abdominal pain, such as infection, gallbladder disease, bowel obstruction, pregnancy, and cyclic vomiting syndrome. A careful history of cannabis use helps. The presence of hot-water relief supports the diagnosis. The strongest clue is improvement after sustained abstinence from cannabis.
Differential diagnosis
Cyclic vomiting syndrome shares several features with CHS. In CHS, heavy cannabis use is ongoing, hot showers often help, and symptoms tend to resolve after stopping cannabis. Bloodwork, imaging, and endoscopy may be used to exclude other conditions when red-flag signs appear.
What does treatment look like?
Treatment has two phases: managing an acute flare and preventing future episodes.
Acute care
During a flare, intravenous fluids treat dehydration. Anti-nausea drugs, acid reducers, and pain control can help. Some clinicians use topical capsaicin on the abdomen or arms to trigger heat receptors and reduce discomfort. Warm showers or baths may give short relief. People should avoid alcohol and keep to small sips of clear liquids until vomiting stops.
Long-term resolution
The most reliable step is to stop cannabis. Many patients improve within days to weeks, though full resolution can take longer. Stopping can be hard for heavy users because of withdrawal symptoms such as irritability, poor sleep, and low appetite. Support from a clinician, counselor, or treatment program can make the process easier. Stress-management skills, regular sleep, and non-drug strategies for pain or anxiety reduce relapse risk.
What are the possible complications?
Repeated vomiting can cause dehydration and electrolyte problems. In severe cases, it may lead to abnormal heart rhythms, kidney strain, or fainting. Frequent hot showers can cause skin dryness or burns. Rarely, people can aspirate vomit, which is dangerous. Early recognition and stopping cannabis lower these risks.
When to seek urgent care
Anyone with nonstop vomiting, blood in vomit, chest pain, severe belly swelling, confusion, or signs of dehydration—such as very dark urine or dizziness—should seek medical care. Pregnant people and those with chronic diseases should contact a clinician early in a flare.
What do researchers still not know?
Scientists are working to understand why only some frequent users develop CHS. Active lines of study include the role of cannabinoid receptors in the gut and brain, the hypothalamus and temperature regulation, and the stress-response system known as the HPA axis. Researchers are also comparing product types, dose patterns, and genetic markers. Large, multi-center studies may clarify which factors matter most and guide better treatments for acute flares.
Points of debate
Open questions include whether certain terpenes or minor cannabinoids affect risk, how long abstinence must continue for full recovery, and whether specific anti-nausea drugs work better than others. Until those answers are clear, abstinence remains the most consistent long-term solution.
Practical guidance for people who use cannabis
People who use cannabis often should watch for patterns of stomach pain, nausea, and vomiting that come and go. If hot showers help and symptoms return with continued use, CHS is possible. Keeping a simple log of use and symptoms can help a clinician make the link. A planned break from cannabis is a useful test. If symptoms fade over several weeks, the diagnosis becomes more likely. Those who choose to continue using cannabis should discuss safer strategies with a clinician, but they should know that reduction may not prevent future flares in susceptible individuals.
Tips for an abstinence trial
Pick a start date, ask for support, and plan for the first two weeks, when sleep and mood can be rough. Stay hydrated, keep regular meals, and set a wind-down routine for sleep. Replace cannabis-based coping with light exercise, breathing exercises, or counseling. If cravings are strong or other substance use is present, consider a structured treatment program.
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Cannabinoid Hyperemesis Syndrome (CHS): Frequently Asked Questions
What is cannabinoid hyperemesis syndrome (CHS)?
CHS is a condition seen in some long‑term, frequent cannabis users that causes cycles of severe nausea, vomiting, and abdominal pain; many people report temporary relief with hot showers. The most reliable way to stop CHS is to stop using cannabis.
What causes CHS?
The exact mechanism isn’t fully understood. Current evidence points to chronic cannabinoid exposure affecting gut–brain pathways; only a subset of heavy, long‑term users develop CHS.
Why do hot showers help with CHS symptoms?
Hot showers or baths often give short‑term relief. Proposed explanations involve thermoregulation (including hypothalamic pathways) and heat‑induced vasodilation, but definitive mechanisms remain unproven.
How is CHS diagnosed?
Diagnosis is clinical: clinicians rule out other causes of vomiting and consider Rome IV diagnostic features for CHS, including long‑term cannabis use, stereotypical episodes, and improvement with cannabis cessation.
What is the best treatment for CHS?
During flares, supportive care (hydration and anti‑nausea strategies) is used; some patients get short‑term relief from topical capsaicin. The only consistently effective long‑term treatment is complete cannabis cessation.
How long does CHS last after quitting cannabis?
Vomiting often eases within a day or two, but full resolution can take weeks, and recovery timelines vary by person; some reports describe improvement over weeks to months after stopping.
Is CHS dangerous?
Yes—uncontrolled vomiting can cause dehydration and electrolyte imbalances, which in severe cases may lead to complications like kidney injury or heart‑rhythm problems. Prompt medical care is important during severe episodes.
Is CHS the same as cyclic vomiting syndrome (CVS)?
No. They share features, but CHS is linked to chronic cannabis use, whereas CVS occurs without that exposure; distinguishing them relies on history, patterns, and response to abstinence.
Does capsaicin cream actually help?
Evidence is mixed but promising: small trials and observational studies suggest topical capsaicin can reduce symptoms in the emergency setting, while larger, rigorous studies are still needed.
Can you get CHS from edibles or vaping, or only from smoking?
CHS has been reported in people who use cannabis long‑term in various forms (smoked, vaped, or oral/edible). Risk appears tied to cumulative THC exposure rather than a single route of administration.
When should someone with suspected CHS see a doctor or go to the ER?
Seek urgent care for nonstop vomiting, signs of dehydration, chest pain, confusion, or fainting. Severe dehydration and electrolyte problems can be dangerous without treatment.
Will cutting back help, or do I have to stop completely?
Cutting back may not prevent recurrence. The most reliable way to stop CHS is to stop using cannabis entirely.
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Medical Disclaimer
The information provided on this page is for educational purposes only and should not be taken as a substitute for professional medical advice, diagnosis, or treatment. Cannabis use and conditions such as cannabinoid hyperemesis syndrome (CHS) should be discussed with a licensed healthcare provider. Do not start, stop, or change any medical treatment without consulting your doctor. If you are experiencing severe side effects, persistent vomiting, dehydration, or thoughts of self-harm, call 911 in the United States or seek immediate medical attention. For mental health support, you can dial 988 to connect with the Suicide & Crisis Lifeline, available 24/7.
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