What Is CHS?
Cannabinoid Hyperemesis Syndrome (CHS) is a gastrointestinal condition associated with frequent, long-term cannabis use. Its characterized by repeated episodes of severe nausea, uncontrollable vomiting, and abdominal pain. Many people with CHS report temporary relief from symptoms by taking hot showers or baths. CHS has been increasingly recognized in medical literature, particularly as cannabis use becomes more widespread.
CHS happens when using cannabis regularly for a long time causes your body to react in an unexpected way. Instead of helping with nausea (which cannabis is sometimes used for), it can cause severe nausea and vomiting that comes in cycles. Think of it like your body’s system for managing nausea getting confused after too much cannabis use-it starts working backwards. The good news is that hot showers can temporarily help because the heat seems to reset those confused signals, at least while you’re in the water.
Core Symptoms
CHS typically presents with:
- Persistent nausea and repeated vomiting
- Intense abdominal pain
- Episodes of vomiting that can be cyclical and severe
- Relief from hot showers or baths (common but not required for diagnosis)
- Weight loss, dehydration, and aversion to food during episodes
- Episodes often follow patterns of long-hours or frequent cannabis use
Patient-focused breakdown of symptom phases (prodromal, hyperemetic, recovery) is available from the Cleveland Clinic. Cannabinoid Hyperemesis Syndrome – Cleveland Clinic overview
The main signs of CHS are feeling really sick to your stomach, throwing up a lot, and having bad stomach cramps. These symptoms don’t happen all the time-they come in waves or cycles. You might feel fine for a while, then suddenly have a really bad episode where you can’t stop throwing up. During these bad episodes, many people discover that getting into a very hot shower makes them feel better, at least while they’re in there. But when they get out and cool down, the sickness often comes back. Because you’re throwing up so much, you can lose weight and get dehydrated (your body doesn’t have enough water), and you probably don’t want to eat anything because you feel so sick.
How CHS Develops
CHS usually occurs after chronic, heavy cannabis use – often daily or near-daily for months or years. Clinically, its thought that prolonged exposure to cannabinoids may disrupt the bodys normal regulation of nausea and vomiting, though the exact mechanism is not fully understood. Review of CHS mechanisms – PubMed (biphasic effect on nausea)
CHS doesn’t happen overnight. It usually develops after someone has been using cannabis regularly-like every day or almost every day-for months or even years. Think of it like this: your body has a system that controls when you feel nauseous and when you don’t. When you use cannabis a little bit, it might help calm that system down. But when you use it too much for too long, that system gets confused and starts working backwards. Instead of helping with nausea, it starts causing severe nausea. Scientists are still figuring out exactly why this happens, but they know it’s related to how cannabis affects the parts of your brain and body that control these feelings.
Diagnosis
There is no single lab test for CHS. Diagnosis is typically clinical, based on:
- A history of regular, long-term cannabis use
- Recurrent cyclic vomiting and abdominal pain
- Symptom relief after cannabis cessation
- Often, but not always, compulsive hot bathing to relieve symptoms
Research indicates that the only consistent curative intervention is stopping cannabis use entirely.
See: Cannabinoid Hyperemesis Syndrome: systematic review (diagnosis & treatment)
There’s no blood test or scan that can tell a doctor “yes, you have CHS.” Instead, doctors figure it out by looking at the whole picture. They need to know: Have you been using cannabis regularly for a long time? Do you have repeated episodes of severe vomiting and stomach pain that come and go? Do you feel better when you stop using cannabis? Do hot showers help? If the answer to most of these is yes, and doctors have ruled out other causes, they can diagnose CHS. The tricky part is that CHS looks a lot like other conditions, so it often gets misdiagnosed at first. That’s why it’s really important to be honest with your doctor about your cannabis use-it helps them figure out what’s really going on.
Treatment & Management
Current guidelines and research suggest:
- Complete cessation of cannabis use – the only documented long-term solution for CHS
- Intravenous fluids and electrolyte replacement for dehydration
- Some patients receive anti-nausea medications, although traditional antiemetics often have limited effect
- In clinical settings, medications such as haloperidol or topical capsaicin cream may provide short-term relief
- Some patients benefit from behavioral support for cannabis cessation, including counseling or therapy
The best evidence-based review on management options includes hot water hydrotherapy, capsaicin, and other supportive treatments, but emphasizes that doctors need more research on standardized treatment.
