Cannabinoid Hyperemesis: High on the Differential for Intractable Vomiting

July 15, 2010

By Sarah A. Buckley & Nicholas M. Mark

Faculty Peer Reviewed

An 18-year-old male presents complaining of crampy abdominal pain, nausea, and intractable vomiting for the past year. The symptoms are episodic, lasting several weeks and remitting for weeks to months. The patient states that his abdominal pain is 10 out of 10 in severity, and that he has been vomiting up to 20 times each day. He has been evaluated at multiple hospitals, and he has had numerous upper endoscopies, colonoscopies, swallowing studies, and CT and MRI imaging studies, all of which were unrevealing. He underwent a cholecystectomy, but had no improvement in his symptoms after the surgery. His pain and nausea are unresponsive to antacids and antiemetics. The patient’s only relief is with hot water bathing: he spends hours each day in the shower with the temperature set as hot as he can bear. The patient’s history is otherwise unremarkable, except that he admits to daily marijuana use beginning at the age of 14.

This patient’s story is typical of cannabinoid hyperemesis, a clinical syndrome characterized by intractable vomiting and abdominal pain associated with the unusual learned behavior of compulsive hot water bathing, occurring in the setting of long-term heavy marijuana use. Treatment consists of medication for immediate symptomatic relief and marijuana cessation for long-term relief. Symptoms usually remit within weeks of becoming abstinent.

If this disorder is so easily diagnosed and treated, why were the patient’s past doctors confused to the point of performing what might have been an unnecessary surgery? Cannabinoid hyperemesis is a new diagnosis, first described in 2004, and currently sixteen papers on the subject have been published. Therefore, it is likely that the patient’s prior doctors had never considered this disorder. Second, the pathogenesis of cannabinoid hyperemesis is poorly understood. How can marijuana, which is used in cancer clinics as an anti-emetic, cause intractable vomiting? And why would symptoms abate in response to high temperature? The connection between marijuana, vomiting, and heat is non-intuitive, and a medical team unfamiliar with this syndrome would be hard-pressed to reach the diagnosis.

The largest study of cannabinoid hyperemesis to date was the landmark report by Allen et al in 2004 in an area of Southern Australia where marijuana use is largely decriminalized.[i] The report tracked 10 patients who presented with cyclic vomiting after 3 to 27 years of cannabis abuse and no other history of drug abuse. All but one displayed compulsive hot water bathing; the remaining patient had only experienced his symptoms for 6 months, and the authors theorize that he had not yet learned to associate hot water with symptom palliation. The 9 compulsive bathers reported that this bizarre behavior occupied hours of their days and said that their symptoms were ameliorated within minutes of bathing and returned when the water cooled. All 10 patients were counseled to cease cannabis use, and 7 did so. Within weeks of cessation, the symptoms resolved for these 7 patients; the remaining 3 patients did not cease cannabis use and continued to have cyclic vomiting and abdominal pain. After several years of abstinence, 3 patients resumed cannabis use and were hospitalized again with cyclic vomiting and abdominal pain. Once again, 2 of these patients successfully stopped using cannabis, and their symptoms resolved. The remaining patient continued to use cannabis and continued to experience symptoms at the time of publication.

Following the first case report, further cases have been described on three continents. All patients presented with the classic triad of symptoms described by Allen et al: cyclic vomiting and abdominal pain, an extensive history of cannabis abuse, and palliation with hot water bathing. The fact that this unique triad is preserved in diverse patient populations suggests that there is a pathogenic mechanism that underlies this syndrome.

Several authors have speculated about the pathophysiology of cannabinoid hyperemesis, and though the specifics remain unclear, there is consensus over some of the basic principals: It appears that the high lipophilicity of delta-9-tetrahydrocannabinol (Δ9-THC, the active compound in marijuana) causes cumulative increases in concentration with chronic use, which may lead to toxicity in susceptible patients.  The abdominal pain and vomiting are explained by the effect of cannabinoids on CB-1 receptors in the intestinal nerve plexus, causing relaxation of the lower esophageal sphincter and inhibition of gastrointestinal motility.[ii] This finding is supported by gastric emptying studies performed on one of the patients presented by Allen et al, which revealed severely delayed emptying. While cannabis appears to have anti-emetic effects that are centrally mediated,[iii] it is possible that these effects predominate at low doses whereas the gastrointestinal effects predominate at the high concentrations that occur with long-term use.

