No, CHS Does Not Occur When Cannabis is Stopped—It Resolves With Cessation
Cannabinoid Hyperemesis Syndrome (CHS) occurs during chronic, heavy cannabis use and resolves when cannabis is stopped, not the other way around. 1 The confusion may arise because there is a distinct entity called Cannabinoid Withdrawal Syndrome (CWS) that does occur with cessation, but this is not CHS. 1
Key Distinction: CHS vs. Cannabinoid Withdrawal Syndrome
CHS is caused by ongoing cannabis use and is treated by stopping cannabis:
- CHS occurs in patients with prolonged cannabis use (typically >1 year before symptom onset) who use cannabis frequently (>4 times per week on average). 1
- The syndrome is characterized by stereotypical episodic vomiting (≥3 episodes annually), nausea, and abdominal pain during active cannabis use. 1
- Resolution of CHS symptoms requires cannabis abstinence for at least 6 months or a duration equal to 3 typical vomiting cycles. 1, 2
Cannabinoid Withdrawal Syndrome (CWS) is what occurs when cannabis is stopped:
- CWS occurs commonly on cessation of heavy and prolonged cannabis use, with a pooled prevalence of 47% among cannabis users. 1
- Symptoms typically begin within 24-72 hours after last use and most resolve within 1-2 weeks. 3
- CWS symptoms include irritability, anxiety, restlessness, nausea, and stomach pain. 4, 3
The Paradox of Cannabis in CHS
A critical clinical pitfall is that patients with CHS often report that cannabis helps relieve their symptoms, leading to continued use and perpetuation of the syndrome. 1, 4 This paradoxical relationship makes diagnosis and patient counseling challenging, as patients are skeptical that cannabis is causing their symptoms when they perceive it as providing relief. 5
Definitive Treatment Requires Complete Cessation
Cannabis cessation is the only definitive treatment for CHS and the only intervention that leads to long-term resolution. 2 For proper diagnosis confirmation, counseling should specify the need for a minimum of 3 months of cannabis cessation to achieve symptom relief and avoid unnecessary investigations. 6
Clinical Recognition Points
When evaluating patients with cyclic vomiting, consider CHS if:
- Regular cannabis use is present, especially >4 times weekly for >1 year. 2
- Patient reports compulsive hot water bathing for symptom relief (reported in 71-92% of CHS cases). 1
- Stereotypical episodic vomiting occurs ≥3 times annually. 1, 2
The key takeaway: CHS is a syndrome of active cannabis use that resolves with cessation, not a syndrome that begins when cannabis is stopped. 1, 2, 7