The exact cause of CHS remains uncertain, but studies suggest that high levels of tetrahydrocannabinol THC over an extended period can disrupt the body’s cannabinoid receptors. We created Right as Rain to serve as a resource to connect you with health and wellness information you can trust from researchers, healthcare providers and faculty from UW Medicine and the University of Washington. “Some doctors recommend different forms of antipsychotic and antidepressant medications to ease symptoms, but the early research suggests that these additional medications don’t work in the absence of quitting cannabis use,” says Walker. While symptoms can be managed, the only way to stop CHS for good is to quit using cannabis in any form. Addiction rehab programs or CBT may be helpful resources for quitting cannabis. Speak with a doctor or healthcare professional if you or someone you know has symptoms of CHS.

Potential Mechanisms Behind CHS

Many times, presentation during the hyperemesis phase may be similar to panic disorder. This similarity could be the reason why CHS tends to respond well to benzodiazepines, especially during these acute episodes. It is essential to treat the underlying mood disorder to achieve cannabis discontinuation and CHS remission. The Hamilton Rating Scale for Anxiety is commonly used to assess anxiety, while alcoholism the Zung Depression Inventory is employed to evaluate depression severity 99,100. Parenteral narcotics are contraindicated for abdominal pain from CHS, as these drugs may exacerbate hyperemesis and lead to addictive behavior. Abdominal pain management in CHS should focus on treatment that avoids G.I.

• New research also suggests that people affected by CHS may have genetic differences than regular cannabis users who don’t develop CHS.
• Not only that, but the condition is rare, and some people are afraid to be honest with their healthcare providers about their substance use.
• Future research, both clinical and pre-clinical, should continue to investigate the underlying mechanism and pre-disposing factors of CHS, to further understand the consequences of high-dose cannabinoid use and dysregulation of the endocannabinoid system.
• Importantly, for the definition of cyclic vomiting syndrome, these episodes of vomiting cannot be attributed to other disorders.
• Mindfulness-based meditation is a new approach that promotes inner reflection and acceptance of experiences and negative effects by enhancing present-moment awareness and thus decreases the impact of triggers of use 93.
• This variance suggests that a range of elements, including individual biology, metabolism, and genetics, can play a role.

4 CHS and plant viruses

During the last decade, the discovery of CB1R allosteric modulators has provided new tools to target the CB1R 32. The CB1 receptor is a valuable target for treating a wide range of disorders, including anxiety, pain, and neurodegeneration. However, the development of drug candidates for CB1 is challenged by side effects, rapid tolerance buildup, and the risk of abuse 33. Historically, cannabis has been used to stimulate appetite and as an anti-emetic. The FDA approves its use for chemotherapy-induced nausea and vomiting when other anti-emetic treatments fail.

Mental Health Treatment

The amitriptyline effect on CHS is significantly lowered in patients with continued usage of cannabis products. Once the patient has maintained CHS remission, defined as the absence of CHS attacks for 6–12 months while on TCA, its dosage can be gradually decreased by 10 mg per month. The management of CHS largely relies on the severity of symptoms, the emergence of complications, and measures to prevent future recurrence. Evidence-based management of CHS is based on case series and small clinical trials 63. The recent 2024 American Gastroenterology Association (AGA) clinical practice update recommended combining evidence-based psychosocial interventions and pharmacological treatments for the successful long-term management of CHS 63.

Causes and Risk Factors

These factors may contribute to the likelihood of developing cannabinoid hyperemesis syndrome and cannabis use disorders. When you stop using cannabis entirely, you can step into the recovery phase. Over days or sometimes months, the vomiting decreases, your nausea eases, and you can start eating normally again. You begin to regain lost weight and find that hot showers are no longer necessary for comfort.

Genetic factors and individual differences in how the body processes cannabis may also play a role in the development of CHS. Many individuals use cannabis to chs syndrome manage chronic pain, but this long-term use can potentially lead to CHS. Sometimes, doctors actually recommend cannabis for specific conditions like cancer-related nausea. However, these beneficial effects seem to backfire when use becomes too frequent or too heavy. The active chemicals in cannabis build up in fatty tissues over time, and researchers believe this accumulation can overstimulate receptors, fueling persistent vomiting.

• If administering antiemetics, the nursing staff should be familiar with the adverse event profile so they can report any concerns that may arise.
• In addition to frequent and severe vomiting, patients may have difficulty eating and drinking, and only find (temporary) relief in hot showers and baths.
• The exact cause of CHS isn’t fully understood, but researchers believe it involves the body’s natural cannabinoid system.
• Doctors rely mostly on a person’s symptoms, medical history, and history of marijuana use to identify CHS.
• While it is effective, other medications are still needed in conjunction with topical capsaicin for total symptom resolution.178 The mechanism of how capsaicin reduces CHS symptoms is not known; therefore, its exact role in CHS treatment is not yet clear.
• However, these beneficial effects seem to backfire when use becomes too frequent or too heavy.

This was demonstrated in a study by McCallum et al., where male participants were given either marijuana or a placebo before undergoing a radionuclide gastric emptying test 53. The same factors apply to clinicians, specialists, nurses, and pharmacists, as well as other healthcare personnel, to consider the diagnosis in any chronic vomiting disorder, and to better inform themselves regarding the condition. They should also have the freedom and empowerment to speak up to other team members if they feel that this may be getting overlooked in the diagnostic picture.

1. Acute Treatment Strategies

TCA is used in caution with underlying cardiac arrhythmias, recent myocardial infarction, mania, or severe liver disease 97. Amitriptyline use is not advised during pregnancy, and it is classified as a Category C drug by the FDA. Discontinuation of cannabis use in any form is required for complete long-term management of CHS. A multimodal approach, including structured psychotherapy such as cognitive behavior therapy (CBT), along with addiction counseling in educating patients about the consequences of cannabis use, is necessary 92. Some patients may require rehabilitation programs to monitor the patient’s progress, ensure treatment adherence, and offer therapeutic support to achieve and maintain recovery.

Mutual-help groups such as Marijuana Anonymous are beneficial to patients without access to structured programs. TPRV1 receptors are activated at temperatures above 43 °C attained during hot showers. Understanding the ECS and its impact on the brain’s vomiting center is essential in the CHS pathophysiology 25,26.