The proposed explanation for compulsive hot water bathing is based on the fact that cannabis disrupts autonomic and thermoregulatory functions of the hippocampal-hypothalamic-pituitary system. There is a high concentration of CB1 receptors within the limbic system,[iv] and the hypothalamus in particular is known to be responsible for integrating central and peripheral thermosensory input.[v] Furthermore, Δ9-THC induces hypothermia in mice in a dose-dependent manner.[vi]  While this evidence links cannabis to the hypothalamus and to thermoregulation, it does not provide a causal relationship. Two mechanisms proposed by Chang et al are that (1) cannabinoid-induced hypothermia causes the desire for hot water bathing, or (2) hot water bathing is the direct result of CB1 activation in the hypothalamus. The true mechanism underlying hot water bathing remains enigmatic, and further studies are needed to elucidate the relationship between this bizarre learned behavior and the other features of cannabinoid hyperemesis.

A timely diagnosis of cannabinoid hyperemesis is essential not only to effect proper treatment but also to prevent iatrogenic morbidity and mortality from unnecessary diagnostic procedures and surgical interventions.  There are, however, several obstacles to effective diagnosis:

First, the legal status of marijuana makes eliciting an accurate drug history challenging. Second, the bizarre hot water bathing is likely often attributed to psychological conditions such as obsessive-compulsive behavior. Third, the knowledge of the anti-emetic effects of cannabis likely disguises cases of cannabinoid hyperemesis, leading to the erroneous belief that cannabis is treating cyclic vomiting rather than causing it.  Finally, the fact that this syndrome is so recently described and relatively unknown outside an esoteric subset of the GI literature means that most clinicians are unaware of its existence.  The following diagnostic criteria adapted from Sontineni et al[vii] can be used to facilitate a diagnosis of cannabinoid hyperemesis syndrome: 

ESSENTIAL FEATURES
  History of chronic cannabis use
  Nausea and cyclic vomiting over months
  Relief with cessation of cannabis use
SUPPORTING FEATURES
  Compulsive hot water bathing with transient relief of symptoms
  Colicky abdominal pain
  Exclusion of other etiologies (especially gall-bladder and pancreas)

 

In the case of the 18-year-old patient presented above, asking the open-ended question, “What makes you feel better?” followed by more focused questions regarding the temperature of the water and the history of marijuana use were sufficient to suggest the diagnosis of cannabinoid hyperemesis.  We propose that these questions be used as a screening tool for all patients presenting with cyclic vomiting.  Based on our experience and a review of the literature, we believe that these questions may be both sensitive and specific for detecting this unusual syndrome.

The patient presented in this case was counseled on his likely diagnosis. Though he was initially skeptical, giving him printouts of case reports on cannabinoid hyperemesis syndrome and discussing the etiology of the disease were sufficient to convince him of the diagnosis. He was treated symptomatically in the hospital.  Two weeks after discharge, he remains abstinent from marijuana and reports that his symptoms are improving.

Sarah A. Buckley and Nicholas M. Mark both are 4th year medical students at NYU School of Medicine

Faculty reviewed by Robert Hoffman, MD, Director NYU  Poison Control Center,  Associate Professor Departments of Medicine and Emergency Medicine, NYU Langone Medical Center

References:

 [i]. Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut. 2004;53(11):1566-1570.

[ii]. Izzo AA, Coutts AA. Cannabinoids and the digestive tract. Handb Exp Pharmacol. 2005;(168):573-598.

[iii]. Simoneau II, Hamza MS, Mata HP, et al. The cannabinoid agonist WIN55,212-2 suppresses opioid-induced emesis in ferrets. Anesthesiology. 2001;94(5):882-887.

[iv]. Herkenham M, Lynn AB, Little MD, et al. Cannabinoid receptor localization in brain. Proc Natl Acad Sci U S A. 1990;87(5):1932-1936.

