Understanding Cannabinoid Hyperemesis Syndrome: Symptoms, Causes, and Treatment

Cannabis, once considered solely for its therapeutic and recreational benefits, has increasingly become associated with some adverse health effects. One such condition that has emerged is Cannabinoid Hyperemesis Syndrome (CHS). This syndrome presents a perplexing medical challenge, characterized by cyclic episodes of vomiting, nausea, and abdominal pain in chronic cannabis users. In this blog post, we delve into the information known about CHS, exploring its symptoms, potential causes, and available treatment options.

Symptoms of Cannabinoid Hyperemesis Syndrome:

CHS manifests through distinct stages, with three primary phases:

1. Prodromal Phase: This phase is marked by early warning signs such as nausea, abdominal discomfort, and mild stomach pain. These symptoms often occur for months or even years before escalating to more severe stages.
2. Hyperemetic Phase: The hallmark of CHS is relentless vomiting, which can occur cyclically and persist for hours or even days. Due to excessive vomiting, patients may also experience severe abdominal pain, dehydration, and electrolyte imbalances.
3. Recovery Phase: Following the hyperemetic phase, patients typically experience a period of relief from symptoms, often achieved through cessation of cannabis use. However, without intervention, the cycle may eventually repeat.

Causes of Cannabinoid Hyperemesis Syndrome:

While the exact mechanisms underlying CHS remain unclear, several hypotheses have been proposed:

1. Dysregulation of the Endocannabinoid System: Prolonged cannabis use may disrupt the body’s endocannabinoid system, leading to abnormal signaling and gastrointestinal dysfunction.
2. Toxic Effects of Cannabinoids: Certain cannabinoids, particularly THC (tetrahydrocannabinol), may exert toxic effects on the digestive system, contributing to the development of CHS.
3. Compounding Factors: Genetic predisposition, heavy cannabis use, and individual variations in cannabinoid metabolism may exacerbate susceptibility to CHS.

Treatment Options for Cannabinoid Hyperemesis Syndrome:

Managing CHS poses significant challenges, primarily due to the limited understanding of its pathophysiology. Nonetheless, several strategies have shown promise in alleviating symptoms and preventing recurrence:

1. Abstinence from Cannabis: The most effective treatment for CHS involves complete cessation of cannabis use. Patients often experience symptom resolution within days to weeks after discontinuing marijuana consumption.
2. Supportive Care: During acute episodes, supportive measures such as intravenous fluids, antiemetic medications, and electrolyte replacement help alleviate dehydration and electrolyte imbalances.

Treating marijuana use from a mental health perspective typically involves a multifaceted approach that addresses both the psychological and physiological aspects of abuse, addiction, and dependence. A comprehensive and individualized treatment plan tailored to each person’s specific circumstances is essential for achieving successful outcomes in the treatment of marijuana use.  Here are some common strategies used in the treatment of cannabis use disorder: 

1. **Assessment and Diagnosis**: The first step in treatment is often a comprehensive assessment by a mental health professional to evaluate the extent of marijuana use, any co-occurring mental health disorders, and other factors contributing to substance use.

2. **Psychotherapy/Counseling**: Various forms of psychotherapy, such as cognitive-behavioral therapy (CBT), motivational interviewing, and contingency management, can be effective in helping individuals modify their behaviors, cope with cravings and triggers, and develop healthier coping strategies.

3. **Lifestyle Changes**: Encouraging individuals to adopt healthier lifestyle habits, such as regular exercise, proper nutrition, stress management techniques, and engaging in fulfilling activities, can support overall well-being and reduce the likelihood of relapse.

4. **Education and Awareness**: Providing education about the risks and consequences of marijuana use, as well as strategies for harm reduction, can help individuals make informed decisions and develop a greater understanding of their substance use patterns.

5. **Continued Monitoring and Relapse Prevention**: Ongoing monitoring and relapse prevention planning are crucial treatment components. Developing coping skills to manage triggers and stressors, identifying early warning signs of relapse, and having a plan in place to address setbacks are important aspects of long-term recovery.

Cannabinoid Hyperemesis Syndrome presents a complex interplay of symptoms and underlying mechanisms, posing diagnostic and therapeutic challenges for healthcare providers. As cannabis use continues to rise, awareness of CHS among both clinicians and cannabis users is important. Further research is needed to understand the precise etiology of CHS and develop more targeted treatment approaches. In the meantime, early recognition and cessation of cannabis use remain the cornerstone of managing this relatively new syndrome. We at R&A Therapeutic Partners are quite familiar with CHS and first started recognizing this condition in our clients a little over 5 years ago. Most people that recognize they are suffering with this condition recover permanently if they stop using cannabis but for some, they are unable to abstain despite knowing that continued use will result in them becoming ill again. For us, this is often diagnostic and likely means the individual has become dependent on marijuana and will need treatment and support to stop. Contrary to what many people believe, marijuana is addictive and can be difficult for some to abstain from. Also, with the increased potency we see in different strains and forms of THC, we suspect more and more individuals that use marijuana heavily will experience this condition in the future. 

If you or someone close to you struggles with Cannabis Use Disorder, remember you’re not alone. At R&A Therapeutic Partners, our referring professionals are here to guide you at every step of the way. Together, we can navigate the challenges and find a path to recovery. We work with numerous treatment centers nationwide to provide you with various program options, so you don’t have to make these difficult decisions alone. We also can provide customized outpatient treatment plans to help someone recognize their problem and get on the road to recovery.  Reach out to request help today.

March 2024

At R&A Therapeutic Partners Raymond Estefania and Ana Moreno specialize in substance use and mental health disorder evaluations, treatment, intervention and therapeutic/educational consulting for clients throughout the greater South Florida area, as well as nationally and internationally. For more resources and information please visit Therapeutic-Partners.com or on Facebook.