By: Katie E. Golden, MD 

It’s an easily recognizable condition in the ER. The medics come through the ambulance doors with a young patient on the stretcher, doubled over, clutching their stomach with one hand, and holding a vomit bag with the other. While there are certainly many conditions that lead to vomiting, few seem to induce such unrelenting nausea and utter misery for the patient.


After we get the patient feeling better with medication and IV fluids, it’s time to break the bad news: the likely cause of the condition, which feels like a malicious gremlin has set up camp in their stomach, is marijuana. This can understandably be difficult to believe.  These patients have typically used marijuana for years without complication before it causes this unwelcome side effect. Marijuana, furthermore, is well known to be an effective treatment for nausea in many patient populations. So let’s mellow out and review this seemingly bizarre phenomenon.


What is this condition?


It’s called Cannabis Hyperemesis Syndrome (CHS) – an annoyingly long diagnosis to say even if you’re sober. It essentially translates to ‘marijuana (cannabis) is the reason you are puking a lot (hyperemesis), but we don’t know exactly why it happens (syndrome).’ This is becoming an increasingly common phenomenon as habitual marijuana use is becoming more prevalent in our country, and we still have a lot to learn about why it happens.


What are the symptoms?


CHS reliably causes episodes of repeated, uncontrollable vomiting. While nausea and vomiting is the hallmark symptom, most patients also experience a component of abdominal pain. The quality of the pain is variable from patient to patient, but can sometimes be sharp, severe, and felt diffusely throughout the abdomen rather than just in the stomach – like that vengeful gremlin is twisting their intestine into knots.


These violent episodes tend to be the first time CHS patients seek medical treatment, but they are often preceded by a longer interval of morning nausea and milder abdominal pain. Many patients, unfortunately, use marijuana to try and treat their symptoms at home, further precipitating the condition.


Why does this happen?


The short answer is that we don’t know. The longer answer is that it likely has something to do with receptors in your digestive tract that are activated by marijuana. Marijuana predominantly activates receptors in the brain, leading to the desired ‘high’ effect of the drug. This includes a part of the brain that controls the sensation of nausea, which is why it can be an effective treatment for nausea and loss of appetite. When these molecules attach to the receptors in the gut, however, the opposite effect takes over. It leads to abnormal function of the smooth muscle that lines our gastrointestinal tract, leaving the patient double over in pain and retching.


What we do know is that CHS only occurs in long term and frequent marijuana users – you really have to be committed to the stuff if the stomach gremlin is going to pay you a visit.


How is it treated?


The only definitive treatment for CHS is abstinence from marijuana use. Most patients will see a complete resolution of symptoms within 48hours of drug cessation. There are other, less effective means to control symptoms within that time. For reasons we don’t understand, typical anti-nausea medications are ineffective in CHS. Interestingly, hot showers seem to be very effective in helping to alleviate the symptoms, as are topical creams that are essentially made from the substance in hot peppers that make them spicy (capsaicin). That’s right – we spice you up in chili pepper cream to calm you down. (Public service announcement: covering yourself with the tabasco sauce from the fridge is unlikely to be effective, but will give your friends a good laugh. Especially if they are high.)


Is this dangerous?


CHS is not a dangerous condition unless it leads to complications from the repeated vomiting (severe electrolyte imbalances, tears in the intestine, etc). It is, however, a highly unpleasant experience that often results in a trip to the ER. And no one wants to leave the hospital at 5am on Sunday morning covered in chili pepper cream.