What is Cannabinoid Hyperemesis Syndrome?

Often mistakenly called Cyclical Vomiting Syndrome, Cannabinoid Hyperemesis Syndrome is a rare form of cannabinoid toxicity that develops in chronic smokers. It’s characterized by cyclic episodes of debilitating nausea and vomiting. People who suffer from the syndrome often find that hot showers relieve their symptoms, and will compulsively bathe during episodes of nausea and vomiting. Symptoms stop after cessation of cannabis use.

Cyclic Vomiting Syndrome is different from Cannabinoid Hyperemesis Syndrome—though the symptoms are very similar. Cyclic Vomiting Syndrome is not caused by cannabis consumption.

This may sound scary, but it’s very rare. I’ve known many heavy smokers all my life and have only recently heard of it through research online. People are blaming the recent and increasing popularity of dabs for Cannabinoid Hyperemesis Syndrome (CHS), but CHS has been around since way before concentrates were popular. An Australian clinical study from 2004 looked into the syndrome in a group of 10 patients suffering from CHS, and all were marijuana smokers, not dabbers.

CHS develops in heavy, longtime consumers of cannabis; there is generally daily use in excess of three to five times a day for many years before the appearance of symptoms. A clinical study from Philadelphia, PA states that the average duration of cannabis use before the onset of symptoms was around 16 years, and the earliest symptoms had developed in a patient was after around three years of smoking weed.

People who suffer from CHS often find that hot showers alleviate their symptoms, and this provides another clue for the cause of the syndrome. According to the study from Philadelphia, “hot bathing may act by correcting the cannabis induced disequilibrium of the thermoregulatory system of the hypothalamus.”

While cannabis is revered for its nausea-calming (antiemetic) properties, it’s paradoxical that it causes severe nausea and vomiting in certain people. Due to its widely known antiemetic properties, people who develop CHS will often increase the amount of cannabis they consume in hopes that it will cure the nausea, but it never helps.  It goes to show how little we know about not only about the body, but also about the interaction between cannabis and cannabinoid receptors.

CHS is a very rare syndrome and is easily cured by stopping the consumption of cannabis. This should not, by any means, hurt marijuana’s reputation for being the safest recreational drug around, but people need to be aware of the syndrome’s existence. If you know anyone with these symptoms tell him or her go to a doctor and stop smoking.

  1. I’m glad this condition is starting to gain awareness. I know 2 people whom I know suffer from this and fit the symptoms to a ‘T’ (vommiting, hot showers, etc). Both are extremely heavy users and refuse to quit or even reduce their intakes. Neither can hold down jobs and frequent the ER 5 to 6 times a year. It’s hard to watch and be around because their moods are so negatively polarized during these episodes. I used to smoke as much as them but never felt CHS symptoms ever. I have since quit all together by choice and for me it has been one of the best decisions I’ve made. However, not against the use for medical reasons or even for private casual use. I just hope my brother and friend will wake up and listen to their bodies, doctors and articles like this to improve their healths and live a little more fulfilling life.

  2. Hey guys I’ve literilly spent the last few days in hospital and they are thinking it is thins.. only problem is this has been going on for about 8 months for me and if I don’t smoke I vomit every 15-20 mins no nausea tablets are helping I’ve already lost 23KGs what has others done to help with there symptoms because this is horrible

    1. I was in the same exact boat as you a few days ago… I was constantly vomiting and it landed me in the ER. it was such a painful decision to stop cold turkey and the first 2 days were rough…. but once you get through it you will recover very fast. I promise it is so worth it. I’m on day 4 no nausea and I feel 100% better. I plan on returning to smoking but not as much. I really hope you recover. You’ll definitely come out a warrior!

      1. I was told a month ago after four times in urgent care and once to er in same amount of days. The last day a doctor finally asked me if I smoked pot. Of course I said yes. I was so sick constantly vomiting and my stomach wouldn’t stop hurting. The first week I lost 17 lbs. The second week 15 more. My symptoms fit to a tee. I’ve smoked for over 35 years. I’ve quit several times. When I got bone cancer I really started to smoke more and only oil.I sent my story to a local news station and they came to my house last week and did a story. This needs to get out to all pot smokers. It’s real. And it’s bad. I was trying to smoke the high cbd. That’s what put me over. When I started Rick Simpson oil. The next day it started and laser 2 weeks. And no you can’t eat or hardly drink. The whole time I can only sleep about 3 hours a day. The showers and pacing and rolling myself in a ball to feel better. It sucks. But. It’s been a little over a month and I haven’t smoked or eaten any pot. Never again. I just want people to be aware it can make you very sick.

