Cannabinoid Hyperemesis Syndrome (CHS)

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Cannabinoid Hyperemesis Syndrome (CHS), quite a mouthful isn’t it? I bet you have no idea what this syndrome is unless you suffer from it. There are several theories about the cause of CHS and they are all related to long-term use (over one year) of THC-rich cannabis. Yes, weed can cause trouble for some folks. And the only way to stop the CHS is to stop consuming weed.

Since the legalization of weed in many states, emergency room physicians have noticed an uptick in the number of patients with the symptoms of CHS. It is often mis-diagnosed as Cycle Vomiting Syndrome (CVS) when you take that first trip of many to the ER. Treatment options for CHS are limited because of a lack of available research and an understanding of the syndrome.

There are four phases to a CHS attack

  • symptom-free phase
  • prodromal phase
  • hyperemetic phase, and
  • recovery phase.

The symptom-free phase is the period between episodes. This period can last days, weeks, or months.

The prodromal phase signals an episode is about to begin. Often marked by nausea, with or without abdominal pain. This phase can last from several minutes to several hours. Or you might just wake up sick. Yes, attacks typically begin in the morning hours.

The hyperemetic phase consists of nausea and vomiting. Sufferers cannot eat, drink, or take medicines without vomiting. Some sufferers also find relief by trying to induce vomiting.

An additional characteristic of the hypermetic phase is the need to take long hot showers or baths. All day, for as many days as it takes for the symptoms to end. Relief from the hot shower is brief and soon the sufferer is back in the tub.

The recovery phase begins with cannabis cessation and can last days, weeks, or months, and is associated with relative wellness and normal eating patterns.

Common CHS symptoms are

  • severe abdominal cramping
  • vomiting and dry heaves
  • diarrhea
  • fever
  • dizziness
  • sensitivity to light, and
  • headaches.

Obvious results of vomiting and diarrhea are dehydration and weight loss. At this point you need ER intervention to replace fluids.

Anecdotal remedies shared by some users include

  • heating pads and hot water bottles, and
  • rubbing capzasin cream on your abdomen or small of the back (in small amounts so you don’t burn yourself).

An article by Shusen Sun, PharmD, BCPS and Anthony E. Zimmerman, PharmD reported that some relief was provided by the use of

  • analgesics such as morphine to relieve abdominal pain, and
  • lorazepam by IV have made it useful for treatment because of the antiemetic properties that allowed a patient to transition to oral lorazepam and resume a regular diet.

Note: medications such as promethazine do little to help with nausea and vomiting, but if you use suppositories, it will help you get some sleep.

The article by Sun and Zimmerman theorized that the causes of CHS might include

  • a genetic variation in cannabinoid metabolism that leads to toxic accumulation in the user
  • an accumulation of THC in cerebral fat witch may lead to toxicity and emesis in sensitive patients
  • an imbalance between the enteric and central nervous systems caused by THC
  • the effects of long-term cannabis use on the hypothalmus-pituitary-adrenal system, and
  • an impairment of the thermoregulation system by THC hat might account for the relief of symptoms with compulsive hot bathing.

Abstinence from THC is the only known cure for CHS at this time. If you think you suffer from CHS, have an honest conversation with your doctor about marijuana use and consider abstaining from cannabis use.

Do you suffer from CHS? Have you found relief from your symptoms? I would like to hear from you.

Looking for a support group? Try “cannabinoid hyperemesis syndrome (chs) support group” on facebook.

Namaste

Shusen Sun, PharmD, BCPS and Anthony Zimmerman, PharmD. ‘Cannabinoid Hyperemesis Syndrome’ 17 September 2013, www.ncbi.nlm.gov, PubMed Central (PMC). Accessed 6 July 2019.

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