Unfortunately, there is such thing as too much of a good thing when it comes to weed. If you overtax your body’s weed-processing machine, the endocannabinoid system, too many times, you can come down with cannabinoid hyperemesis syndrome (CHS). And if that happens, you’re in for a world of hurt.

Don’t panic though! Not every toker is vulnerable to CHS. Only an unfortunate subset of cannabis consumers will experience this. What’s important is to recognize whether you’re at risk of joining that club, and what to do if you do contract CHS. Here’s what we know so far.

A System Like Any Other

Your standard biology textbook will detail 10 organ systems in the human body: nervous, respiratory, urinary, muscular, skeletal, cardiovascular, reproductive, lymphatic/immune, endocrine and digestive. Transcending all of these is the system seldom – if ever – presented in those same books: the endocannabinoid system (ECS). This system regulates and even controls many of our body’s most critical functions, from learning and memory to sleep, pain control and more. 

The body’s endocannabinoid system is comparable to any of the body’s other systems.

As might be inferred from the nested word “cannabinoid,” the ECS is unique to the body’s processing of the cannabis plant. The system’s primary active enzymes, the endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG), are molecules that our bodies produce to stimulate cannabinoid receptors in the brain. “Endocannabinoid” was created as a classification owing to the similarity of these molecules’ structures to those of the molecules in cannabis. 

Basically, our bodies have little weed copy-cats in them, and they do the equivalent workload of our body’s 10 organ systems (individually), so they get their own system.

The human body has a system whose molecules look and act just like the molecules in the cannabis plant: endocannabinoids.

System Overload and Crash

Extreme, prolonged stress and anxiety can cause your nervous system to crash, resulting in heart palpitations, insomnia and numerous other health issues. Bingeing on junk food can cause your digestive system to crash, resulting in heartburn, sweating, dizziness and more. Jogging without stretching beforehand can cause your muscular and/or skeletal system(s) to crash, leading to torn ligaments, sprains or other problems. Every organ system has its limits. The ECS is no different; push it beyond its limits, and it will crash, resulting in CHS.

In the same way that you can have a nervous (system) breakdown from too much stress over a long period of time, you can have a “cannabis breakdown” from too much cannabis over a long period of time./Photo by Pixabay

Cannabinoid Hyperemesis Syndrome

Author’s Note: This condition is also known as “cannabis hyperemesis syndrome,” but the author chose to refer to it as “cannabinoid hyperemesis syndrome” to use the same lexicon employed by the scientists who first discovered CHS in 2004.

The term “hyperemesis,” whether induced by ECS oversaturation or anything else, refers to severe vomiting (“scromiting” if you’re screaming from pain while in the act). When long-term frequent, heavy cannabis consumption is the cause of the hyperemesis, you’ve likely got CHS. Note, however, that this pertains only to habitual consumption of tetrahydrocannabinol (THC) in particular, as cannabidiol (CBD) does not appear to cause CHS by itself.

Cedars-Sinai identifies three stages of CHS: 1) prodromal, 2) hyperemetic and 3) recovery. During the prodromal phase, which can last for months or even years, the main symptoms are morning nausea and frequent, severe abdominal pain. The hyperemetic phase maintains those symptoms but adds intense, overwhelming vomiting. This carries on at least monthly until the person ceases to consume cannabis entirely to give their body time to rebalance, which is the third phase, recovery. In some cases, returning to cannabis consumption will cause the symptoms to return; in other cases, giving the ECS time to rest and reboot gets things back to where they were.

The primary symptoms of CHS are nausea and irregularly painful vomiting, experienced recurringly for months or years./Photo by Polina Tankilevitch/pexels.com/Photo for illustrative use only

Here’s a checklist of the symptoms, for quick reference:

  • Persistent nausea (often in the morning)
  • Incapacitating vomiting (up to 20 times a day for 24 to 48 hours)
  • Repeated retching (up to five times an hour)
  • Heartburn and burping
  • Intense abdominal pain (epigastric and periumbilical)
  • Fear of throwing up
  • Rapid heart rate
  • Low blood pressure
  • Loss of appetite (and potential weight loss)
  • Dehydration and electrolyte disturbances

Of note, these symptoms start abruptly within 24 hours of your last use of cannabis (specifically, THC). A diagnosis is usually made in people who have had three or more yearly episodes of nausea, vomiting and abdominal pain that last less than one week, and who are affected by the risk factors identified below.

CHS Risk Factors

Long-term, frequent weed smoking does not, in of itself, indicate that you will absolutely, definitely contract CHS. The link between THC and CHS is nowhere near as understood, documented, corroborated and established as the link between, for example, cigarette ingredients and lung cancer. So, rather than concluding, “If I smoke weed regularly for years, I will get CHS” (which is false), consider, “If I smoke weed regularly for years and experience severe cyclical vomiting, it might be CHS.” 

CHS is so new in the medical community, and all cannabis research – CHS-related or otherwise – is hampered by the plant’s legal status, so incredibly little is known about CHS’ causes. What is known derives from limited trend analysis, nothing more. Every expert-written and/or expert-reviewed article in the Sources and Suggested Reading section that centers on CHS will tell you the same thing: “All we know for sure is that we don’t know anything for sure.” (That’s paraphrasing a study in the “Journal of Medical Toxicology” that states succinctly, “The pathophysiology of CHS remains unclear with a dearth of research dedicated to investigating its underlying mechanism.”)

