Does smoking less than 1 cannabis (marijuana) joint per day cause hyperemesis (excessive vomiting)?

From the Guidelines

Smoking less than 1 cannabis joint per day is unlikely to cause hyperemesis, as cannabinoid hyperemesis syndrome (CHS) typically develops in long-term, heavy cannabis users, usually those who consume cannabis daily for months or years 1.

Key Points to Consider

• CHS is a disorder of gut–brain interaction characterized by cyclic vomiting, nausea, and abdominal pain, often temporarily relieved by hot showers 1.
• The exact mechanism behind CHS isn't fully understood, but it likely involves dysregulation of the endocannabinoid system with chronic exposure to cannabinoids 1.
• Cannabis use patterns that increase the risk of CHS include duration of use more than 1 year before symptom onset and frequency more than 4 times per week, on average 1.
• If CHS is suspected, the only proven effective treatment is complete cessation of cannabis use, with symptoms typically resolving within days to weeks after stopping 1.

Important Considerations for Patients

• Patients experiencing symptoms of CHS despite low cannabis use should consult a healthcare provider, as other conditions could be causing their symptoms 1.
• Temporary relief from symptoms may be found with hot showers, capsaicin cream applied to the abdomen, or anti-nausea medications like ondansetron, though these only address symptoms rather than the underlying cause 1.

Clinical Implications

• The prevalence of CHS is rising, and it is becoming a frequent clinical problem, leading to visits to the emergency department and gastroenterology clinics 1.
• Healthcare providers should be aware of the association between cannabis use and diverse vomiting syndromes, including CHS, and consider this diagnosis in patients with chronic nausea and vomiting and cannabis use 1.

From the Research

Definition and Symptoms of Cannabinoid Hyperemesis Syndrome

• Cannabinoid hyperemesis syndrome (CHS) is a condition characterized by recurrent episodes of nausea, vomiting, and abdominal pain in long-term cannabis users 2, 3, 4, 5, 6.
• The syndrome is often accompanied by compulsive hot water bathing, which can provide temporary relief from symptoms 3, 5, 6.

Relationship Between Cannabis Use and CHS

• CHS is associated with chronic cannabis use, and the exact mechanism of the syndrome is not fully understood 2, 3, 4, 5, 6.
• The frequency and amount of cannabis use required to develop CHS are not well-defined, but it is believed to occur in long-term users 2, 3, 4, 5, 6.
• There is no specific evidence to suggest that smoking less than 1 cannabis joint per day causes hyperemesis, but chronic use of any amount can potentially lead to CHS 2, 3, 4, 5, 6.

Treatment and Management of CHS

• The most effective treatment for CHS is cessation of cannabis use, which can lead to complete resolution of symptoms 2, 3, 4, 5, 6.
• Other treatment options, such as antiemetic medications, analgesics, and hydrothermotherapy, may provide temporary relief but are often ineffective in the long term 2, 3, 4, 5, 6.
• Antipsychotics, benzodiazepines, and capsaicin cream may be useful in managing acute symptoms of CHS 3, 5.