        1. Thanks chris your symptoms sound exactly like mine are it’s horrible. I’ve now left my life in Australia and moved back to New Zealand to be around the family and it’s alot less stressful but hell I had no idea this was a thing and my friends who are also high users dont understand. People need to understand weed is amazing in moderation just like anything and people need to know about the warning signs!! Would love to see your article

          1. Welcome Loran. I just called the channel 12 news guy that did the story. He said he’s done with the story but it’s not yet on the calendar. He’s to let me know. Then I’ll try to put it on hear somehow. Hope your feeling better. Glad your with family. I couldn’t imagine feeling so bad alone. It’s really sad to have to quit but it’s just not worth it.

        2. Good for you. My oldest daughter went to ER 4 times this week. She’ll be so agitated she can’t wait her turn. She’ll leave and a few hours later someone or an ambulance is taking her back to hospital. She normally goes for the dehydration her vomiting causes. She was diagnosed with this syndrome about 10-12 years ago. Pitiful. She’s a 24/7 smoker for most of 15 years.

    2. Hi thanks for replying. Did you find it hard to eat properly again for a while after.. my condition has been going on a solid 8 months and they have only just suspected this so I’m pretty worse for wear im on day 4 now of cutting right back to 2 smokes a day vomiting has stopped and have just started being able to eat small portions. Also has anyone else noticed a bubbly kind of sensation where they usually get the pain after they cut right back/stop?

  3. I have this. Been smoking heavy for two decades plus a few years. I’m a chronic ER visitor, usually for extreme nausea that zofran won’t even stop. I’ve been told by a substance abuse counselor and two ER doctors that I have CVS. I didn’t believe it at first. I’m two weeks off Mary J now. It sucks quitting but I’m trying it out I guess. I wonder if I can still intake THC and just not smoke? I’m eating some Dogg Treats right now so we’ll see!

  4. I am so happy that I found and read this article! I have been suffering with this for years! Surgeries, meds, ER visits and numerous tests! It has been so hard. Thank you so much for this info, I am taking this to my doctors today! Thank you!

  5. Just got out of the hospital today. I’ve been diagnosed w this a few months ago after 3 years of stumping doctors. The compulsive bathing (in my case) causes acute kidney injury & leads to 3-5 day hospital stays. After 20 years of anywhere from 1-5 grams a day of ridiculous high quality weed I started getting sick most days when I woke up.
    I’ve cut down to a gram a day & 1.5 on weekends but still occurs usually with no warning of the onset. Zero to projectile vomiting in 1.1 seconds. I don’t want to live sober but when the other option is eventual dialysis then the kidneys win out over the pot. Seriously tho this can kill you if you don’t get medical attention when it’s severe

    1. Hi there. I was just wondering… If you have CHS but are still smoking the greenery are you sick every day? Or when you smoke are you sick right away? Is there something that triggers the vomiting and ER trips? Sorry for the questions I’m just confused how you can continue to smoke if your body has a negative reaction to THC.

      1. It doesn’t happen every day. I’ll be perfectly fine for 3 months or so and then it’ll hit with no warning besides a slight headache about 15 minutes before. I was smoking too much though, a large joint of 20%+ thc to myself every 90 minutes for 16 hrs daily, so now I’ve doubled my work schedule and can’t smoke for at least 12 hrs to see if that’ll make it stop. So far so good, but if it happens again I’ll just quit.

        1. Thank you so much for responding. My boyfriend was hospitalized three times this year already for vomiting and upon the news that he smokes he is told he has CHS right away. Having never heard of it and all I am just full of questions. What you say makes sense and does fit. However, if i may ask one more: when you end up sick did you happen have an elevated white blood cell count? That part always gets me. My man has a crazy WBC which would indicate an infection not CHS but I’m no doctor. Thanks again for your time. You are a true saver of a worried soul.

  6. I vaped 24/7 for about 6 years and i got gastroparesis. Now wheither or not it caused it. I dont know. I believe it was the bing eating on take out and fast food that more than likely did it. I was 310 pounds 6 months ago. I am now 245. I assume it a good thing because as long as i can stay away from fast food and refrain from binge eating. Should be fine. The key thing to note is that cannabis suppresses the nervous system in such a way that it will relax the stomach muscles for some with chronic symptoms. In others like mine I’d asume pot clenches my stomach by supressing the vagus nerve. Lets be real though. I am no doctor but all i can say is pot may not cause it but can impact gastroparesis negatively and some positively

    1. I was a long term smoker (20+ years) for chronic migraines. I have had 6 or 7 episodes now of CHS. This last one almost killed me. Could not get reset at the ER and stop. Went on for 8 days and 5 ER visits. I have developed gastroparesis as well as ibs. No one in my family has these conditions. My diet was relatively good and my weight low and found it very hard to put on and keep weight on.
      I’m thinking there’s a connection between the heavy use for 20+ years and all this.

