Cannabinoid Hyperemesis Syndrome Treatment Guidelines in 2021
Apr 27, 21
Cannabinoid Hyperemesis Syndrome (CHS) is characterized by chronic cannabis use, cyclic episodes of nausea and vomiting, and frequent hot bathing. The condition comes about through an unknown mechanism. Rarely, it could arise from the long term chronic heavy use of marijuana or medicinal cannabis over months or years. Weight loss could arise if the symptoms are not managed. If you or someone you know experiences CHS, seek immediate medical advice or visit the emergency department of your nearest hospital.
Is cannabinoid hyperemesis syndrome genetic?
The mechanism could be due to a variety of factors. The cannabinoids found inside cannabis such as CBD, THC, and CBG can have opposing effects on the emesis (cyclic vomiting syndrome) response, depending on the dosage level, the frequency of exposure, and the genetic makeup of the person. It could also be that the dose-related cyclic emetic response is caused by the cumulative burden of cannabinoid metabolites in chronic users. 
Chronic users generally exhibit CB1 receptor downregulation linked to decreased inhibition of endocannabinoid feedback and elevated excitatory activity in the brain and gut. While it is well known that delta-9 THC functions as an antiemetic, at higher concentrations, it can promote serotonin or dopamine release, both of which can trigger emesis. 
The compulsion to seek hot showers could be due to disequilibrium of the thermoregulatory system of the hypothalamus, secondary to CB1 receptor stimulation.  One recent theory suggests that cannabis use redistributes blood flow from the skin to the gut, therefore, hot water heats the abdomen flood flow from the gut to the skin, which helps to provide symptomatic relief. 
Ceasing cannabis use seems to resolve the syndrome and be the best medicine. If the doctor feels that continued medical marijuana cannabis use by the patient is medically necessary, a washout period of up to one month to allow cannabinoid metabolites to clear the patient may help to reduce any relapse. Subsequent doses must be constrained to find the minimal effective dose needed to treat the condition, and spaced to minimize metabolite buildup. The patient should be monitored carefully during this time.
Capsaicin Cream Treatment for CHS
Given the low risk of adverse effects and ability to provide more complete relief of nausea, capsaicin has a promising role in CHS and more specifically was found to reduce nausea at sixty minutes. 
In 2004, a series of CHS case reports was published in Australia, where 19 people received a cannabis hyperemesis syndrome diagnosis with chronic cannabis abuse and a cyclical vomiting illness. When these patients were advised to cease using cannabis, their symptoms subsided.  Researchers are awaiting a systematic review for CHS.
The endocannabinoid system
The endocannabinoid system (ECS) is a biological system composed of endocannabinoids, which are endogenous lipid-based retrograde neurotransmitters that bind to cannabinoid receptors, and cannabinoid receptor proteins that are expressed throughout the vertebrate central nervous system and peripheral nervous system.
In more understandable terms; the endocannabinoid system maintains order and balance across every other major bodily system. If the ECS becomes overwhelmed due to too much stressors placed upon it, it can become dysfunctional; leading to states of dysfunction in the systems it oversees the health of, which then leads to dis-ease in the body and any number of severe chronic conditions. Therefore, in order to bring order and balance back to the body, the ECS must be restored back to healthy functioning so it can go to work on taking care of the body.
For more information, read our article The Endocannabinoid System Explained, and check out these two videos from WholisticMatters.
About hemp oil
Hemp oil is made from the low-THC (0.3%) hemp variety of the cannabis plant. Hemp contains a variety of compounds including phyto-cannabinoids, essential fatty acids, antioxidants, vitamins, minerals, and other bioactive phytonutrients. When consumed together in a phytonutrient-rich hemp oil, the bioavailability, potency and effectiveness of the product increases in what is known as “the entourage effect” where synergy of of all plant compounds come together in a similar way that all the ingredients of a cake come together to make it “rise” - providing a lift to those who use hemp in this way. For more information read our article on Full Spectrum Hemp Extracts, The Entourage Effect, and Cannabinoids In Hemp.
The information contained in this article is for informational purposely only and does not constitute medical advice. Prior to making changes to your lifestyle or treatment plan, always consult with your doctor.
Frequently Asked Questions
How do I get rid of CHS fast?
The main options that are available to people with CHS are those that provide hydration and help control nausea and vomiting. One possible treatment option involves the use of benzodiazepines, such as lorazepam, to control nausea, vomiting in emergency medicine.
How long does it take to recover from cannabinoid hyperemesis syndrome?
After the nausea and vomiting subside, typically within 48 hours, the person starts the recovery phase. Recovery may range from days to months and is associated with stopping cannabis use. If someone restarts cannabis, symptoms usually return.
Does CBD help with cannabinoid hyperemesis?
According to a 2018 article published in The Journal for Nurse Practitioners, “the cannabinoid CBD, in large doses, increases the symptoms of abdominal pain, nausea and vomiting.” Another study, this one published in 2011, said that “the pro-emetic properties of CBD (at higher doses) and CBG may play a role in the severe nausea and vomiting observed in patients with Cannabinoid Hyperemesis Syndrome.”
Why do hot showers help cannabinoid hyperemesis syndrome?
"Something in the pain system is disturbed by having THC around all the time," Heard told Live Science. If this is the case, hot showers may help to relieve symptoms because the stimulation from the hot water produces a different sensory signal that distracts the body from the pain signal.
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