iRace, Medical Marijuana, Public Health

Too Much of a Good Thing? When Cannabis Leads to Illness

As cannabis becomes legalized for both medical and recreational purposes across the United States, more and more adults are turning to this form of plant medicine for relief from a wide variety of symptoms and conditions, including cancer, chronic pain, depression, glaucoma, and more. While most individuals who consume cannabis are able do so with few, if any, undesirable side effects, increasing reports from emergency departments throughout the country suggest that chronic (daily or almost daily) can lead to a rare condition called cannabinoid hyperemesis syndrome, or CHS, which is characterized by “severe cyclic vomiting, nausea, and abdominal pain occurring within the context of daily cannabis use”¹. Episodes can last anywhere from a few hours to several weeks.
First identified in 2004², CHS is often difficult to distinguish from the umbrella diagnosis of cyclic vomiting syndrome (CVS), which is a “chronic disorder of gut-brain interaction (DGBI), characterized by disabling self-limited episodes of nausea, vomiting, and often abdominal pain with intervening periods of absent or minimal symptoms with a prevalence of approximately 2% in the United States,” with many experts now classifying CHS as a subset of CVS³. No specific diagnostic tests currently exist for either CHS or CVS, both of which remain diagnoses of exclusion. The precise etiology of CHS remains unknown, although numerous mechanisms of pathophysiology have been proposed, with one study noting that cannabis and its components interact with a variety of endocrine, gastrointestinal, and neurologic receptors⁴.
Currently, the only known cure for CHS is the cessation of cannabis consumption¹, many CHS patients compulsively take hot showers or baths to temporarily relieve their symptoms. Researchers from Beth Israel Medical Center at Mt. Sinai School of Medicine in New York suggested the term cannabinoid hyperemesis acute renal failure (CHARF) and noted that the “unique combination of intractable vomiting and constant hot showers seems to put CHS patients at significant risk of severe dehydration and prerenal failure, a common and distinct entity”⁵. 
One promising option for symptom relief is the application of topical capsaicin cream to the abdomen, which primarily targets abdominal pain associated with CHS and has been shown to significantly reduce patient-reported pain scores for over half of patients who were offered this remedy in the emergency department⁶. Further research is needed in order to explore clinical and non-clinical treatment options to help patients who experience this pattern of cyclic vomiting in addition to chronic cannabis use¹. In the meantime, many are turning to online forums such as Reddit to engage in community discussions with other CHS patients regarding symptoms, triggers, and possible treatment options⁷, as well as general support from people who understand firsthand what they’re going through.

1. Collins, A. B., Beaudoin, F. L., Metrik, J., & Wightman, R. S. (2023). "I still partly think this is bullshit": A qualitative analysis of cannabinoid hyperemesis syndrome perceptions among people with chronic cannabis use and cyclic vomiting. Drug and alcohol dependence, 246, 109853.

2. Habboushe, J., Rubin, A., Liu, H., & Hoffman, R. S. (2018). The Prevalence of Cannabinoid Hyperemesis Syndrome Among Regular Marijuana Smokers in an Urban Public Hospital. Basic & clinical pharmacology & toxicology, 122(6), 660–662.

3. Frazier, R., Li, B. U. K., & Venkatesan, T. (2023). Diagnosis and Management of Cyclic Vomiting Syndrome: A Critical Review. The American journal of gastroenterology, 10.14309/ajg.0000000000002216. Advance online publication.

4. Bellamy, S. E., Loor, B., & Gutierrez-Castillo, M. (2023). A Case of Cannabinoid Hyperemesis Syndrome and Acute Kidney Injury: A Review of the Literature. Cureus, 15(1), e34350.

5. Habboushe, J., & Sedor, J. (2014). Cannabinoid hyperemesis acute renal failure: a common sequela of cannabinoid hyperemesis syndrome. The American journal of emergency medicine, 32(6), 690.e1–690.e6902.

6. Lee, A., & Coralic, Z. (2022). Use of Capsaicin Cream in Cannabinoid Hyperemesis Syndrome in Patients Presenting to the Emergency Department. The Annals of pharmacotherapy, 56(2), 151–154.

7. Wightman, R. S., Perrone, J., Collins, A. B., Lakamana, S., & Sarker, A. (2023). An analysis of cannabinoid hyperemesis syndrome Reddit posts and themes. Clinical toxicology (Philadelphia, Pa.), 1–7. Advance online publication.