[v]. Egan GF, Johnson J, Farrell M, et al. Cortical, thalamic, and hypothalamic responses to cooling and warming the skin in awake humans: a positron-emission tomography study. Proc Natl Acad Sci U S A. 2005;102(14):5262-5267.

[vi]. Hayakawa K, Mishima K, Hazekawa M, et al. Cannabidiol potentiates pharmacological effects of Delta(9)-tetrahydrocannabinol via CB(1) receptor-dependent mechanism. Brain Res. 2008;1188:157-164.

[vii]. Sontineni SP, Chaudhary S, Sontineni V, Lanspa SJ. Cannabinoid hyperemesis syndrome: clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse. World J Gastroenterol. 2009;15(10):1264-1266.

Image courtesy of Wikimedia Commons

31 Responses to Cannabinoid Hyperemesis: High on the Differential for Intractable Vomiting

  1. [...] Cannabinoid Hyperemesis: High on the Differential for Intractable Vomiting By:  Sarah A. Buckley and Nicholas M. [...]

  2. Dennis Larsen on March 19, 2011 at 6:17 pm

    Im glad to finally find out what is wrong with me. I’ve been in just about every hosp in the Denver Co area with the same problems as you mention. I am 50 yrs old and have been smoking pot since I was 15. I’ve been going thru this Hyperemesis for about ten years with no diagnosis, except for Unremarkable, and mentioning of everything from Pancreatitis to Cancer. I sure believe now that there is a problem with me smoking pot. Thank You.

  3. psperkins on April 13, 2011 at 11:03 am

    I was recently diagnosed with this syndrome.
    Thank god it was this and not something more complicated and difficult to remedy.

    I had been in the emergency room 11 times in 4 years until I found a doctor who had recently read about it.

    Had every test imaginable performed on me without any conclusive results – ct scan, ultrasound, xrays, blood tests, urine tests etc.

    So thankful for running into a doctor who had done his job and kept up on the journals.

  4. PandaBear on April 27, 2011 at 9:06 pm

    I would like to find more research and information about this. Very interesting correlation. But is it the vomiting that caused the use of marijuana, or has the marijuana caused the vomiting? I completely agree with the study, however I started smoking regularly at the age of 15 to help with the vomiting. And why the hot water? Obviously not many patients diagnosed with cyclic vomiting feel they need the hot water, why herb smokers? I heard they are trying to find out if it has to do with brain transmitters. I was always told I had gastritis, cyclic vomiting, abdominal migraines, was treated for h-pylori. I also have had just about every blood, CT, MRI and scope tests done, results coming back “normal”. One doctor said it was anxiety and deprssion. Another a breakdown of my centrak nervous system. I have had these reccuring vomiting episodes for 8 years. And for eight years almost every doctor I saw told me smoking could not hurt at this point or suggested it v. anit-nausea meds. Very interesting, and disturbing, to find out it was probably making things worse.

  5. Mom4Life on June 9, 2011 at 6:46 am

    I too TOTALLY believe the study. Some things I have read say that it has something to do with the cannabinoid receptors in the brain (particularly in the hypothalamus) – which regulates the body temperature and digestive system. If this is true it would explain why the patients are unknowingly seeking to warm up their “core body temperature” and keep throwing up. For years my husband has been diagnosed with everything under the sun, ibs, possible parasites etc etc. The first episode I remember was ?19 years ago maybe? I personally believe there is a Gastric Emptying component to this as well. I believe that the cannabis also slows down digestive motility, which causes your supper to sit in your gut all night…rotting…which would also explain why this phenomenon occurs (at least for him) always with onset in the early morning hours. Once I convince him…we can “fix” it. :)

  6. Michele on July 1, 2011 at 6:47 pm

    YES, please spread the word. I have gone through horrendous anxiety over the past few years watching my husband repteat this cyclical vomiting cycle- and then sitting in the bathtub with his bong for hours on end. Listening to your loved one retching and suffering is heart wrenching. Until I pack him up and go to the Emergency Rooms. No conclusive diagnosis after $30,000 worth of tests. To now know that he has been causing this because of his habit/addiction is revelatory. He is in denial at the moment, using the excuse of “why don’t the doctors know about this?” or “I overate-that’s why I threw up”. Once his physician hears about this, I pray that he will listen and get help to quit.