See: Systematic review on CHS management options
The only way to truly fix CHS long-term is to stop using cannabis completely. That can be really hard, especially if you’ve been using it for a long time, but it’s the only thing that actually works. During bad episodes, doctors can help by giving you fluids through an IV (a needle in your arm) to keep you hydrated, since you’re probably throwing up too much to drink water. Regular anti-nausea medicines often don’t work very well for CHS, but some special medications or capsaicin cream (the stuff that makes peppers hot) applied to your stomach might help temporarily. Some people also need help stopping cannabis use-like counseling or support groups-because it can be difficult to quit on your own. Hot showers can help you get through the worst moments, but they’re not a cure-they just make you feel better while you’re in them.
Epidemiology & Trends
CHS appears to be under-diagnosed and often misidentified as other gastrointestinal conditions like cyclic vomiting syndrome. Medical reviews note that lack of clinician awareness contributes to delays in diagnosis. The frequency of emergency department visits for CHS has increased in regions with widespread cannabis legalization.
See: Emerging gastrointestinal disorder review – PubMed (under‑diagnosis & ED patterns)
CHS is probably more common than we think, but many doctors don’t recognize it right away. People with CHS often get misdiagnosed with other conditions that cause similar symptoms, like “cyclic vomiting syndrome” or “stomach flu.” This happens because not all doctors know about CHS yet, especially since it’s a relatively new condition that doctors are still learning about. As more places legalize cannabis, more people are using it regularly, which means more people are developing CHS. This has led to more people going to the emergency room for severe vomiting episodes. The good news is that as doctors learn more about CHS, they’re getting better at recognizing and treating it.
Complications
If left untreated, CHS can lead to:
- Severe dehydration and electrolyte imbalances
- Kidney injury or failure
- Weight loss and nutritional deficits
- Dental enamel erosion from chronic vomiting
- Hospitalization for supportive care
Medical literature notes hospital visits may increase without recognition of the syndrome, leading to repeated, unnecessary testing.
See: Cannabinoid Hyperemesis Syndrome – JAMA Network article (complications)
If CHS isn’t treated, it can cause serious problems. When you throw up a lot, your body loses water and important minerals (called electrolytes) that your body needs to work properly. This can make you really dehydrated, which can damage your kidneys-the organs that filter waste from your blood. You’ll also lose weight because you can’t keep food down, and you might not be getting the nutrients your body needs. All that stomach acid from vomiting can also damage your teeth over time. Many people with CHS end up in the hospital because they’re so dehydrated they need IV fluids. Unfortunately, if doctors don’t recognize CHS, they might do lots of expensive tests trying to figure out what’s wrong, when the real problem is the cannabis use. That’s why getting the right diagnosis is so important.
Phases of CHS
CHS typically evolves through three phases:
- Prodromal Phase – early nausea, abdominal discomfort, reduced appetite
- Hyperemetic Phase – frequent vomiting, often intense, sometimes with repetitive hot bathing for symptom relief
- Recovery Phase – symptoms subside after cannabis cessation
These stages are described in clinical reviews and patient education resources. Cannabinoid Hyperemesis Syndrome literature review (phases & symptoms)
CHS usually happens in three stages. The first stage (prodromal) is like a warning sign-you start feeling nauseous in the mornings, your stomach feels off, and you don’t really want to eat. This can last for months or even years, and many people don’t realize it’s connected to their cannabis use. Some people actually use more cannabis during this phase, thinking it will help with the nausea, but that just makes things worse. The second stage (hyperemetic) is when things get really bad-you have severe vomiting episodes that can last for hours or days. This is when people often discover that hot showers help, and they might take multiple showers per day just to feel better. The third stage (recovery) happens when you stop using cannabis-your symptoms gradually go away over days or weeks. But if you start using cannabis again, the whole cycle can start over.