Is Cannabinoid Hyperemesis Syndrome a Burden on HealthCare?

Cannabinoid Hyperemesis Syndrome (CHS) is a relatively new condition that we are still learning about.  CHS can be experienced by cannabis users that partake in prolonged and frequent use.  It is typically characterized by:

• Severe nausea
• Vomiting
• Abdominal pain
• Symptomatic relief through increasingly hot bathing

A new study¹ completed by researchers at George Washington University (GWU) has found that as cannabis consumption becomes more widespread, particularly with increasing legalization, CHS poses a growing concern for healthcare systems, as an increased burden is placed on resources.

Cannabinoid Hyperemesis Syndrome: A Paradoxical Condition

Before diving into the study’s findings, it is important to understand what CHS actually is more thoroughly.  As mentioned, it is a relatively new condition that was first identified in 2004.  Notably, it is a condition that presents paradoxically, as it can result in severe vomiting despite cannabis’s proven and well-known antiemetic properties.  For those who experience it, CHS typically follows a three-phase process.

Prodromal Phase: Characterized by early morning nausea, anxiety, and abdominal discomfort.  During this phase, individuals will often increase cannabis consumption, mistakenly believing it alleviates their symptoms.

Hyperemetic Phase: The second phase progresses to include nausea and vomiting in addition to persistent abdominal pain.  From here, patients often find relief through compulsive and increasingly hot bathing or showering.  This is a distinctive behavior associated with CHS, which, in some cases, can progress to the point where water is so hot that patients can unintentionally cause burns.

Recovery Phase: Providing the sufferer abstains from consuming more cannabis, symptoms will subside on their own if normal eating patterns are resumed.  However, relapse is common if cannabis consumption recommences.

While the exact cause of CHS remains unclear to this day, it is believed that prolonged exposure to high doses of THC will eventually result in symptomatic disruptions of the endocannabinoid system, which plays a large role in regulating nausea and vomiting.  Over time, chronic use may desensitize cannabinoid receptors, leading to the previously mentioned paradoxical effects.

Another theory suggests that cannabinoids affect gut motility and gastric emptying, contributing to persistent nausea and vomiting in susceptible individuals.  However, a significant knowledge gap remains as to why some chronic cannabis users develop CHS while others do not.

As it stands, the go-to approach for dealing with CHS is a simple one: stop using cannabis.  Treatments undergone (IV fluids, antiemetic meds, etc.) are typically taken simply as a means of controlling associated symptoms.

A Growing Burden on HealthCare

The aforementioned study surveyed 1,052 self-reported CHS sufferers.  Its findings revealed that of those surveyed, 85% had visited emergency departments (EDs) at least once.  Of those that visited, 44% admitted due to hyperemesis symptoms.

The study also highlighted that those suffering from CHS were heavy users, with 40%  of those surveyed indicating daily use in excess of 5 times.

Finally, it found that 44% of those surveyed maintained daily use habits for more than five years before developing CHS.

In discussing the study by GWU, lead researcher Dr. Andrew Meltzer stated that,

This study highlights the substantial burden CHS places on individuals and healthcare systems…It’s crucial to recognize that CHS is a real and potentially serious consequence of chronic cannabis use.

Notably, there is already an existing body of further evidence² that supports the findings of this study.  When looking at data from U.S. Emergency departments from 2006-2013, it was found that CHS related emergency department visits increased from 2.3 to 13.3 per 100,000 incidents.  This is a marked increase that also coincided with the growing legalization and potency of cannabis.

Part of why CHS is such a burden on healthcare is the difficulty of diagnosing it.  This difficulty arises from overlapping symptoms with a litany of other conditions, a reluctance to report cannabis use by sufferers, and its uncommon paradoxical effects – all of which can result in extended and repeated hospitalizations that cost thousands of dollars.

Reducing the Burden

In order to reduce the burden being placed on healthcare, there are a few simple steps that can be taken by medical providers and users alike.

Educating Healthcare Providers: Employers need to provide additional training on how to identify and manage CHS efficiently.

Raising Public Awareness: With legalization spreading, the public needs to be educated on what CHS is and how to avoid it.  Many have never heard of the condition and are completely unaware that their habit may be leading towards a visit to the hospital.

Final Thoughts

As cannabis use becomes increasingly common, particularly with legalization and the availability of high-potency products, CHS has continued to emerge as a public health concern.  At this point, the best way to reduce its burden on healthcare may be through obvious approaches such as awareness education efforts.

Like anything in life, the bottom line is that everything should be consumed in moderation.  Keep your consumption in check, take tolerance breaks, and you can avoid becoming an unfortunate statistic.  Cannabis has many therapeutic benefits, but when overused, these are quickly replaced by a set of symptoms no one wants to endure.

Study Reference:

^{1. Richards, J. R., Lapoint, J., Burillo-Putze, G., et al. (2025). Cannabinoid hyperemesis syndrome is associated with high morbidity and healthcare utilization: A multicenter study. Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2025.01.018}

^{2. Bollom, A., Austrie, J., Hirsch, W., Nee, J., Friedlander, D., Iturrino, J., Ballou, S., & Lembo, A. (2018). Emergency department burden of nausea and vomiting associated with cannabis use disorder: US trends from 2006 to 2013. Journal of Clinical Gastroenterology, 52(9), 778–783. https://doi.org/10.1097/MCG.0000000000000944}