  7. Mike Kavan on July 25, 2011 at 12:11 pm

    WOW….I just spent the last week in the hospital with all associated syptoms. Usually sick in the morning and HOT water was my best friend. I actually became very nasty with the hospital staff when they would not let me in the shower. Nothing else would work. They were throwing everything at me, anti-nausea, acid-reducers, anti-biotics etc….

    Thing is, I don’t smoke weed. I have been making “herbal incense” with the synthetic cannabinoids like JWH-122, 210 etc….I figured it would be no problem at all. I’ts not detectable in general uranalysis, so the doctors, even if aware of CH, would probably not even think once about it.

    All I know at this point, is that I will no longer be partaking in any “sessions”. Last week was the worst I have ever felt in my life and I am sure as heck not going to purposely hurt myself.

  8. Jason Wahl on July 28, 2011 at 6:53 pm

    I’ve been smoking marijuana for 14+ years and everything mentioned in this article is exactly what is happening to me. I’ve had colonosopy, CT scans, ultrasounds, endoscopy, and stomach emptying test and am now realizing that I’ve been keeping myself sick this entire time by continuing to smoke MJ. I have also become obsessed with taking hot showers for relief.

    STOP SMOKING AND YOU WILL BE AMAZED! 2-3 weeks and all your problems will be gone.

  9. TROBO on August 8, 2011 at 11:57 am

    I am very glad to hear everyone else’s story. I have been dealing with this condition on and off for about three years now. This year has by far been the worst. Since January, I have been hospitalized over 20 times, had my gallbladder removed, CT scans, xrays, blood tests, endoscopy, you name it, I’ve done it and with no real diagnosis. I was diagnosed with exclusionary IBS at the hospital, then I went to a homeopathic dr who thought I had parasites. I also had to drop out of my classes at school and miss lots of work. It was awful.
    I have been smoking weed on and off since I was about 14 and before a couple years ago I had never experienced anything like this. I am very glad that I finally found a reason for why I get sick all of the time. I always thought that smoking would make me feel better when I was nauseous, but now I found out that it was just hurting me more. I will miss smoking because I love to be high, but my health comes first and I don’t wanna be sick anymore. Thank you all who shared ur stories.

  10. ck on August 9, 2011 at 4:58 pm

    I am a 26 year old female and have also been suffering from numerous “episodes” of nausea, vomiting, stomach pain…im not 100% on the hot showers, though i do find it helps sometimes when i first start getting flushed-hot/cold flashes… I have not been diagnosed as of yet, but am convinced this is what i am suffering from at this point. They have done ultrasounds/ct scans/xrays/bloodwork/urine..the works..heck i even just got a laparotomy done where they cut my stomach open to examine it…nothing wrong found, everything looks healthy or comes up ok… Met with a stomach specialist today and will be going for a colonscopy and endoscopy but in the meantime was advised to lay off the weed. I hope it is just as simple as quitting smoking….thanks for the article and all the best to any other sufferers of this, it sucks.

  11. Calcula7ed on August 19, 2011 at 6:04 pm

    Just a few questions that I hope can be answered by the experts.

    Does this have anything to do with smoking before the brain is fully developed? i.e. becoming dependent on a substance before the brain is fully functioning or is able to decipher the properties of certain substances? Perhaps the hypothalamus is underdeveloped or perhaps it damaged the synchronization of the hypothalamus? Interval issues due to the use before the brains parts are fully developed?

    At what point/age is the hypothalamus acting at full capacity? On the average.

    Do alternate brain functions develop at alternate intervals with respect to functioning? i.e. parts of the brain could develop much quicker than the brain parts of others? Obviously but I would prefer your opinion and analysis.

    Since a small percentage suffer from this why doesn’t everyone else who smokes suffer from the same symptoms?

    Is this only found in those who smoke chronically?

    Is it different for those who consume the substance other than by purely smoking it? i.e eating, vaporizing, etc. This could be used as a controlled experiment eating vs smoking. Vaporizing vs smoking. Etc.

    Could this occur from an inhalation or consumption of contaminants that are easily dissolved in the body’s system while the substance that stays in the system longer is the culprit? Tainted?

