Cannabinoid hyperemesis syndrome (CHS) is a condition that results from long-term, frequent cannabis use, characterized by severe, recurrent episodes of nausea, abdominal pain, and vomiting. This condition is often mistakenly self-treated with more cannabis due to its known antiemetic properties, which can lead to serious complications like dehydration and electrolyte imbalances. The only known cure for CHS is complete and permanent abstinence from all cannabinoid products, including both THC and CBD. Recovery begins with stabilizing the acute symptoms, transitioning into managing withdrawal, and finally focusing on the physical healing of the gastrointestinal system.
Immediate Relief During the Acute Phase
The hyperemetic phase of CHS involves intense, cyclical vomiting that often fails to respond to standard antiemetic medications like ondansetron. A characteristic feature of CHS is the temporary relief found through compulsive hot bathing or showering, with water temperatures often exceeding 106°F (41°C). This hydrotherapy may work by redirecting blood flow away from the gut or by activating a specific receptor in the skin that also influences the gastrointestinal system.
Another non-pharmaceutical approach involves applying topical capsaicin cream to the abdomen, which is thought to work through the same temperature-sensitive receptor pathway activated by hot water. In emergency medical settings, patients often require intravenous (IV) fluids and electrolytes to correct severe dehydration caused by relentless vomiting. Specific medications, particularly the antipsychotic drugs haloperidol or droperidol, have shown greater success in controlling the acute nausea and vomiting of CHS compared to traditional antiemetics.
Mandatory Cessation and Withdrawal Management
The absolute requirement for long-term resolution of CHS is the complete and permanent cessation of all cannabis use, including products containing THC and CBD. Continued use, even in smaller amounts or different forms, will almost certainly lead to a relapse of the hyperemetic phase. Once cannabinoid use stops, the severe vomiting typically subsides within a few days, but it may take several weeks to months for all symptoms to disappear completely.
After the acute CHS symptoms resolve, the body may experience cannabis withdrawal, which can begin within 24 to 72 hours of stopping use. These withdrawal symptoms are generally mild but can include irritability, anxiety, sleep disturbances, and subtle changes in appetite. Managing these psychological and physical symptoms is crucial for maintaining abstinence and preventing a return to cannabis use. Seeking counseling, joining support groups, or working with an addiction specialist can provide the necessary behavioral and psychological support to navigate the urges and emotional discomfort of withdrawal.
Strategies for Long-Term Physical Recovery
Following the cessation of cannabis and the resolution of acute symptoms, the focus shifts to restoring the body’s physical functions, particularly the gastrointestinal tract. Nutritional recovery involves the careful reintroduction of foods to heal the irritated digestive system and regain any weight lost during the hyperemetic phase. A bland, easily digestible diet is often recommended initially, gradually transitioning back to a normal eating pattern as tolerance improves.
Sustained hydration is important beyond the IV stage, requiring consistent intake of clear fluids and electrolyte-rich beverages to fully correct imbalances. The long-term healing process also involves identifying and managing potential triggers that could mimic the prodromal phase of CHS, such as chronic stress or certain dietary items like caffeine, which can affect the gut-brain axis. In some cases, a healthcare provider may suggest a long-term preventative medication, such as a low-dose tricyclic antidepressant like amitriptyline, which can modulate the gut-brain communication and help prevent future episodes.