Cannabis-Related Vomiting

One of the most popular uses of medical cannabis is the treatment of nausea and vomiting, especially in chemotherapy patients. Doctors widely prescribe Dronabinol, an FDA-approved cannabis-based medication, for this purpose. Patients might find it surprising that cannabis can also induce severe cannabis related vomiting and nausea as part of cannabinoid hyperemesis syndrome. This syndrome underscores cannabis’s complexity and the imperative to deepen our understanding of the drug to harness its many benefits.

Do You Have Cannabinoid Hyperemesis Syndrome?

Cannabinoid hyperemesis syndrome, or CHS, leads to ‘repeated and severe bouts of vomiting’ after using cannabis. Medical literature first mentioned the term in 2004. CHS, a very rare condition, appears in a few long-term, heavy users of high-THC cannabis. Those with the condition often go through an acute hyperemetic phase marked by nausea, vomiting, gastrointestinal discomfort, and an urge to bathe in hot water. This urge to soak in hot water during an episode, occurring in over 90% of CHS sufferers, distinguishes CHS from other illnesses like cyclic vomiting syndrome, stomach flu, appendicitis, and gall bladder inflammation. The episodes are cyclic, meaning patients have symptom-free periods between episodes. The similarity of CHS symptoms to other diseases often leads to misdiagnosis. Some users’ reluctance to disclose their cannabis use to doctors further increases misdiagnosis risk.

What Causes CHS?

Understanding the exact cause of CHS or the specific risk factors remains poorly understood. The activation of CBD receptors in the brain regulates vomiting centers, contributing to cannabis’s antiemetic effect. Some suggest that cannabinoids like Cannabigerol, THC, and CBD might exert a paradoxical effect on these centers, leading to cannabinoid hyperemesis syndrome. Some theories propose CHS results from cannabinoids interacting with cannabinoid receptors in the digestive tract. Cannabis activity in the gastrointestinal tract (GIT) may cause:

Acid secretion inhibition
Intestinal motility alteration
Gastric emptying delay
Visceral pain
Lower esophageal sphincter relaxation

Initially, marijuana use allows brain signals to control GIT receptor activities. With ongoing use, brain receptors may develop tolerance and become unresponsive. Without CNS control signals, users experience vomiting bouts after using the drug. This hypothesis has flaws, but it doesn’t negate the potential role of endocannabinoid receptors in the GIT in CHS development. Some researchers believe genetic variations might predispose individuals to CHS, but evidence is scarce, preventing definitive conclusions.

What are the Symptoms of CHS?

We’ve already discussed the primary symptoms of cannabinoid hyperemesis syndrome. For a more precise understanding, we can divide the condition into three phases: prodromal, hyperemetic, and recovery.

1. Prodromal Phase

If you’re going through the prodromal phase, you’ll notice mild symptoms like early morning nausea and abdominal discomfort. The duration of the prodromal phase varies, lasting weeks or months, depending on your body. Many people increase their marijuana use at this stage, believing it will alleviate their nausea.

2. Hyperemetic Phase

During this phase, you’ll experience severe symptoms that may include

Ongoing nausea
Repeated bouts of vomiting
Severe abdominal pain
Loss of appetite and weight loss
Dehydration

These vomiting episodes can be intense and overwhelming. Many sufferers report to the emergency center during this phase. Compulsive hot water showers become a necessity now. A hot shower will relieve your symptoms, and you may be soaking in a hot bath for extended periods. Without knowledge of CHS, you might continue using more marijuana, exacerbating the issue. The hyperemetic phase typically persists until you seek medical help or cease marijuana use.

3. Recovery Phase

In the recovery phase, you’ll feel normal again. You’ll be symptom-free and able to eat normally. This phase also varies in length, lasting weeks or months. Often, CHS symptoms reappear as soon as you resume marijuana use.

What are the Possible Complications that Could Arise from CHS?

Severe vomiting can lead to various complications, primarily dehydration and electrolyte loss. Unaddressed, CHS could potentially result in:

Seizures
Muscle spasms
Abnormalities in heart rhythm
Shock

Please note that CHS in itself is a very rare condition. Your chances of developing any of these complications are slim, if not non-existent. Once you address your losses of fluid or electrolytes, you will have much less to worry about.

How can I Treat CHS?

Seeking medical attention after severe vomiting episodes is crucial. Accurately describe your symptoms and answer all questions truthfully. Most CHS sufferers find relief upon stopping cannabis use. The goal of medical intervention is to restore fluids and electrolytes. If you suspect you’re in the prodromal phase, quitting cannabis should ease your symptoms. Over-the-counter medications may provide relief from vomiting. Regular hot showers and applying capsaicin cream to your abdomen can also help manage symptoms. However, the most effective treatment is stopping cannabis use.

What if I Use Medical Marijuana for Another Condition?

If you’re using cannabis for an approved condition and develop CHS, consult your medical marijuana doctor. Long-term, high-THC cannabis users are more prone to CHS. You might benefit from strains with very low THC or CBD-only products. Ultimately, your doctor will provide the best guidance.

Is CHS Preventable?

Yes. For one thing, the number of people who develop CHS is small in comparison with the number of people who use marijuana. To prevent cannabinoid hyperemesis syndrome, you have to avoid long-term, heavy use of high-THC cannabis. You may achieve this by refraining from excessive recreational use or via microdosing—tips for safely enjoying marijuana edibles.

When using cannabis for any medical purpose, it is essential to get legal. In addition to CHS, cannabis has a number of other side effects you need to be aware of. Self-medicating could put you at risk of a wide range of conditions you may not even know about. Seniors may be at especially high risk. At Kind Health Florida, we have experienced marijuana doctors who would evaluate your case of cannabis-related vomiting and help you obtain your medical marijuana card if appropriate. Call us today to schedule an appointment.