  7. I’m wondering if anybody has symptoms that are more similar to mine. About 3 months ago I started having episodes about 2-3 times a week where I would wake up sick to my stomach. I would have consistent nausea during this time and usually vomit every hour or so depending on how much was in my stomach. By mid afternoon I am symptom free. I’ve only been smoking regularly for about the past 8-10 months or so. Since my symptoms have started, there’s been times where I haven’t smoked for a week or two, yet I don’t always experience relief. All the doctors have blamed it on my antidepressants which have been changed multiple times with no success. My therapist was actually the one to suggested CHS, but my symptoms don’t seem to be a perfect match. Especially since I haven’t been smoking long.

  8. I have CHS, been a heavy smoker for 8 years. Developed after 3 years, have to quit for a month or 2 when nausea/vomiting become too frequent. I know i should quit permanently but im in love with Mary.

    1. Hi there. I was just wondering… If you have CHS but are still smoking the greenery are you sick every day? Or when you smoke are you sick right away? Is there something that triggers the vomiting and ER trips? Sorry for the questions I’m just confused how you can continue to smoke if your body has a negative reaction to THC. My boyfriend sounds very much like being a heavy smoke who loves Mary 😉 you and i am just not convinced that CHS is the answer since he comes home from the hospital smokes and is fine for months… does this also sound like you?

    1. It happens because the receptors in the brain become damaged. Switching how you get the TCH (eating, smoking, etc) makes no difference. If someone wants to never have another episode then they never put that substance in their body again. Period.

  9. The question I have is why is this only coming up in the past decade, and not known or heard of decades ago? I’m sure it could be due to misdiagnosis over the years, but cannabis has been consumed for centuries. So, why now? Is it pesticides? Potency levels? Is it due to growing methods? Could variation in terpenes and other compounds due to current growth methods be causing it? Could it be due to interactions with types of food (and their pesticides or growing methods), other medications, etc.?

    I’m not saying that CHS is caused from cannabis. And I’m not discounting people’s personal experiences. Although, please recall that correlation does not imply causation.

    My concern is that there seems to be little information out there, and people are starting to turn this into another “reefer madness” campaign. Which is made worse since there are lots of questions and few answers. I hope sufficient studies will be done to find out what is really happening.

  10. Ive been smokig (daily) for a year and 2 months now. Mostly to help with a bludging disk problem for a car accident (which helps tremendously, I am relived so much from smoking).
    Anyways, these symptoms have been going on every morning for the past 7-9 months (theres probably 3-5 days out of the whole month where I don’t feel sick). Every time its throwing up and really bad nasuea. And at night, I do have a fear of feeling sick in the morning. I sometimes cry to my boyfriend about how I dont wanna feel bad. Im normally a pretty heavy sleeper, but man does it wake me up in the middle of the night! Its like clock work too. Normally around 5am-6am. After Im in the bathroom (anywhere from 20 minutes to an hour) dying of pain, I go back to bed. Normally I throw up or just gagging makes my stomach feel better. Enough to where I can go back to bed.
    In the morning–still a little nauseous, but it goes away as I slowly start to wake up. The rest of the day I am perfectly normal. Im pretty sure I’ve lost about 10-15 lbs because of this! But, Im still at a healthy weight. I try to stay hydrated as much as I can because of the additional fluid loss.
    I’ve been to doctors about this problem and they could not find anyhing wrong with me. Except suggest I keep a food diary and figure out what foods have been botherig my stomach. (Food has never been an issue for me, Im not allergic to anything). Hense, I wasnt convinced.
    This post says that the only treatment is to completely stop. I really would like not to–mostly for my back. However, I’m going to cut down. Maybe not smoke before I go to bed. Take my last hit with dinner. See if I see any improvements in the mornings. If not, I will probably have to stop 🙁
    Sorry for the long post, but they said this syndrome is rare. I just want to let people know what I go through, so they could maybe find some answers.
    I just wish I knew this sooner. I literally thought it was my birth control or the sex making me so sick.

    1. Please read my other comment (sorry it’s so long). Cutting down won’t stop it. Once the receptors in brain are damaged, putting TCH in your body is risking an episode and increases the likelihood of a full-blown episode: vomiting every minute or two for 1-5 days. Nothing stops it- no phenergan, zofran, nothing. You end up puking blood because it’s irritating the stomach lining. Can’t go to work, no relief at hospital (other than fluids to prevent dehydration). It’s horrible. There’s gotta be an alternative for your back.

