CHS

What is CHS?

CHS stands for Cannabinoid Hyperemesis Syndrome. "Cannabinoid" deriving from the components in marijuana, and "hyperemesis" meaning excessive or severe nausea and vomiting. Now, I know what you're thinking, "how could a drug derived from a plant that is legal, told to be harmless, have no major side effects, and help certain illnesses CAUSE harm?" My girlfriend and I were ignorant, and thought the same thing when she was first diagnosed two years ago. That ignorance caused her to relapse, getting it again this year in April 2024. So therefore, I urge you to keep reading to make sure you never have to suffer like she did. The baseline to understand is this: Too much of ANYTHING is harmful to your body.

Let's start with what we know: CHS is caused by the long-term / frequent use of marijuana. There are many studies still being conducted as it becomes more popular, but the main theory is that it may happen due to long-term overstimulation of receptors in your endo-cannabinoid system (ECS). This may lead to issues with your body’s natural control of nausea and vomiting. So, what does this mean? In a nutshell, long-term use can alter your brains receptors to cannabis, leading to a paradoxical (opposite) effect (ie: Things weed may be used to treat such as pain, nausea, vomiting and anxiety, will be CAUSED rather than fixed). It is something even clinicians cannot completely grasp just yet. People who use marijuana long-term — typically for about 10 to 12 years — are at high risk of developing CHS. But not every person who uses marijuana, even long-term, develops CHS. It tends to affect people who use cannabis at least once a week and happens more often in adults who’ve been using cannabis since their adolescent years. When you use marijuana for many years, it can start to slowly change how the receptors in your body respond to the cannabinoid chemicals. This may lead to CHS symptoms. For example, the drug affects the receptors in the esophageal sphincter (esophagus). It’s the tight band of muscle that opens and closes to let food go from your throat to your stomach. If this flap doesn’t work properly, your stomach acids might flow upward and cause you to have the symptom of nausea and vomiting.

One major factor is body fat percentage. The amount of body fat you have paired with your THC metabolite level (how much THC is in your body) can determine how long your CHS episode will last. Cannabinoids (including THC & yes, CBD too) are stored in the body’s fat cells, so the longer somebody has been using marijuana and the more fat cells they have, the longer it takes the chemical compounds to leave the body. It could take up to six months without using marijuana for some people to feel better.

Here is a website to help calculate how many days THC will be left in your system based on your body fat % and metabolite level (to obtain your metabolite level you can look up drug tests that you can buy or possibly ask a provider): https://cannapassdetox.com/thc-detox-calculator/

The rare condition is becoming more common, perhaps because of increased availability of more potent marijuana products in different forms, like vapes and edibles. CHS is a very unpleasant, potentially very dangerous gastrointestinal illness that, some studies have estimated, might plague as many as 12.5 percent of regular cannabis users, or about 2,750,000 Americans. In some rare cases, people have died due to the intense dehydration and electrolyte imbalances (See articles in Conclusion).

The Three Phases of CHS

Prodromal: This is the very early onset of CHS. You may have stomach pain or morning sickness. You may also have a fear of throwing up but never actually do it. You may notice that your diet has changed. In terms of foods you used to enjoy, you can no longer handle even the thought of eating them (PERSONAL EXPERIENCE: For my girlfriend, an avid chicken cutlet lover, after her first diagnosis couldn't fathom eating meat, it would make her gag or vomit. To this day she still cannot stomach eating certain meats). During this phase, the biggest mistake people make is smoking weed to suppress these early symptoms leading to a longer road to recovery, or possibly never being diagnosed until weed is forced to be stopped, finally allowing the symptoms to surface. I would characterize it as an obvious, conscious dependance on weed for daily activities. For example: when you don't have an appetite, you smoke weed. If you cannot sleep, you smoke weed. You know that your body has natural regulators to help you feel hungry and tired, but you now rely on marijuana to create these feelings because it has become second nature to you. If I just described your smoking habit, I would recommend you dramatically cut back, or quit while you're still ahead.

Hyperemesis: This is by far the worst part of CHS. This phase usually lasts 24-48 hours. It can be intense and overwhelming. You may have nausea and repeatedly vomit (up to 5+ times an hour) causing dehydration. You may start to compulsively bathe in very hot water to suppress symptoms, avoid certain foods, or just not eat because foods or liquids can no longer be tolerated. This is also when the abdominal pain will peak. In some cases the pain becomes so bad you scream. Clinicians have called it "scromiting" which is the combination of screaming from pain while vomiting. It will feel like the longest 48 hours of your life. The abdominal pain usually persists after the 48 hour period, but a majority of the vomiting will cease. This is the phase where you may go to the hospital for; dehydration, rapid weight loss, electrolyte imbalances, chest pain due to acid reflux, tachycardia (fast heart rate), palpitations , stress, or terrible anxiety / panic attacks.

