As marijuana use becomes more prevalent, a severe illness linked to chronic cannabis use, known as Cannabinoid Hyperemesis Syndrome (CHS), is on the rise. This debilitating condition affects a small but growing number of frequent marijuana users, causing severe nausea and vomiting.

What is CHS?

Cannabinoid Hyperemesis Syndrome (CHS) is characterized by severe nausea and vomiting, sometimes occurring 20-24 times a day. These episodes can last for days or even weeks and are often difficult to control. The only reliable relief for many sufferers is a hot shower or bath. The syndrome can significantly impact the quality of life, leading to frequent hospital visits and a need for extensive medical care.

Signs and Symptoms of CHS

The National Library of Medicine outlines the following criteria for diagnosing CHS:

- Long-term cannabis use:Often daily or near-daily use over several months or years.

- Cyclic nausea and vomiting: Patients experience recurring episodes of severe nausea and vomiting that can be debilitating.

- Relief when stopping marijuana: Symptoms tend to subside once cannabis use is discontinued.

- Hot showers/baths relieve symptoms. Many patients find temporary relief through hot showers or baths.

- Abdominal pain: This is a common symptom, often described as severe and cramping.

The Paradox of Marijuana Use

Ironically, marijuana is often used to treat symptoms such as pain, anorexia, nausea, and vomiting. However, in chronic users, it can cause CHS, complicating the understanding of its effects. Recent data compiled by the U.S. Food and Drug Administration concluded there is "credible scientific support" for the use of marijuana to treat these symptoms, highlighting the complex relationship between cannabis use and its side effects.

Phases of CHS

According to the Connecticut state’s Adult Cannabis Use website, CHS progresses through three phases:

1. Prodromal Phase: This initial phase is marked by nausea and vomiting following long-term cannabis use. Often, individuals increase their cannabis intake in an attempt to alleviate the nausea, unknowingly exacerbating the problem.

2. Hyperemetic Phase: Triggered by increased cannabis use, this phase involves intense nausea, abdominal pain, and frequent vomiting. It is during this phase that patients often seek medical help due to the severity of symptoms.

3. Recovery Phase: Once a person stops using cannabis, symptoms gradually decrease and eventually disappear. However, this process can take several weeks. If the individual resumes cannabis use, the cycle restarts, leading back to the prodromal phase.

Understanding the Cause

Researchers are still exploring the causes of CHS. Dr. Sushrut Jangi, a gastroenterologist at Tufts Medical Center, suggests it involves the endocannabinoid system, which regulates critical bodily functions such as sleep, mood, pain control, immune response, and appetite. Long-term cannabis use may alter the receptors in the brain and gut that bind to THC, the psychoactive component of cannabis. These changes can lead to the development of CHS in susceptible individuals.

Prevalence and Impact

Dr. Jangi estimates that between 5% and 20% of chronic marijuana users will experience CHS. Data from the National Library of Medicine shows that after Colorado legalized recreational marijuana, emergency room visits for cyclic vomiting nearly doubled. This increase highlights the growing recognition of CHS as a significant public health issue.

Marijuana Use on the Rise

A survey published in May 2023 revealed that daily marijuana users in the U.S. have surpassed the number of daily alcohol users for the first time. In 2022, an estimated 17.7 million people reported using marijuana daily or near-daily, compared to 14.7 million who drank that often. This marks a significant increase from 1992, when less than 1 million reported near-daily marijuana use. This trend underscores the importance of understanding and addressing the potential health risks associated with chronic cannabis use.

Changes in Marijuana Classification

The Biden administration is moving to reclassify marijuana as a less dangerous drug. Currently, marijuana is a Schedule I substance, categorized alongside heroin, LSD, and ecstasy. If the rule change becomes law, marijuana will be moved to Schedule III, alongside ketamine and some anabolic steroids. This reclassification would acknowledge marijuana's lower potential for abuse and open up new avenues for research and medical use.

Marijuana Use Disorder

Marijuana use disorder, defined as continued use despite negative impacts on one’s life, is real but less severe compared to other drugs. In 2021, about 30% of non-medical marijuana users met the criteria for marijuana use disorder, with roughly 5% of these cases considered severe. In comparison, 81% of heroin users meet the criteria for substance use disorder, highlighting the relative risks of cannabis use.

Withdrawal Symptoms

Regular marijuana users who decide to quit may experience withdrawal symptoms, including:

- Nervousness, anger, and depression

- Difficulty relaxing

- Fatigue

- Trouble sleeping

- Difficulty concentrating

- Chills and shaking

- Night sweats

- Headaches

- Stomach pains

- Loss of appetite

These symptoms can vary in intensity and duration, often peaking within the first week after cessation and gradually subsiding over time.

Conclusion

As marijuana use becomes more widespread, understanding and recognizing conditions like CHS is crucial. Awareness and education about the potential risks associated with chronic cannabis use can help mitigate the impact of this emerging health issue. Medical professionals and public health officials must continue to monitor and research the effects of long-term marijuana use to provide accurate information and effective treatments for those affected by CHS.