Imagine, you have been using cannabis for years. At first, there was no problem. But after a while, suddenly you start to vomit violently and have stomach cramps. This does not happen for a day or two, but occurs periodically. The strange thing is, the only relief from this severe discomfort is a hot bath. Have you had this experience? If so, do not dismiss it as normal. Today we are talking about this condition. In medicine, we call it Cannabinoid Hyperemesis Syndrome (CHS) .
Simply put, what is this CHS?
Okay, let's simplify this name a bit. "Hyperemesis" refers to severe vomiting. "Cannabinoids" refer to the chemical compounds found in the cannabis plant. You've probably heard of THC (Tetrahydrocannabinol) and CBD (Cannabidiol) . These are also types of cannabinoids. These chemicals bind to cannabinoid receptors in our brain, spinal cord, digestive system, and other parts of the body.
Simply put, CHS is a condition characterized by intermittent severe nausea, vomiting, and abdominal pain caused by prolonged cannabis use. A characteristic feature of this is that it is temporarily relieved by taking a hot bath or shower.
This is not just a side effect of using cannabis. This is a condition that can cause serious health complications. Therefore, it is very important to be aware of this.
How common is CHS?
To be honest, it's hard for researchers to say exactly how common this condition is. The reason is that not everyone with these symptoms seeks medical advice and doesn't tell their doctor that they use marijuana.
However, one study found that 32.9% of frequent cannabis users presenting to the Emergency Department (ETU) had symptoms of CHS. With cannabis use on the rise in Sri Lanka, this condition may be more common than before.
What are the symptoms of CHS? How do we recognize it?
CHS symptoms usually begin to appear after long-term cannabis use, often for several years. However, not everyone who uses cannabis continuously develops CHS.
The main characteristics of this condition are:
- Persistent nausea: This is especially felt in the morning.
- Recurrent vomiting: Sometimes you may vomit up to five times an hour. You may feel like you are going to vomit, but there are also times when you do not vomit (retching).
- Severe stomach pain: You may experience unbearable pain in your stomach.
- Fear of vomiting: This can lead to a fear of eating or even drinking water.
- The food is tasteless.
The most unique and surprising feature of all this is that these symptoms are temporarily reduced when you take a hot bath. This is why many people with CHS are tempted to take hot baths for hours a day. This becomes a habit.
There are three stages of CHS condition.
These symptoms do not always occur in the same way. Doctors have identified three main stages of this disease.
| Phase | Description |
|---|---|
| First phase (Prodromal phase) | This is the initial stage. This is especially common in people who have been using cannabis since they were young. Here you may experience things like morning sickness and stomach pain. Although you may be afraid of vomiting, you actually do not vomit. This stage can last for months, maybe even years. |
| Second phase (Hyperemetic phase) | This is the most severe and major stage of CHS. It usually lasts for 24 to 48 hours. There is unbearable, incessant vomiting and nausea. It is during this time that the habit of bathing in hot water is formed. Eating almost completely stops. |
| Recovery phase | This stage occurs after you have completely stopped using cannabis. You should not use even a small amount. After stopping use, the symptoms gradually decrease over a few days or months, and then disappear completely. |
What is "Scromiting"?
Some people use this word to describe the most severe form of CHS. It is a combination of the words "screaming" and "vomiting." It refers to the intense pain of vomiting that causes the person to scream.
Why does this happen? What causes CHS?
Scientists still don't know the exact cause of CHS, but the main theory is that it is caused by overstimulation of the body's endocannabinoid system (ECS) when cannabis is used for a long time .
Simply put, our bodies have a natural system that controls nausea and vomiting. It is believed that when this system is constantly receiving signals from cannabis, it becomes out of balance and nausea and vomiting begin to occur uncontrollably.
Who is most at risk for this condition?
People who use cannabis for a long time, usually 10-12 years, are at the highest risk of developing CHS. This risk is particularly high for those who use cannabis at least once a week and those who started using cannabis at a young age .