Recovery: This phase starts when marijuana use has been stopped for an adequate duration of time (usually 10 days) to allow symptoms to start subsiding. When you fully quit during this period, your symptoms may start to go away over a few days or months. Over time, they’ll go away completely unless you start to use marijuana again. Yes, while this phase is called the "recovery phase" it still may take weeks or months to fully recover from CHS. During this phase, the worst is over, but now its your job to manage the symptoms and withdrawl of marijuana in hopes you dont relapse. You may have little to no appetite, trouble sleeping, anxiety, nausea, and dull abdominal pains. Its an odd phase to be in because you're happy that youve reached the end, but now have to retrain your body to function without using marijuana. I would recommend using the website I listed above to see how long this phase could possibly last for you as an individual, and it is also just good to know when the marijuana has completely left your body. If you plan on quitting marijuana for good or just want support slowing down, BEST PLLC is a great detox / addiction counseling center to reach out to for help. They are very friendly, actually show care, and can get you a next day appointment. They also help with mental illnesses, etc. I highly recommend it.

Diagnosis

Diagnosing CHS especially if you've never had it before can be a very frustrating process. If you are unaware of what CHS is or do not inform your providers about your use of marijuana, they may put you through various tests such as: ultrasound, endoscopy, CT scan, etc in order to rule out any other medical emergencies before they even begin to treat you for CHS. Of course, if you have a history of other health issues related to your digestive system, get the tests done to make sure you're healthy. Otherwise, make sure you're honest with your provider so they can treat and diagnose you properly. (PERSONAL EXPERIENCE: During my girlfriend's first diagnosis she was put to sleep to have an endoscopy done and nothing was found. She was admitted to the hospital for days and put through so much unneeded testing before they realized she had CHS. So, save yourself the trouble, and bring up that you may have CHS if you genuinely suspect you do.)

Symptoms may include:

-Nausea, vomiting, "scromiting", dry heaving or "hurling", loss of appetite, or trouble sleeping without marijuana use

-Anxiety or panic attacks

-Chest pains due to acid reflux, anxiety, or fast heart rate

-Hot baths or showers allow for temporary symptom relief

-Abdominal pain or discomfort

-Cessation of symptoms when using marijuana

-No longer being able to hold down any food or drink

-Anti-nausea medications or over-the-counter pain killers do not work

Complications may include:

Dehydration: Caused by intense, cyclic vomiting and also compulsive, persistent hot showers. If you experience dehydration (thirst, dark colored or little to no urine, rough skin, dry mouth) it is best to go to the ER to be put on IV fluids (this stands true for most of these complications).

Electrolyte Imbalances: Also from cyclic vomiting. May result in hypokalemia (potassium deficiency), hyponatremia (sodium deficiency), etc.

Malnutrition: Caused from vomiting and not being able to hold down food or drink. Results in weight loss, thinning hair, feeling weak or fatigued, etc.

Tooth Decay: Due to constantly vomiting up stomach acid and bile

Other common complications may include: damage to the esophagus, choking, aspiration pneumonia, hot water burns, etc.

Less common complications include: seizures, shock, kidney failure, muscle spasms or weakness, and heart rhythm problems.

Death is also a rare but major complication (See articles in Conclusion).

Treatment

Treatment options may vary from person to person. Typically, over-the-counter pain and anti-nausea medications will not work at all. Hot showers and baths may give some temporary relief.

If you end up checking yourself into the ER, the most helpful treatment will be IV fluids. Although it wont help the pain and vomiting, your body will remain hydrated to prevent further bodily harm. The downside of being in the ER is: if they know you have CHS, they will most likely treat you as an addict. You are no longer their top priority, as obviously there are others around you suffering from potentially serious medical conditions and injuries. Their main concern will be the vomiting as it can cause a series of health issues. As soon as you are able to hold down some sort of food for a few hours, you will be discharged even if you're still in severe pain. UNLESS, you get lucky and have a doctor that is familiar with the condition, they might treat you for the pain (typically with IV morphine).

Haloperidol is a drug currently being used (experimented with) to treat CHS within hospitals, but I personally do not recommend it. Haloperidol is a very problematic antipsychotic drug. It is sometimes used to treat nausea and vomiting, but once again from what I've seen, it does not work in the case of CHS. Its primary use is to treat schizophrenia and other mental illnesses. It is known to be neurotoxic, and sometimes cause paradoxical (opposite) reactions. Here is just one of many terrible reviews on the drug: "They gave me this medicine for stomach pain and all it did was make me loose control physically and mentally. I could not stop moving my arm and legs and I thought I was going to be put in a rubber room scared the life out of me never again.(https://www.drugs.com/comments/haloperidol/) If a doctor talks you into trying Haloperidol for CHS, or any physical illness really, ask for Benadryl to be given immediately after. Benadryl is the antidote to Haloperidol and will cause you to feel calm and relaxed after the injection rather than risking the paradoxical effect. Especially if you have underlying mental health issues or are currently taking any medications for mental health, I would avoid it at all costs.

Alternative therapies for symptom relief such as capsaicin cream (can be bought over-the-counter) may be used to relieve pain. The chemicals in the cream have the same effect as a hot shower. In some people, it can ease the nausea, vomiting and pain when you rub it on your belly.

Certain detox clinics (such as BEST PLLC stated earlier) may be able to offer support throughout the detox process.