      1. Hi are you a doctor, neurologist, DNS expert with the credentials to make this comments? this can be very misleading since this has not been even researched to that extent. I just want to know, since everyone has the right to their opinion, but it should not be posted as a scientific statement. But if we are just posting comments out there without any cynical or scientific proof, it can be misleading. And this my opinion.
        Don’t men to be critical.

  11. Could this be due to excessive nutrient feeding (hydroponic bottled nutrients especially), no proper drying/curing, and/or excessive ammonia ingestion from lack of drying/curing properly? Most Cannabis in dispensaries isn’t properly grown, dried, nor cured and essentially has excessive nutrients and ammonia still present upon combustion. (black ash).

    1. This. The grow methods need to be reviewed. Is there a poison build up going on? I was recently pointed to the black ash problem. Be mindful. When I smoke white ash Mary, there is no cough, no restrictions to the lungs, smooth exhale, etc. Becoming a cannabis user is every bit about being a conscious user. More needs to be done about the growing conditions of cannabis. What this means for regular users, and how to be alerted to it before purchase, or use.

  12. Having started smoking in the early 60s, when all pot was imported & ‘relatively’ inexpensive, everyone smoked copious quantities of weed. We used to sit around dining tables where everyone would bring out their stash, and we’d roll, smoke, drink lots of fluids, maybe munch a little. We smoked a lot of pot!. Now, decades later, pot is grown indoors, you rarely see pot that has been grown in sunlight, and people are getting sick. Not one of my friends who continued to smoke over the past decades has fallen victim to anything not related to getting older. We also don’t consume indoor pot whenever possible. Most either grow their own, enough to last till the next year’s harvest, or they get their pot from someone who guerilla grows outdoors.

    In 1980, Reagan started the ‘War on Drugs’, he effectively stopped the importation of exotic outdoor pot worldwide, and ushered in the age of hydroponic, indoor pot. Introducing chemicals/pesticides to the process that had hitherto been ‘clean’ hasn’t really improved anything. Now, we’re seeing the evidence of the negative aspects of indoor pot. I strongly believe the proliferation of hydroponics, genetic manipulation, and using chemicals & pesticides have caused far more problems than any benefits.

    People who may argue that these new strains are superior to anything organic that was imported, certainly never smoked some of the incredible pot my friends and I did. I don’t remember anyone saying, “Gee, I don’t think I’m wasted enough. . .and I’d like my pot to taste like bubblegum, blueberry, or some other ‘flavour'”. We savored exotics, and could tell the difference between Afghan, Columbian, Mexican, Thai or myriad of other distinct marijuana. In fact, many of us prided ourselves on our discerning ability.

  13. As the loved one of someone with this, who has been researching this for 2+ years, let me reply to anyone who thinks its “how” you get the TCH or the “type” of bud, etc. My spouse has been dealing with intense vomiting episodes or over 10 yrs (been smoking for 20 yrs). For the first 7-8 years it happened once every 12-18 months. He was diagnosed (mistakenly) with pancreatitis, gastroenteritis, acid reflux and more. His episodes can be triggered by a stomach virus that everyone in the house gets but he’ll end up in hospital. It wasn’t until he mentioned hot baths that the ER dr figured out what was happening. For 2 years my spouse refused to accept the diagnosis but after seeing the stress it puts on his children seeing their dad so sick, the medical bills for ER visits and hospital stays and the strain on our marriage I think he finally gets it. My understanding is that the receptors in the brain become damaged and these are in the same area of brain that controls the smooth muscle in stomach (which is why it helps nausea in chemo patients) and the hypothalamus (temperature-regulating system). So the messages to your smooth muscle in stomach are disrupted, leading to slower stomach emptying. The messages can also get stuck in a pattern which cause intense vomiting and somehow being in warm water (dilation of blood vessels) can trip up this pattern (my husband now believes the baths are compulsive and don’t actually help, which still indicates damaged receptors). The dr told him that this will become more frequent and he was right. It now happens every 2-6 months. If you are dealing with this please find a recovery program. Whoever said weed isn’t addictive is a liar. It is and yes, it does cause brain damage. I used to smoke and laughed at people who said it caused brain damaged. I guess the jokes on us.

    1. As noted, in a 2006 review of the 2004 original research by Australia that coined this term, the case study was poorly done, inconclusive. Secondly, as a doctor from Seattle shares his skepticism, and another possible explanation.