But keep in mind that not everyone who uses cannabis for a long time develops CHS. The reason for this is still unclear.
How does a doctor diagnose this as CHS?
When you go to see a doctor with these symptoms, he will mainly ask about your symptoms, medical history, and your habits to determine if it is CHS.
The doctor may ask you questions like these:
- How long have you been using cannabis?
- How often do you use it?
- What time of day do you vomit or feel nauseous?
- Do certain foods increase vomiting?
- Have you lost weight for no reason?
- Do you have a habit of bathing in hot water to reduce symptoms?
The most important thing here is to tell your doctor the truth about your cannabis use. If you hide it, your doctor may misdiagnose it as another condition, such as Cyclic Vomiting Syndrome (CVS), and the treatment you receive will be wrong.
Doctors typically use these criteria to diagnose CHS:
- Frequent cannabis use for more than a year.
- Severe vomiting that occurs periodically.
- Stomach pain.
- The symptoms disappear when you stop using cannabis.
- Having a strong desire and habit of bathing in hot water.
To make sure there are no other medical conditions, your doctor may also order tests such as blood tests, urine tests, or CT scans or MRI scans.
What are the treatments for CHS?
Here is the most important and perhaps the most unpleasant thing to hear.
The one and only treatment that can permanently cure CHS is to completely stop using cannabis.
No other medication can cure this permanently. After you stop using cannabis, you may have symptoms and side effects for a few weeks. But over time, they will all go away.
If you're having trouble quitting marijuana, meaning you're addicted to it, you can get help. Talk to your doctor or an addiction counselor.
If you have severe CHS, you may need to be hospitalized. There,
- If the body is dehydrated due to vomiting, give IV fluids ( saline ) and electrolytes.
- Giving antiemetics (but these are not very effective in CHS).
- Providing other treatments, such as capsaicin cream, to reduce pain.
While taking a hot bath may provide temporary relief, it is not a cure. Taking a bath in excessively hot water can cause sweating and further dehydration.
Other complications that can occur due to CHS
If CHS is not treated properly, that is, if cannabis use is not stopped, serious complications can occur.
- Dehydration: Continuous vomiting can cause the body's water levels to become dangerously low.
- Electrolyte imbalance: Disturbance in the body's salt and mineral levels.
- Malnutrition and weight loss.
- Tooth decay: Due to the acidity in vomit.
- Damage to the alimentary canal: Excessive vomiting can cause conditions such as Boerhaave's syndrome or Mallory Weiss tear .
- Hot water burns: Get relief from using too hot water.
When should you go to the Emergency Treatment Unit (ETU)?
The most serious complication of CHS is dehydration. If you have any of the following symptoms of dehydration, go to the Emergency Department (ETU) of the nearest hospital immediately.
| Emergency! If you have these symptoms, go to the ETU immediately! | |
|---|---|
| ⚫ Urine that is very dark or the amount excreted is very reduced | ⚫ Increased heart rate |
| ⚫ Sudden loss of consciousness (Confusion) | ⚫ Increased breathing rate |
| ⚫ Extreme dizziness | ⚫ Fainting |
| ⚫ Extreme fatigue or unexplained sleepiness | |
CHS is a very unpleasant and dangerous complication that can occur with long-term cannabis use. This is why it is important to be careful when using cannabis and its products. If you think you have CHS or need help quitting cannabis, please talk to a doctor. They are ready to help you.
Take-Home Message
- CHS is a real disease: This is a real condition that causes severe vomiting and stomach pain, caused by long-term cannabis use.
- The only cure is cessation: The only way to permanently cure CHS is to completely stop using cannabis.
- Hot water baths are a symptom: Temporary relief from hot water baths is a key symptom of CHS. However, it is not a cure and can lead to increased dehydration.
- Tell the doctor the truth: If you have these symptoms, seeing a doctor and being honest about your cannabis use is essential for accurate diagnosis and treatment.
- Don't be afraid to ask for help: If you're having trouble stopping cannabis use, don't hesitate to seek medical advice and support.
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