Weed Woes: Exploring Cannabis-Induced Sickness

(Cannabis Hyperemesis Syndrome)

• What is Cannabis Hyperemesis Syndrome (CHS)?
• I use cannabis to prevent nausea; how can it cause me to vomit?
• How long does CHS last?
• Is CHS a real disorder?
• Is there a test for CHS?
• CHS Look-Alikes- Other Conditions with Similar Symptoms
• How Serious of a Condition is CHS?
• Can CBD products cause CHS?
• Can you get CHS from secondhand cannabis smoke?
• Can you treat CHS with CBD?
• How do you treat CHS?
• What should you do if you think you have CHS?

Key Takeaways

• If you use cannabis daily for years and in large amounts, it may make you ill.
• Cannabis today has much more THC than it did in years past. This may be the cause for the rise in nausea and vomiting seen with cannabis use.
• The only known cure for the nausea and vomiting caused by cannabis is to stop using the product.
• No blood tests or X-rays are needed to diagnose CHS.
• Other names for cannabis include marijuana, weed, pot, ganja, herb, Mary Jane, reefer, bud, dope, and grass.

What is Cannabis Hyperemesis Syndrome (CHS)?

CHS is a medical condition in which regular use of cannabis causes you to have recurrent and frequent episodes of nausea and vomiting that are difficult to control. Abdominal pain is also common. While cannabis can help treat some types of nausea and vomiting, it can paradoxically cause nausea and vomiting if you use it daily for years and in large amounts.

Many people report that taking a hot bath or shower helps temporarily relieve symptoms of CHS, although the reasons are unknown.

One theory is that long-term cannabis use changes the parts of your brain and stomach that control nausea and vomiting.

I use cannabis to prevent nausea; how can it cause me to vomit?

That is an excellent question and one that we do not entirely understand.  One theory is that the long-term overstimulation of nerves and hormones in your brain and stomach that are involved in nausea and vomiting by regular cannabis use leads to some changes or damage.

Some feel the ratio of different chemicals in cannabis may be responsible. Two of the most common chemicals in cannabis are THC (tetrahydrocannabinol) and CBD (cannabidiol).

Over the years, the amount of THC (tetrahydrocannabinol) in cannabis has increased compared to that of CBD (cannabidiol). This may be causing more people to develop nausea and vomiting while using cannabis.

How long does CHS last?

If you have CHS, it does not go away on its own. However, it usually comes and goes. For example, most attacks involve several days of nausea, vomiting, and abdominal pain. After a few days, the symptoms go away, only to return a few weeks or months later.

The only known cure for CHS is to stop using cannabis. As long as you continue to use cannabis, the nausea and vomiting will continue.  So, CHS is permanent for as long as you use cannabis.

Is CHS a real disorder?

CHS is absolutely real. Not everyone who heavily uses cannabis gets CHS. We do not know why. Some genetic or environmental exposures may increase your CHS risk, but researchers have not discovered such findings yet.

Is there a test for CHS?

No specific blood test, X-ray, or other test can diagnose CHS. Your doctor will consider other conditions with similar symptoms and then decide if testing is needed to evaluate for other possible diagnoses.

If your doctor has ruled out other causes of your symptoms and you are a regular or heavy user of cannabis, they may diagnose you with CHS. If you stop using cannabis and your symptoms disappear, that confirms the diagnosis.

CHS Look-Alikes- Other Conditions with Similar Symptoms

Not every cannabis user with nausea, vomiting, and abdominal pain has CHS. There are other possible diagnoses that your doctor will check for.  Alternative diagnoses include:

1. Gastritis.  Gastritis is an inflammation of the stomach lining brought on by stress, excessive use of NSAIDs like aspirin/ibuprofen or other anti-inflammatory medications (NSAIDs), alcohol, or smoking. A family history or infection with a bacteria called Helicobacter pylori(H. Pylori) can also contribute to gastritis.

Abdominal pain, especially in the right upper abdomen, is common. While nausea can occur with gastritis, frequent vomiting is uncommon.  Gastritis can improve after you eat, and you may also feel better after taking antacids.

You can have both CHS and gastritis, and this is common. Frequent vomiting from CHS can lead to gastritis.

2. Esophagitis (pron. eh-so-vaj-itis). Esophagitis is an inflammation of your esophagus. Your esophagus is the tube that connects your throat to your stomach. All the foods we eat and drink travel through our esophagus.

Causes of esophagitis include acid reflux (GERD) and the excessive use of NSAIDs such as ibuprofen, naproxen, or aspirin. Certain antibiotics and meds used to treat osteoporosis, such as bisphosphonates like alendronate and risedronate, can also contribute to esophagitis. Lastly, alcohol, smoking, infections of the esophagus, and radiation treatment are all possible causes.

The pain of esophagitis can go from your upper abdomen into your chest and even your jaw. It can be burning but can also be sharp or tight. It may hurt when food is passing through the esophagus on the way to your stomach.

