Cannabinoid Hyperemesis Syndrome (CHS)
Severe cyclic vomiting in chronic cannabis users — paradoxical, because cannabis acutely relieves nausea. Resolves only by stopping cannabis, often dramatically within weeks.
Category
Chronic
Red flags
2
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
CHS is a condition in chronic cannabis users where they develop cyclic episodes of severe vomiting — strikingly similar to Cyclic Vomiting Syndrome but caused by cannabis itself. Almost universal feature: relief from prolonged hot showers/baths. The only definitive treatment is stopping cannabis.
How common is it?
Increasing as cannabis use rises globally. Affects daily/near-daily users for 2+ years. In Saudi Arabia, cannabis use is illegal but does occur — patients may be reluctant to disclose.
Why does it happen?
Long-term high-dose cannabinoid receptor stimulation in the gut and brain alters thermoregulation and digestive control. Why some chronic users develop CHS and others don't isn't fully understood.
Symptoms
- Episodes of severe nausea and vomiting (usually morning), separated by symptom-free periods
- Diffuse abdominal pain
- Compulsive hot showers or baths — provides striking relief
- Weight loss, dehydration
- Episodes worsen over time without cannabis cessation
Red flags — seek urgent medical care
Severe dehydration
Need IV fluids — go to hospital.
Vomiting blood
Possible Mallory-Weiss tear — ED.
How is it diagnosed?
Diagnosis is clinical. Pattern of cyclic vomiting + chronic cannabis use + relief with hot bathing = CHS until proven otherwise. Tests rule out other causes (CBC, lipase, electrolytes, abdominal imaging). Definitive proof: symptoms resolve completely after 4-8 weeks of cannabis cessation.
Outlook — what to expect
Excellent if cannabis is stopped — usually full resolution within weeks. Continued cannabis use leads to ongoing cycles of vomiting, weight loss, and ED visits. Relapse is common if cannabis resumed.
Treatment
Habits & Lifestyle
Stop cannabis. There is no other path to lasting relief.
- Stop ALL forms of cannabis (smoked, edibles, vapes, oils, CBD products with THC).
- Seek addiction support — cannabis dependence is real.
- Hot showers help during attacks.
- Stay hydrated; small frequent fluids.
Diet
Standard healthy diet.
- No specific diet, but small frequent meals during recovery.
Medications
Acute treatment is similar to CVS.
- IV fluids during attacks.
- Topical capsaicin cream on the abdomen often helps.
- Haloperidol or droperidol — surprisingly effective.
- Standard antiemetics (ondansetron) often don't work well.
Procedures & Surgery
No procedures needed.
- Counseling for cannabis cessation.
In the Saudi context
Cannabis use is illegal in Saudi Arabia. Patients may be reluctant to disclose use. Confidentiality between patient and physician is preserved by law for medical assessment. Open conversation is essential for diagnosis and recovery.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Could my cyclic vomiting be from cannabis use?
- How long until I feel better after stopping?
Medically reviewed by: SGA Patient Education Panel · Last reviewed 24/04/2026