My cannabis hyperemesis syndrome (CHS) story goes back 20 years and it’s taken me a long time to learn how to manage it. Before we get to it, we need to discuss CHS.
What is Cannabis Hyperemesis Syndrome
Cannabinoid hyperemesis syndrome is characterized by recurring episodes of intractable nausea, abdominal pain, and vomiting in long-term cannabis users. Onset of the syndrome occurs after several years of chronic cannabis use and occurs more frequently in males. Each episode of hyperemesis typically lasts 24-48 hours.
A patient history of chronic use of marijuana and compulsive hot showers to alleviate symptoms of hyperemesis suggests cannabinoid hyperemesis syndrome.
Let’s Unpack CHS
It’s clear there are many people (both women and men) who, after consuming cannabis for a long period of time (typically many years of Chronic or Daily use) develop a bio-physical response (which includes: nausea, sweating and vomiting) after consuming cannabis.
Further, one way which CHS sufferers manage their symptoms is by taking hot showers. In some cases the hot shower counters hyperthermia symptoms and in some cases (like mine) the hot shower calms the stomach and stops the nausea and vomiting.
How Come CHS Occurs
This is the big mystery and the question which has yet to be answered. The metrics tell us that CHS occurs more frequently in:
• Men
• Chronic Consumers
• Under the age of 50
There are three ‘working’ theories about Cannabis Hyperemesis Syndrome documented in Wikipedia:
| CHS Theory | Details |
|---|---|
| Cannabinoid buildup theory | Tetrahydrocannabinol (THC) is a fat-soluble cannabinoid that can be deposited into a person's fat stores, accounting for the long elimination half-life of THC. During periods of stress or food deprivation, a person's fat stores can be mobilized (lipolysis) for energy consumption, releasing the previously stored THC back into the blood. The mechanism can be characterized as a "reintoxication effect." Another cannabinoid called cannabigerol acts as an antagonist at cannabinoid 1 (CB1) and serotonin 1A receptors, antagonizing the anti-emetic effects of cannabidiol that occurs through its effects on serotonin. |
| Hypothalamic theory | Cannabidiol, a cannabinoid found in cannabis, can increase the expression of the CB1 receptors in the hypothalamus of the brain. Additionally, THC acts at the CB1 receptors to induce a hypothermic effect, lowering body temperature. This might explain how exposure to hot water can relieve symptoms of CHS, reversing the decrease in the thermoregulatory set point induced by cannabinoids. |
| TRPV1 theory | Alterations in the transient receptor potential vanilloid subtype 1 (TRPV1) receptor, which is involved in gastric motility and is activated by cannabinoids, nociceptive heat (temperatures above 43°C), and capsaicin, has been proposed as potential mechanism of CHS. In vitro cannabinoids mediate dephosphorylation of TRPV1 and desensitize the receptor. The TRPV1 theory posits that chronic exposure to cannabinoids down regulates TRPV1 signaling, and that compulsive hot-water bathing is a learned behavior to normalize diminished TRPV1 activity by exposure to nociceptive heat. This may also explain the salubrious effects of topical capsaicin in treating CHS. |
My Cannabis Hyperemesis Story
In 1993 I was in a bicycle accident the result of which is a spinal cord injury. The accident crushed 12 vertebra in various areas of my spine. When I left the hospital I was given a prescription for the “opiate of the day” and sent home.
Fortunately I was familiar with cannabis and instead of taking the opiates I began using Cannabis to manage pain. Over the past 27 years I’ve consumed between 1.5 and 3.0 grams of cannabis per day to manage my ongoing, chronic pain.
Starting about 20 years ago, I would on occasion, be sick in the morning with some vomiting. I didn’t think much about it because I had been diagnosed with “extra large turbinates” (mucus producers in our nose) and, typically, what I did get “up” in the morning was mucus.
Starting 10 years ago, my wife and I realized I had a food allergy to nightshades. The discovery was accidental, however, once we made the connection between certain food and my “CHS” symptoms, we started to eliminate those foods, and, over time, the frequency and severity of my symptoms diminished.
In 2016 things changed. I woke up one morning and had a bout of CHS but NOTHING would stop the vomiting. Not a Shower. Not Ginger Tea. Not Cannabis. Finally, around 2 in the afternoon, I was lying on the floor in the fetal position suffering dry heaves and we decided to go to the emergency room.
It was during this process that the attending physician and I talked about my history and he determined I was indeed experiencing Cannabis Hyperemesis Syndrome. After treating me with Benadryl and Compazine, and after a two hour long nap, I was released.
Since then, every night before bed I take a dose of Children’s Benadryl (to mitigate mucus production while I sleep) and, IF I experience nausea in the morning I just take a HOT shower and my nausea discomfort stops!
Common Situation?
Is my CHS story the common situation? I’m not really sure. Some folks are so affected by CHS they stop consuming cannabis altogether.
For me, that’s not really an option. I still have serious chronic pain management challenges and, for me at least, cannabis continues to be the best way for me to manage it and maintain my ability to work, be an active member of my family and enjoy life.
Epilog and Update
In January of 2021 we made the decision to eliminate dairy and milk products from our diet. Since we did this, I haven’t had a bout of CHS at all. This leads me to believe my “CHS” was, in reality, an allergy to dairy (specifically milk). I have to say I’m relieved and continue to use medical cannabis to manage my pain. Onward!
What to do Next
Read our blog post: What is Cannabis Hyperemesis Syndrome or Book an Educational Cannabis Tour with Happy Travelers Tours.