Cannabinoid Hyperemesis Syndrome – What Is Cannabinoid Toxicity?


It was an early Saturday morning. John woke up, turned on his coffeemaker. While that was brewing, he decided to roll a joint and smoke his weed as was his routine on Saturday mornings. Only this Saturday was going to be different.

He’d smoked his joint halfway, and was about to go pour some coffee, when he was gripped by a fitful bout of coughing, immediately followed by nausea, abdominal and repeated bouts of vomiting. This went on for the better part of 2 hours before he dialed 911 and was rushed to the hospital.

Upon arrival at the hospital, the doctors were stumped at the symptoms, until one doctor who was on transfer from Portland, Oregon suggested that John’s condition bore a striking similarity with one he’d seen twice in Portland. The condition was Cannabinoid Hyperemesis Syndrome.

Long story short, he was give the requisite treatment and discharged after a 48 hour observation with strict orders to never smoke marijuana again, or risk a more severe recurrence and subsequent return to the hospital.

CHS is a rare, newly diagnosed condition linked to extreme cannabinoid toxicity. The first known case was in 2004, and has become increasingly more common in hospitals, particularly those located in states where marijuana is legalized.

A 2009 report estimates that cannabis is currently the most popular and frequently used illicit drug In the US, with over 16 million individuals indulging in the drug, and most of them being in the 18-25 age range.

Multiple research have also estimated that there are over 2.5 million new users every year in the US, most of whom are aged 19 and below. In Europe too, lots of individuals engage in the consumption of weed.

Another 2006 report released by the European Monitoring Centre of Drugs and Drug Addiction, states that as at the end of 2005, the use of this illicit drug was prevalent among 15 percent of young adults, up from 5 percent, 15 years before.

Naturally, this widespread increase in consumption of the drug has resulted in higher rates of cannabis related disorders and conditions, particularly among males, divorcees, those separated from their spouses and people with low income.

Most doctors who have seen cases of cannabinoid hyperemesis syndrome are puzzled by the occurrence. More so, when cannabis is routinely used as an anti-emetic to suppress nausea and reduce instances of vomiting in cancer patients and other individuals who don’t want to take regular anti-emetic drugs for their conditions.

So, when patients start throwing up for hours end, many tend to take even more weed to curb the urge, triggering another round and keeping them in a cycle that involves them ignorantly taking the exact thing that’s causing their condition in the bid to get some relief.

As if this is not bad enough, many patients are routinely misdiagnosed for years, and unwittingly subjected to unnecessary psychological agony, physical examination and prolonged suffering because the symptoms bear a striking similarity to conditions like cyclic vomiting syndrome (the singular difference between the two conditions is that CHS sufferers are usually smokers while CVS patients aren’t) and many other health conditions.

This is why the medical community needs to pay attention to the syndrome as most emergency doctors aren’t trained to look for these specific symptoms.

Causes of Cannabinoid Hyperemesis Syndrome and Risk Factors

So far, it does appear that the common causative agent of cannabinoid hyperemesis syndrome is the long term consumption of cannabis. It is often more commonly seen in individuals who have been smoking a minimum of two joints a day over the course of many years. This so far is the known cause.

Then, there are the suggested or possible causes (please note that these are not confirmed yet). For instance, the rise in the use of dabs concentrates has been noted as a possible cause (although the fact that CHS was already identified long before the popularity of dabs punches possible holes in this hypothesis).

It has also been suggested that there might be other factors like the addition of pesticide or other compounds to the weed. This suggestion was made by a considerable number of individuals who say they have been smoking their own organically grown weed for years –some as long as 20+ years- without any incidents. Then, there are those who are suggesting that it could be a case of late onset allergy to cannabis.

Some other people have suggested that there might be a link between the frequency of occurrence and the individual’s medical history. As you probably know, many cancer patients regularly take marijuana to help manage the pain and suppress the urge to vomit, particularly after a round of chemotherapy and/or radiotherapy, and then get addicted to taking it.

Unfortunately, even when the treatment works and the cancer goes into remission, the treatments can cause permanent damage or change to patient’s organs, thus changing their internal state and making them sensitive to cannabis; which then begs the question: is it possible that many Cannabinoid Hyperemesis Syndrome sufferers have a history of cancer treatment or any related treatment?

For now though, the studies on CHS are limited, and there are no studies that point to any of the suggested causes. However, it should be an area of interest for medical researchers to find out if one or more of these suggested causes really play a role in the overall sensitivity to cannabis.

Studies and research are still being carried out to clearly define and pinpoint the exact causes of this syndrome. We’ll update this post when we have more information.

Symptoms of Cannabinoid Hyperemesis Syndrome (CHS)

  • Prolonged cycles of nausea and vomiting (can last as long as 48 hours)
  • Abdominal cramps
  • Frequent stomach ache particularly when you’re eating or right after meals
  • Weight loss as a result of consistent vomiting
  • Some individuals become bed-ridden for 1-2 weeks
  • Severe dehydration usually from all the vomiting

These are the six best known symptoms for now. As you can see, they bear striking similarities to some other medical conditions. This is why doctors often need to be sure of the diagnosis (we’ll talk about it in the next section). Once you or anyone you know starts exhibiting these symptoms, and you/they have been smoking weed for a prolonged period, you need to get to the hospital.

How is Cannabinoid Hyperemesis Syndrome Diagnosed?

For a start, your doctor is bound to ask you some questions about your current state of health, medical history and whether you recently ingested chemicals, poisons or any toxic substances.

They may not ask about the weed, so we’ll strongly recommend that you volunteer that information. This is important because not many healthcare providers are aware of such adverse reaction to weed. Also, it could be the difference between recovery and needing a kidney transplant to save your life.

Depending on your symptoms, they may carry out some of the following tests:
  • Electrolyte test to ensure that you still have sufficient minerals in your body
  • Test for urinary tract infection and other infections
  • Pregnancy test
  • Liver and pancreas screening
  • Endoscopy of the upper GIT
  • Head CT to ensure you don’t have a tumor –most head tumors present with frequent vomiting as a symptom
  • Abdominal scan to check for possible bowel problems

Complications or Damages Caused by Cannabinoid Hyperemesis Syndrome

  • Possible acute kidney injury, damage or even failure in very extreme cases
  • Metabolic acidosis
  • Muscle weakness and/or spasms
  • Arrhythmia
  • Possible cerebral edema (swelling of the brain)
  • seizures

Cannabinoid Hyperemesis Syndrome Treatments and Cures

  • Administration of normal saline to combat dehydration
  • Prolonged exposure to hot water under a shower
  • Administering of antiemetic drugs that are meant to help reduce vomiting (there are indications that patients tend to vomit this immediately)
  • Complete and total cessation of marijuana smoking

Please note that recovery can typically take anywhere from 48 hours to 2 weeks depending on the severity of the individual’s condition. Most of the time, patients will need to spend the first 48 hours in the hospital for monitoring purposes.

This is pretty much all there is to know about this syndrome. As at the time of writing this guide, there are some ongoing studies on the cause and best treatments for the illness. We’ll make sure to update this post as we get the information.

That said, this guide is not to dampen people’s enthusiasm about the consumption of such a fantastic recreational and legal (in some states) drug. The occurrence of these incidents are often very rare –this is why most doctors don’t know about it- but the symptoms are severe enough to warrant this exposé.

If you take the drug without any side effects, by all means enjoy the benefits. But once you start experiencing one or more of these symptoms, you need to quit immediately. Most of those who stopped smoking weed after experiencing CHS, recorded 100 percent recovery, while those who went back to smoking weed relapsed, often within a few hours of indulging themselves.

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