There is no “If X, then Y” formula for determining which weed smokers will contract CHS. The truth is, we simply don’t know why some THC consumers get it and some don’t. All we know so far is that the people whose symptoms warranted a CHS diagnosis all smoked weed daily for years. Was that the actual cause of their CHS? Maybe. Maybe not. That has yet to be determined due to insufficient evidence. For now, it’s a factor to keep in mind./ Photo by Liza Bakay/pexels.com/Photo for illustrative purposes only.

Evaluate your CHS risk by using the “If X AND Y, then Z” formula, where X represents the list of CHS symptoms presented above, Y represents the correlating risk factors below, and Z represents contracting CHS. 

Here are, based on available data, the risk factors associated with CHS:

  • Consuming cannabis (THC) at least once a week since adolescence (before age 16)
  • Consuming cannabis (THC) at least four times a week for at least one year
  • Consuming cannabis (THC) at least once a week for at least five consecutive years
  • Smoking cannabis at least 20 times a month
  • Smoking cigarettes regularly
  • Having a substance abuse disorder

Unrelated to any biological predisposition to CHS are external mitigating factors. Even if your body doesn’t carry the CHS curse, you can still be hexed by things nature never intended:

  • Cannabis plants treated with chemicals (fertilizers, bug repellants, etc.)
  • Cannabis plants grown in soil treated with chemicals within the past four years
  • Cannabis plants grown indoors by artificial sunlight
  • Synthetic cannabinoids (aka synthetic marijuana) 

Note that this isn’t to say that all cannabis grown indoors should be avoided. Rather, keep in mind that anything that doesn’t occur in nature introduces risks otherwise not present. This point was made several times by medicinal cannabis expert Dr. Pepper Hernandez during a lecture of hers that included CHS risk factors. (To learn about her lecture series, see our article “Head Magazine at Cannabis University: Part 1.”)

CHS is among the many things covered by Dr. Pepper Hernandez, whose course at The Shift Network has lots of valuable key takeaways that we share with Shift’s permission in our “Head Magazine at Cannabis University” series. Read Part 1 of the series here!

CHS Diagnosis

If you are experiencing hyperemesis (severe, cyclic episodes of vomiting), it might be caused by something other than habitually oversaturating your ECS. So, don’t immediately assume that weed is the culprit. Only suspect that it’s CHS if your symptoms are accompanied by the risk factors presented above and the following:

  • Compulsive hot bathing (a CHS-specific learned behavior that is pathognomonic for CHS)
  • Symptoms that stop with cannabis cessation for at least six months
  • Results from blood tests, urinalysis, imaging tests (CT scan, MRI, etc.), pancreas and liver enzyme tests, abdominal x-rays, and other tests that can identify CHS

There’s also an algorithm from the Cleveland Clinic Journal of Medicine, available here, that was created for doctors but that you can use to self-diagnose prior to seeking medical attention.

It’s important to be completely honest with your doctor when seeking treatment for hyperemesis, as no doctor can help you if you aren’t. And the type of hyperemesis in CHS requires treatment that is different from the treatments for other types of hyperemesis. There’s an understandable reluctance to admit to consuming something illegal (see our analysis of that hypocrisy here), but it’s not like you’re bringing your bong and stash with you to the clinic, so fess up.

It’s critical to tell your doctor the truth about your cannabis consumption when seeking medical treatment for something potentially related to it, no matter how awkward that might be. Photo by Mart Prodcution/pexels.com. Photo for illustrative purposes only.

CHS Treatment and Prognosis

The symptoms are treated as follows:

  • Nausea/vomiting: hot showers (to engage the hypothalamus), capsaicin cream (0.025% to 0.1%, rubbed on the belly) and/or antiemetics (most commonly droperidol, as ondansetron/Zofran doesn’t work on CHS)
  • Abdominal pain: proton-pump inhibitors and/or capsaicin cream
  • Dehydration: intravenous (IV) fluid replacement
  • Fear (of vomiting): benzodiazepines (anti-anxiety) and/or haloperidol (antipsychotic)

The illness itself can only be cured by not consuming cannabis for however long is necessary to reboot your ECS. In some cases, CHS patients won’t be able to consume THC ever again without contracting ECS immediately; in other cases, things will go back to normal for another long stretch of time. The probability of each outcome is impossible to determine with the minimal amount of data currently available, but your doctor might be able to assist you with determining what your body can handle.

Just like taking a vacation from a high-stress job to let your nervous system reset after a nervous breakdown, you might just need to give your ECS a vacation, and then it will work again as intended./Photo by Gaspar Zaldo/pexels.com

Conclusion

CHS is relatively new to the epidemiology scene, so scientists and doctors are at the bottom of a very steep learning curve. What’s important for you to know today is that if the perfect storm of CHS symptoms, CHS risk factors and CHS diagnosis elements presents itself, you might have CHS. Having that knowledge could be the deciding factor in getting you the right medical treatment. That way, you won’t spend years hugging the toilet bowl as you “scromit” and wonder why the (non-CHS-specific) treatments aren’t working. 

So, given how little we know about CHS, this condition is just something to be aware of, not afraid of – far be it from Head to harsh your vibe!

The information in this article and any included images are for educational purposes only. This information is neither a substitute for, nor does it replace, professional legal advice or medical advice, diagnosis or treatment. If you have any concerns or questions about laws, regulations or your health, you should always consult an attorney, physician or other licensed professional.

Kathleen Hearons is a writer, editor, linguist and voice over actor from Los Angeles. She specializes in creative writing and research-intensive analysis and reporting.

 

 

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