Cannabinoid Hyperemesis Syndrome

Marijuana legalization has eventually contributed to increased emergency department visits for the consequences of chronic marijuana use, such as the cannabinoid hyperemesis syndrome. A particularly concerning trend in emergency care for central nervous system depression has increased in pediatric visits for unintentional marijuana exposure.

Cannabinoid Hyperemesis Syndrome (CHS) is characterized by recurrent episodes of difficut to control nausea and vomiting in patients who have been using natural or synthetic cannabis one or more times per week over at least one year. Most common clinical signs and symptoms include: abdominal pain, compulsive bathing in hot water with symptom relief, age younger than 50 years, morning predominance of symptoms, and resolution of symptoms with cannabis cessation. Cannabinoid hyperemesis syndrome is most often confused with cyclic vomiting syndrome. Patients with cyclic vomiting syndrome are more likely to have a history of psychiatric illness and a personal or family history of migraines.


Patients with CHS are usually unaware that cannabis use is the cause of their symptoms. CHS may be difficult to diagnose because cyclic vomiting syndrome and cannabis withdrawal syndrome have (CWS) a similar signs and symptoms, though with important differences. Cannabis withdrawal syndrome is associated with nausea and vomiting after abrupt cessation of cannabis use. Patients presenting with CWS usually have other symptoms in addition to nausea, vomiting, or abdominal pain such as irritability, sleep disturbance, decreased appetite, or depressed mood. Cases of cannabinoid hyperemesis syndrome that resulted in acute kidney injury have also been reported.

Cannabinoid hyperemesis syndrome (CHS) is seldom responsive to traditional antiemetic therapies and treatment is supportive. Symptomatic relief with lorazepam, butyrophenones or intravenous haloperidol is still in research stage.


  1. Cannabinoid hyperemesis syndrome. Chelsey King, MSc and Andrew Holmes, MD. CMAJ. 2015 Mar 17; 187(5): 355.
  2. Successful Treatment of Suspected Cannabinoid Hyperemesis Syndrome Using Haloperidol in the Outpatient Setting. Jennifer L. Jones, and Karen E. Abernathy Case Rep Psychiatry. 2016; 2016: 3614053.
  3. Colorado Cannabis Legalization and Its Effect on Emergency Care. Howard S. Kim, MD* and Andrew A. Monte, MD Ann Emerg Med. Author manuscript; available in PMC 2016 Jul 11.



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