Cannabis Hyperemesis versus Withdrawal Syndromes

Cannabis hyperemesis syndrome (CHS) describes a condition in which heavy, chronic use of cannabis, unusually inhaled, leads to repeated episodes of severe nausea and vomiting and severe abdominal pain. A thorough health history should include the frequency, quantity, and route of cannabis consumption. CHS appears to be related to overstimulation of the CB receptors. The symptoms of CHS usually go away after several days of abstinence from cannabis.

Cannabis withdrawal syndrome (CWS) presents similarly to CHS with abdominal pain, nausea, and vomiting, an adverse effect of cannabis. It usually appears with the sudden cessation of cannabis and is likely due to reduced central nervous system stimulation. Other identifying symptoms include psychological symptoms like irritability, anxiety, sleep problems, decreased appetite, and physical discomfort. The severity of withdrawal symptoms varies and can range from mild to severe.

Critical differences in CHS versus CWS are the onset of symptoms either less or more than 24 hours from their last cannabis use, respectively. For example, compulsive showers are more commonly seen with CHS, as are symptoms worsening with resumed cannabis consumption. Conversely, CWS is associated with psychological symptoms often relieved with cannabis use. 

Read the complete study for more information on CHS and CWS and how to approach patients who present to the emergency room with these symptoms.