Pain caused by esophagitis does not come and go in cycles like CHS. Pain from esophagitis is constant. Nausea and vomiting occur with both CHS and esophagitis.

The use of antacids and eating small/frequent meals can make esophagitis feel better temporarily.

It is common to have both CHS and esophagitis. Frequent vomiting from CHS can damage the lining of the esophagus, causing esophagitis.

3. Ulcers. Ulcers are similar to gastritis but more severe. The abdominal pain can be burning, dull, or gnawing, like hunger pain. However, the symptoms of ulcers tend to be worse than those of gastritis.

Compared to CHS, ulcer symptoms are more constant, not weeks apart like CHS. Like gastritis, ulcers can feel worse on an empty stomach and feel better after antacids. Nausea can occur, and infrequently vomiting.

4. Cyclic vomiting syndrome (CVS) and abdominal migraine. Cyclic vomiting syndrome and abdominal migraine are closely related. Some think they may even be different versions of the same problem. They are both similar to CHS and may be related. However, cannabis use does not affect CVS or abdominal migraine.

Both conditions are more common in children but are getting diagnosed more in adults than they used to be. A family history of migraines is very common with these conditions.

CVS tends to have more vomiting than abdominal pain, and abdominal migraine tends to have more pain than vomiting. These symptoms last for hours to days. Each attack is very similar to the others, and they recur after some weeks or months.

The hot baths and showers that relieve CHS symptoms can also work in CVS. If you have CVS or abdominal migraines and use cannabis regularly, stopping the cannabis will have no effect.

Both CVS and abdominal migraine can be triggered by typical migraine triggers such as stress, certain foods, menses, overexertion, hot weather, or dehydration.

There are no tests specific for either of these conditions. Doctors diagnose both conditions by identifying the typical symptoms. Tests are often done to rule out other possible diagnoses.

How Serious of a Condition is CHS?

Prolonged vomiting can cause severe illness requiring intensive care treatment. Dehydration, severe electrolyte abnormalities, pneumonia, and aspiration can all occur with any condition involving prolonged vomiting, including CHS.

Aspiration occurs when the fluid travels to your lungs instead of your stomach. Persistent vomiting can also cause a rip or tear in your esophagus.

If you develop one of these serious complications of CHS, there is a risk of death.

Can CBD products cause CHS?

Any form of cannabis can cause CHS. This includes CBD and THC.

Can you get CHS from secondhand cannabis smoke?

The amount of cannabis use required to develop CHS is heavy daily use for years. You would not likely be exposed to enough cannabis from secondary smoke to develop CHS.

Can you treat CHS with CBD?

Cannabis has more than 100 different chemicals known as cannabinoids. Two cannabinoids are THC and CBD. Until researchers learn more, no cannabis product, including CBD, is considered safe for people with CHS.

While scientists know that THC is involved in CHS, they don’t know which other cannabinoids or what combination of other cannabinoids might be involved in CHS.

How do you treat CHS?

The only treatment that cures CHS is avoiding all cannabis products. If you stop cannabis entirely and continue to have vomiting and abdominal pain, then something else besides CHS is going on, and you need to see a doctor.

Most medications used to treat nausea and vomiting do not work with CHS. Your doctor may still try some of them to see if they help.

Since many people with CHS develop gastritis or esophagitis from CHS, your doctor may prescribe medication to help treat these conditions. This is usually a medication to decrease your body’s production of stomach acid. Some examples are famotidine, ranitidine, cimetidine, omeprazole, pantoprazole, esomeprazole, and lansoprazole.

Your doctor can check if one of these is right for you, determine the correct dosage, and review potential drug interactions and side effects based on your underlying health.

What should you do if you think you have CHS?

The first thing to do is seek medical care. Depending on the severity of your symptoms, you may visit your primary care provider, an urgent care center, or an emergency room. 

You need to seek emergency care if you are experiencing severe abdominal pain, prolonged vomiting, or developing signs of dehydration.

Dehydrated persons may experience lightheadedness, lethargy, decreased tears or urine production, and dry mouth.

One of the easiest ways to check your hydration level at home is to monitor the color of your urine. A light yellow or clear urine indicates adequate hydration. Dark urine reflects dehydration. No urine production signifies severe dehydration.

Severe dehydration requires a visit to an urgent care center or emergency room. You may need intravenous (IV) fluid to restore your hydration level.

It is best for you to stop all cannabis use. If you use cannabis regularly, you could find it difficult to stop due to withdrawal symptoms. While withdrawal from cannabis is generally not considered dangerous, as it can be with other drugs, it can still be unpleasant and difficult. In addition, a small percentage of people who use cannabis regularly can develop marijuana use disorder, including addiction.

