Cannabinoid Hyperemesis Syndrome, all-hype or half-truth?

Being in Colorado, it’s hard to escape the effluence of pot culture: tourists joke about feeling “high” right when they get off the plane. While Colorado has become a hub for weed-seeking adventurers, it has also garnered a reputation for controversy.

The latest cultural contention centers on a purported “spike” in a cannabis-related illness called “Cannabinoid [Pot] Hyperemesis [lots of vomiting] Syndrome” (CHS) where cannabis users are suddenly beset by uncontrollable vomiting and painful dry retching. Emergency Departments in Colorado confirm an up-tick in inexplicable upper GI symptomology, usually afflicting younger males who come to the ER with constant, uncontrollable and painful vomiting, only to find the battery of routine diagnostics to be inconclusive.

Kelly Fox, a Nurse Practitioner, commented on Colorado Public Radio’s coverage of CHS, saying:

“I have had patients with all of these symptoms that have undergone every possible test, revealing no clear explanation. With any substance use, whether alcohol, marijuana, or pharmaceuticals, individuals have unique pharmacodynamics (the effect of a drug on the body). So although a substance may be benign in the majority of the population there is a chance of some people reacting badly.”

As it turns out, there is some sound science behind CHS, which, by the way, is NOT a new syndrome caused by legalized marijuana, the increase in cases is related to accessibility, and reporting, as well as sheer volume of consumption.

Researchers in Australia were studying CHS in 2004 from which they concluded:

“In all [19] cases, including the published case, chronic cannabis abuse predated the onset of the cyclical vomiting illness. Cessation of cannabis abuse led to cessation of the cyclical vomiting illness in seven cases. Three cases, including the published case, did not abstain and continued to have recurrent episodes of vomiting. Three cases rechallenged themselves after a period of abstinence and suffered a return to illness. Two of these cases abstained again, and became and remain well. The third case did not and remains ill. A novel finding was that nine of the 10 patients, including the previously published case, displayed an abnormal washing behaviour during episodes of active illness.”

But it doesn’t all add up…


AP image from


Of course the die-hard cannabis advocates (and users alike) are not convinced the hype is all its made out to be. On this end, we only have anecdotes and empirical research to back up claims such as:

  • I’ve known plenty of hard-core, long-term smokers who never got sick. It turns out that CHS only appears in heavy users who have been smoking heavily for at least 3 years and appears more frequently after 16 years of abuse. (according to this High Times article)
  • It must have something to do with the quality of the weed they’re smoking to get sick – it is a fact that unless its certified organic, commercially grown cannabis is covered in pesticides and chemicals
  • The headlines are trying to keep people scared about pot, when its therapeutic uses far outweigh the prevalence of this rare, non-life-threatening discomfort.
  • Pot culture wisdom says to take a hot shower and eat a piece of pizza, and you’ll feel better in no time. Turns out, the “abnormal desire for frequent bathing” witnessed by the Australian researchers was an expression of the body’s instinct for self-regulation: “hot bathing may act by correcting the cannabis induced disequilibrium of the thermoregulatory system of the hypothalamus.” (abstract from “Cannabinoid Hyperemesis Syndrome” as published on the National Institute for Health website)

A little common sense goes a long way

Every action has an equal and opposite reaction. This can be witnessed by the effect coffee has on the body: first to stimulate, then the body compensates with a slight depression, or that “sluggish” feeling you get mid-morning when you think, “I’ll just have another cup of coffee.” Chronic, long-term, and heavy use of caffeine will produce the opposite effect – it can calm you down (depression) and you don’t get the “jitters” from synthetic over-stimulation.

Every substance that we take into our bodies has an effect – are we so surprised to see the effects of cannabis abuse strongly reflected in the upper gastro-intestinal system?

“Cannabinoid Hyperemesis Syndrome occurs by an unknown mechanism. Despite the well-established anti-emetic properties of marijuana, there is increasing evidence of its paradoxical effects on the gastrointestinal tract and CNS.” (ibid)

Moderation in all things is good medicine for our times. If you are using pot and experiencing uncomfortable symptoms…do I really have to say it?…well, STOP SMOKING. TAKE A HOT SHOWER. EAT A PIECE OF PIZZA. CALL ME IN THE MORNING.

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