The only real treatment and cure for CHS is the cessation of marijuana use completely. While other drugs such as narcotics have an antidote like Naloxone (narcan) or Suboxone, weed unfortunately does not. It is unfortunate, but a majority of people suffering from CHS will have to go through the detox process on their own. As stated earlier, symptoms should begin to subside after about 10 days of marijuana cessation.

Quitting weed can improve memory and thinking skills, improve lung function, lead to better sleep, and even lower your risk for depression and anxiety.

Recovery Advice & Recommendations

This section will cover as many things that I can think of to aid people in their recovery, including general recommendations to get through the symptoms and begin eating again. Let's get you back to normal!

Medications and methods I would recommend for symptom relief are: Zofran for nausea, even if it may not work its always worth the try. If you go to the ER this is the main medication they will give you. Upon discharge I would make sure you are prescribed things such as Famotidine to help heart burn and acid indigestion from vomiting, Sucralfate to coat your stomach to protect it and possibly prevent vomiting (especially if you are ready to try eating and drinking again, this could be a game changer), and possibly Aleve (Naproxen) to relieve inflammation and potential muscle pains. Although I would normally never recommend narcotics, (I know just how bad the pain can get) Morphine, Oxycodone and Percocet do allow long durations of pain relief (2-6 hours). Consult with your doctor about potential narcotic use, but remember, to them you are already there for a drug related issue so they may not approve. I would only ask in cases of extreme pain, and again, do not expect to be discharged with any narcotics or pain medication at all (other than maybe Tylenol).

Capcaisin cream is a 50/50 shot. It all depends on the person. This cream can be bought over-the-counter at pretty much any drug store. I would rub it on the areas of the stomach that are in pain, but be prepared for your stomach to turn red and feel a burning sensation. The cream should mimic the feeling of a very hot shower, but does not provide the moist heat that some people may need instead. Of course, hot showers and baths are the alternative.

In terms of introducing food back into your body, a bland diet is the best way to go. I would suggest: saltines or other crackers, broth, plain white rice, plain oatmeal, applesauce, watermelon, plain chips like Tostitos, toast, plain pasta, boiled or baked potatoes, beans, unseasoned steamed vegetables, plain chicken breast, and plain yogurt. The general idea is to eat unseasoned foods, and to avoid heavy fat and grease. Dairy and meats may take longer to be able to tolerate. I would start with one of these foods and add a new one every few days to see if your stomach can handle it. Try not to immediately fill your stomach. I know you're hungry! But you don't want to risk throwing up your food or putting yourself into pain again. I would suggest eating until you feel about 50% full and allowing the food to digest before eating again. Avoid: caffeine, heavy sauces or seasonings, and citrus fruits. Ultimately, you will learn what your body can and cannot tolerate over time. Take things slow, I know it can be frustrating, but you will eventually reach your regular diet again.

Conclusion

Cannabinoid hyperemesis syndrome (CHS) is a very unpleasant — and potentially dangerous — complication of long-term marijuana use. Because of this possible complication, it’s important to use caution with marijuana and other cannabis products. It is best to try to limit your intake of THC. While it is tempting to look for the most potent formulas and "the best high", acknowledge and educate yourself on how it can effect your body both long and short-term. If you think you have CHS or a cannabis use disorder, talk to a healthcare provider. They’re available to help.

Too much of anything is bad for you and can cause disastrous results in your body. The best example I could use is eating too much fruit and drinking too much fruit juice. While fruit is healthy for you and has great benefits within your body, consuming an excess of fruit or fruit juices may cause your glucose (sugar) levels to become too high. This can lead to things such as; fatty liver disease, diabetes, weight gain, etc. The same goes for marijuana. While it is okay to be used in moderation and can help with pain, mental illness', etc, too much can lead to CHS and other complications.

If you are interested in reading more about CHS, here are some articles: (Warning, some may be very hard to read)

https://www.usatoday.com/story/news/nation/2019/09/20/indiana-boy-17-died-smoking-weed-chs-blame-what-chs/2387571001/

https://www.therecoveryvillage.com/marijuana-addiction/cannabinoid-hyperemesis-syndrome/#:~:text=A%202019%20article%20reported%20on,blood%20sugar%20and%20electrolyte%20abnormalities.

(Above) "A 2019 article reported on the deaths of three patients who experienced CHS; two of these deaths were directly caused by CHS-related dehydration, which caused low blood sugar and electrolyte abnormalities. These chemical disturbances in the body caused cardiac arrest in one patient and kidney failure in the other patient, leading to their deaths."

https://www.dailymail.co.uk/health/article-12174189/Boy-17-died-health-condition-linked-marijuana-causes-severe-vomiting.html#:~:text=Brian%20Smith%2C%2017%2C%20died%20in,condition%20being%20hospitalized%20for%20weeks.

(Above) "Brian Smith, 17, died in Indiana in October 2018 from dehydration due to CHS. Smith is one of four known deaths linked to CHS - the others are a 27-year-old female, a 27-year-old male, and a 31-year. However, there are numerous cases of people with the condition being hospitalized for weeks"