    I’ve never heard of this until recently and I do acknowledge it’s importance in understanding it completely. I’m trying to gather more information for my own hypothesis. Thank you and good day. My email is Calcula7ed@hotmail.com

  12. Kendall on September 14, 2011 at 12:56 am

    I have been suffering from this syndrome for 4 years now. I spent a lot of time in denial that my smoking (typically about 5x/day) was the problem but over time the patterns never changed. Cyclic episodes of severe nausea and vomiting along with hours upon hours spent in the bathtub and shower to get relief. I spent weeks upon weeks in the hospital on over a dozen occasions in the time period having every test done imaginable as well as had a completely unnecessary surgery performed on me. I encourage anyone who even THINKS they or someone they know might be suffering from this condition to take a closer look at your symptoms and talk to a doctor. I am thankful to have discovered the root of the problem.

  13. SMS on October 9, 2011 at 10:35 pm

    For the past two years I’ve been suffering with gastrointestinal issues that have gotten worse and worse. I’ve had test after test (all of which were normal except for gallbladder which was removed) but still my symptoms persisted and worsened. Finally, right before my gastroenterologist was going to run a battery of more tests, he asked me if I smoked marijuana and if I took a lot of hot showers. Embarrassed, I admitted that I smoke every day, all day, and yes I’ve noticed I’ve been taking a lot of hot showers, even this summer. He told me he knew what was wrong with me and printed off info about Cannabinoid Hyperemesis Syndrome. At first I didn’t want to believe it. I cried so hard in his office. I have smoked pot for 18 years because I suffer from Bipolar Disorder and pot stops my manic episodes. It also relieves my anxiety (but I have noticed in recent years that it sometimes CAUSED more anxiety). Well, since I had been suffering so much and had lost 36 lbs in 2 months because I couldn’t eat solid food, I stopped smoking pot to see if it was true. Unbelievably, within 2 weeks I was completely cured. After two years of horrible stomach pain and all these invasive tests, I can now eat whatever I want with out a problem. Like the rest of you suffering from this syndrome, I will miss pot A LOT. Since stopping it I’ve gone into a pretty serious manic episode and I’ve had to go on Lithium to even me out, but I’m so happy to not be vomiting and having excrusiating pain, so it’s worth it. Good luck to all of you who have this. I know it will be hard to let go of smoking, but you will see its way worth it in the end.

  14. Larry Quade on January 16, 2012 at 12:03 pm

    This is the dawning of the age of new illnesses, and shall I say, the discovery of some of them. Cannabinoid Hyperemesis seems to be very reel although there may be quite a few factors that run hand in hand with its symptoms and diagnoses.

    Long term THC consumption will definitely lead to gastrointestinal issues at some point. The trouble here for doctors is identifying this problem. Many doctors are unaware and limited in their scope. Too many things for people to have to avoid. By choice or not; like poor diet, STRESS, lack of exercise, dangerously improper food staples, chemical poisoning by doctor prescribed drugs, farm field pesticides, and general water & air pollution,,,, and now even THC!

    All things in moderation,, something a lot of us chronic users never considered when it came to getting high. I started up with MJ at 13 years old and I thought it was the best relaxing thing ever,, now almost 40yrs old, I have had a number of very serious health problems related to my long term use.

    My problems became worse than just vomiting and pain after about 15 year of chronic use. With very heavy daily use my gastro-system can become confused and began clamping off certain sections of the GI tract where many CB-1 & CB-2 receptors are concentrated. These areas of the gut may also include many immune system cells that respond (hyperactivacte) when THC is absorbed. The worse part in a modern sense is, if there are allergic components (toxic food debris) in the intestine at the time of this intestinal spasming,, that’s when the confusion begins.

    When your bodies immune system activates it uses existing sugars to charge the immune response. The intestines hold sugar/energy by means of food/waste sources and will use any means nessecary to obtain the glucose that is vital to its task.
    Stressed or unfit intestines don’t act well & normal under the persure of THC’s annonomus immune system command. Chronic use of THC means an overused exhausted and confused immune system attempting to operate with often horribly dangerous and improper energy sources.

