MDLinxAn Unpleasant Syndrome Surfaces as Cannabis Use Grows

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Recent research highlights the complex relationship between cannabis use and cannabinoid hyperemesis syndrome (CHS), particularly as cannabis potency increases. The condition, characterized by cyclical episodes of nausea and vomiting with abdominal pain, presents diagnostic challenges due to its similarity to cyclic vomiting syndrome (CVS) and paradoxical effects of cannabis use.

Key Points:

• CHS occurs following prolonged, high-dose cannabis use, with symptoms triggered by cannabis’s biphasic effects—low doses provide antiemetic benefits while high doses can induce emesis
• Diagnostic criteria focus on three key factors: cannabis potency, frequency of use, and mode of inhalation
• Daily or near-daily use of high-potency cannabis typically precedes CHS onset; occasional use (1-2 times monthly) is unlikely to trigger the condition
• First-line treatment includes reducing cannabis use rather than complete cessation, along with prophylactic amitriptyline and rescue therapy for acute episodes
• Psychological evaluation is crucial, as many patients use cannabis to manage stress and anxiety, which can complicate treatment adherence

“Not all cannabis is made equal. The problem is that cannabis potency has increased over the last two decades. What has happened, I think, is that [cannabis] is exacerbating or unmasking symptoms in people who are probably predisposed to cyclic vomiting.”
– Dr. Thangam Venkatesan, Professor of Clinical Medicine in Gastroenterology, Hepatology, and Nutrition at Ohio State University Wexner Medical Center

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