29 Oct When Marijuana Makes You Sick: The Truth About Cannabinoid Hyperemesis Syndrome

MedicalResearch.com Interview with:

Shemyia Smith

Shemyia Smith, MBS
Department of Medical Education
Geisinger College of Health Sciences
Scranton, PA 18509

MedicalResearch.com: What is the background for this study?

Response: Over the past several years, legal marijuana (also known as cannabis) use has substantially increased in many states and countries. Alongside this, more patients visit the emergency room and specialist with severe recurring nausea, vomiting, and abdominal pain. Often, this may be misdiagnosed since these symptoms are now known as Cannabinoid Hyperemesis Syndrome (CHS). Although CHS is now widely known, there is still a lot of uncertainty among clinicians about how to diagnose it confidently and manage it effectively.

MedicalResearch.com: What are the main findings?

Response:  The biggest takeaway from this literature review is that Cannabinoid Hyperemesis Syndrome has a pretty recognizable pattern: long-term or frequent cannabis use, cycles of nausea and vomiting, and abdominal pain. There is often relief with hot showers. The best management strategy is cannabis cessation, supportive therapies, antiemetics, and some antipsychotics. Once cannabis is stopped, most patients improve, but going through unnecessary testing before being diagnosed can be hard for patients to accept, especially if they have been using cannabis as a coping mechanism.

I also found that there is no single duration for how long you have to be using cannabis before symptoms start. Some people develop Cannabinoid Hyperemesis Syndrome in months or after several years. We still do not fully know why some people develop CHS while others do not. Cannabis has been used for thousands of years but CHS did not become a diagnosis until 2004.  We were also surprised to find case-reports which appeared to show that changing the route of administration would be beneficial for decreasing symptoms.

MedicalResearch.com: What should readers take away from your report?

Response: If you know someone who is struggling with repeated vomiting and a history of cannabis use, inform them about Cannabinoid Hyperemesis Syndrome. This can save patients from a lot of unnecessary testing, pain and suffering. The best thing to do is to have an open, judgment-free conversation about cannabis habits with your health care provider. It is important for clinicians to be open to asking their patients those personal questions as well. Stopping a habit may be hard, but ceasing cannabis can be a step towards a healthier life.

MedicalResearch.com: Is there anything else you would like to add?

Response: Yes, I think it’s important to remember how distressing this is for patients. They are exhausted, scared, and frustrated from several ER visits and the stigma associated with it. Providing support, empathy, and trust help patients to be more honest and comfortable. Also, education is key for both healthcare providers and the public, so people can get the answers they need and quicker. As cannabis legalization continues to expand, we need more high-quality prospective studies. There is a need to better understand the biological underpinnings to predict who is at greatest risk of developing CHS. Knowledge of the neural or liver enzyme substrates will help healthcare workers and patients to respond most efficiently to identify those who are most at risk including the routes of administration or dose or other contaminants (e.g. lead) most likely to cause CHS, and how we best can support patients through their journey. Cannabis cessation can be challenging and more controlled studies of. pharmacological and non-pharmacological interventions are also needed. 

Citation: Smith S,  et al.  Unraveling the  enigma  of Cannabinoid Hyperemesis Syndrome:  A narrative review of diagnosis and management. Cureus 2025

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Editor’ note:  Cannabis and THCA/HEMP CBD products should have an active ingredient list on the container and have a Certificate of Analysis (COA). Discuss your use of THC, Cannabis or CBD products with your health care provider.  Dosing of CBD is variable, especially since it is not FDA regulated. Cannabis/CBD may interfere with other medications and should not be used in individuals with certain health conditions, including liver issues. CBD skin care products can be absorbed through the skin and have similar effects. Do not use Cannabis products including edibles and CBD if you are pregnant, nursing or may become pregnant. Do not use cannabis products if driving or operating difficult or dangerous machinery. Children should not be exposed to cannabis or CBD products.

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Last Updated on October 29, 2025 by Marie Benz MD FAAD