      “I have an additional theory which is that cannabis grown with chemicals is affecting people in various ways, [and] this may be one of them,” he said. “I’ve traveled through India and Asia extensively and know heavy long-term users without ever having issues regarding hyperemesis. Perhaps long term use and concentrated levels could produce these issues in certain susceptible individuals; however, I feel like it’s more of a chemical issue.”

  14. I only started smoking to help with my depression, PTSD, and back pain from scoliosis about 5 months ago and I just experienced a 2 and a half day bout like this, but I’m not a very heavy user or been using for a really long time. (A few hits here or there from a vape every day or so, 1 evening a week for an “debugging” session of thought getting pretty high.) 5 months not a single issue, then Saturday morning I’m in agony and can only sit in a hot bath to keep from vomiting and being in debilitating abdominal pain. The only thing that’s really changed in the past 2 weeks I was prescribed Wellbutrin as my new primary antidepressant. Apparently this is rather rare, but is it more common when interacting with that other medication? I had other friends who had to stop using cannabis for depression or recreation while on Wellbutrin too. Does it make it more likely or susceptible to these symptoms for others? I couldn’t find much data comparing possible drug interactions regarding this.

  15. I couldnt believe this was a real thing until i lost 33% of my bodyweight and ended up in the emergency room over and over and over. It caused extreme gastroparesis for me and honest to god i was near death at least 3 times. When i seen articles about it a month ago i had to pick my jaw up off the floor. It was the hot showering that tipped me off that this might actually be what is happening to me. I would find myself in a hot shower laying in the feetled position throwing up literally hundreds of times a day. I cant tell you how serious this is in words you would have had to see me to understand its severity. Im now 3 weeks sober and im insanely upset i cannot smoke marijuana. I miss it so much, but it literally was killing me. I pray for anyone who has gone through this and hope people who need to know about it learn about it. Im very pro marijuana and will be voting to legalize medical in florida this year in less than a month…
    – One Super Sad Ex Stoner 🙁

    P.s. i plan on smoking once a week dry cannabis (lightly) only after i regain all my weight back some months down the road. It does not effect light users as it is directly related to the amount of thc consumed over time.

  16. With all the concerns over what you smoke, you need to watch what you breath as well. https://www.colorado.edu/today/2020/03/11/can-brown-cloud-make-you-gain-weight is the first article to tie poor air quality with gastrointestinal disorders. If you look up into the sky, that gray is less than clouds, and more in your gut.

    Stay off the “reefer-madness” train, and start looking at other factors in your life. If you are a chronic Car/Truck/Vehicle user, think about the last opportunity you had the air filter changed, the use of a small vehicle means you are inside a closed air filtered chamber, if you step out into the dense pollution in the air, bring all those particles into your lungs, what do you think will happen in your gut, your abdominal area. To blame this on cannabis, and to so quickly have “doctors” tell you this is the cause just because you now alert them to smoking cannabis. Try again.

  17. ive been smoking everyday for 20 years 38 now, and have had this CHS for 10 years now,
    Sometimes twice a month of vomiting for 12 to 16 hours. It would seem There maybe a connection, and have decided to cut back.

  18. CHS isn’t rare. Most people who have it are misdiagnosed or living in denial. I went to the ER about fifty times last year. I have to work extra hard when I’m well. I have been smoking delta 8 from October 2020 until February 4 2022. I had to become sober because it was getting hard for doctors to find veins to give me IV fluids. A year ago I would of said I didn’t have it. It get progressive as time goes on. I been in and out of suffering periodate for 13 years and the past five years every morning I wanted to go to the ER . I’ve begged God if he didn’t want to heal me to kill me. Take me on to heaven. The only thing that helped for years was smoking more or hot showers or a massager. Capzasin HP cream is a miracle for CHS. I have been sober 45 days now and I’m still having episodes of pain and nausea. Please get help or find help asap for your loved one. People have died from this. Cannabis is a psychological addiction. Focus on your mental health and quitting can get easier.

  19. I think it is time to do an update to this article! Especially with increasing access to higher THC dosages. Thank you for raising awareness about potential negative side effects. – Dr. Sherry Yafai (cannabis specialist)

  20. It might sound crazy-but I’m wondering if government weed and weed products are to blame for the sudden occurrence of CHS. Could be pesticides, or literally anything they put in. There’s little and controversial scientific research even still in this day and age. Most articles I see view weed negatively, and highlight side effects and rare conditions. A lot of this is political and scientists cannot get funding for marijuana research. It’s super annoying and difficult to find unbiased research.

  21. I survived this after only using 2 months it took 7 months to get properly informed what was killing me. It is real and I’ve lived to tell about it.

    If you want to save lives you will too.

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