If you have difficulty stopping cannabis use, you might have marijuana use disorder (addiction) and should seek help. You can call your doctor for help or find other treatment options in your area at Substance Abuse and Mental Health Services Administration (SAMHSA), 1-800-662-HELP (4357).

Glossary

Abdominal migraine. A type of migraine more common in children, with recurrent episodes of abdominal pain rather than head pain, nausea, and vomiting.

Appendix. A small tube or pouch of unknown purpose attached to the first part of your colon, usually in your right lower abdomen.

Bisphosphonates. A class of medications used to treat osteoporosis. Examples include alendronate, risedronate, and zoledronic acid.

Cannabinoids. Any of several chemicals found in cannabis.

CBD (Cannabidiol). One of the chemicals in cannabis. It is not intoxicating and does not cause you to get “high.”

Cholecystitis. Inflammation/infection of the gallbladder.

Colonoscopy A procedure done by a doctor to look inside your colon. This is done with a flexible scope while you are sedated. The scope has a camera that can take biopsies or stop bleeding if needed.

CT or CAT scan (Computerized tomography). A type of imaging scan that uses multiple X-rays and a computer to create very detailed pictures of the inside of your body.

CVS (Cyclic vomiting syndrome). It is an uncommon condition, more common in children, with recurrent episodes of severe vomiting.

Diverticula A small outpouching in the wall of the colon.

Diverticulitis Inflammation/infection of a diverticula.

Ectopic When something is outside of its normal location, such as a pregnancy that is not in your uterus and usually in your fallopian tube.

EGD (Esophagogastroduodenoscopy, or upper endoscopy). A procedure done under sedation where your doctor places a scope through your mouth down into your esophagus, stomach, and the very first part of your small intestine. The scope has a camera and can also take biopsies or stop bleeding.

EKG or ECG An abbreviation for electrocardiogram. Tracing on a strip of paper showing your heart’s electrical activity. The test is done by placing electrodes on the chest, arms, and legs.

Electrolytes Necessary minerals for proper bodily function, including sodium, calcium, potassium, and magnesium.

Esophagitis Inflammation of the esophagus.

Esophagus The tube that food goes through between your throat and stomach.

Gallbladder The sac behind your liver that stores bile until it is needed for digestion.

Gallstone A hard object, like a tiny pebble, that forms when bile solidifies in your gallbladder.

Gastritis Inflammation of the lining of the stomach.

GERD (Gastroesophageal reflux disease, also known as acid reflux). A condition where acid from your stomach sloshes back up into your esophagus. This is the most common cause of esophagitis.

Groin The part of your body where your thigh meets your body.

Gyn An abbreviation for gynecological. The female reproductive organs include the ovaries, uterus, vagina, and other related structures.

1. Pylori (Helicobacter pylori). A very common bacteria that is the cause of most stomach ulcers and can also cause gastritis and stomach cancer.

H2 Blocker (Histamine H2-receptor antagonist). A group of medications used to reduce the amount of acid your stomach lining produces. Examples include famotidine, cimetidine, and ranitidine.

Jaundice A yellow-orange discoloration that affects the whites of your eyes and skin. Caused by too much of the pigment bilirubin in the blood. Bilirubin levels are high in liver disorders, blockage of the bile ducts or tubes, or destruction of red blood cells.

Lethargy Sluggishness, low energy, and or sleepiness.

Marijuana use disorder A range of problems that can occur with marijuana. This includes issues such as dependence, withdrawal, and addiction.

Migraine A brain disorder with a variety of symptoms that occur in attacks. Commonly, a severe one-sided throbbing headache occurs, often with nausea, vomiting, and sensitivity to light, sounds, or smells.

NSAIDs (Non-steroidal anti-inflammatory drugs). Medications used for pain. They include both prescription and over-the-counter medications, such as ibuprofen and naproxen.

Osteoporosis. Thinning of your bones that leads to an increased risk of broken bones, most commonly caused by aging.

Pancreas. An organ located behind your stomach that produces chemicals for digestion, as well as insulin, to regulate sugar levels.

Pancreatitis. Inflammation of the pancreas.

Prostate. A gland men have that produces some of the fluid in semen that helps sperm function normally.

PPI (Proton pump inhibitor). A class of medications used to stop the production of acid by the stomach. Examples include omeprazole, esomeprazole, pantoprazole, lansoprazole.

THC (Tetrahydrocannabinol). The main chemical in cannabis products responsible for the feeling of being “high.”

Torsion. Twisting.

UGI (Upper gastrointestinal X-ray series). An X-ray test involves swallowing a liquid that coats as it goes down to see the outline of your esophagus, stomach, and the first part of your small intestine.

US (Ultrasound). A type of imaging scan that uses sound waves to see your body’s internal structures.

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Copyright: myObMD, Inc | Author: Lisa Shephard, MD | Editor: Jennifer Abayowa and Dayna Smith, MD | Reviewed September 29, 2023.

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