    In a nut shell, Cannabinoid Hyperemesis is going to become a real problem and mystery to the rapidly growing number of THC users in the next several years.
    Doctors are starting to take notice of this syndrome although they will be thrown way off the mark if they don’t consider the lifestyle, whole body health, the whole person, and the THC too!

    All things must be considered, we must start on the first page in order to finish and understand the book.

    We’re on to something here!!

  15. Justin Johnson on January 17, 2012 at 1:05 am

    I have been dealing with every symptom listed for the last two years. I have smoked anywhere from 1/8 to a 1/2 ounce a week for the last 15 years. Last monday I woke in the morning, smoked a bowl and had three seizures in a row. I then was violently ill for the next day throwing up over 20 times. I have cronic abdomenal pain on my right side and serious temperature control problems. After a day of vomiting I went to the emergency room and was admitted to the hospital. I had a ct scan, ultrasound and many blood tests. My blood pressure and heart rate was completly out of wack. At first they thought I had an infection but after a day on antibiotics they found that to be wrong. Zofran was given to me for the nausua while I was there but did not help at all. They told me that for some reason my kidneys where over run with toxins which was very serious. I was given around 10 bags of fluids over the next week at which my kidneys slowly began to recover. I have never felt that sick in my life. I would find myself shaking from being cold and also I had bouts of anxiety and depression like feelings that would take me over completly. The doctors in the end speculated that the seizures had released the toxins from my muscles into my kidneys causing the illness but admitted to me there was many unanswered questions. The could find no reason for the abdomenal pain. I was urinating fine the whole time and bowl movements where normal other than they were few and far between due to me not eating for five days. I lost about 10 pounds during this time.

  16. DJ on January 19, 2012 at 1:41 am

    I still can’t believe what I’m reading. I guess it’s really that I don’t want to believe it. At the same time I’m so incredibly happy though. I’m a 29 yr old female who has smoked pot everyday, usually several times a day for 16 years now. For the last 12 years I have battled with extreme stomach pain/ upset/ discomfort everyday and until now thought that pot was the only thing that alleviated my symptoms at all. I have been to the ER and been admitted into hospitals so many times now I couldn’t even make an accurate guess. I had my gall bladder taken out 10 years ago, was diagnosed with cyclic vomiting syndrome 8 yrs ago, and have been blaming my agonizing symptoms on this unknown “disease” ever since. To finally discover that I’ve been doing this to myself all these years is almost more than I can absorb.
    I just got done with another two week stay at the hospital with my kids and family at my bedside wondering if I was gonna pull out of this round again or not. Been in this particular hospital so many times they don’t put me through the extensive tests anymore, but don’t think I haven’t been through them all, scoped 3 times, CT scans, MRI’s, etc., etc.. I just happened to get my least favorite ER Dr again this time (this being because he has no sympathy for me when I’m there in complete agony because of my pot habit). He told me again of how they’re finding out how chronic marijuana use can actually cause the symptoms I’ve come in there with so many times. I, like every other time, just denied that I smoke much pot and acted like he didn’t know what he was talking about. After laying in the hospital for 2 weeks afterwards (after returning to the ER to have a different Dr admit me) I decided to Google “cyclic vomiting syndrome” and “marijuana” and I’ll be damned if he wasn’t right.
    Going to have a very hard time giving up my all-day, everyday habit, but if it makes me quit getting sick and feeling as crappy as I do all the time, maybe it wont be so hard. I haven’t read any comments about anyone having near as many “episodes” as I have had yet, but I know in my case, if I have to be hospitalized many more times, well, they’re running out of good veins to even be able to hydrate me through. They’re past trying to put them in my thumbs, wrists, feet, and other painful places. This last time they managed to get IV’s going in my shoulders, but did I mention, I’m 29 yrs old! And in otherwise very good health. All this rambling I guess is just in case anyone is reading this who might still be trying to be in denial like me and might

  17. Bronwyn on April 14, 2012 at 2:10 pm

    Has any one experienced any of this but without the temperature? Have experienced many of same symptoms but not the bathing thing. In fact it is just like food poisoning when it happens. Could be same thing? And answers?

  18. Troy on July 11, 2012 at 7:08 pm

    Hey, just reading these comments and now truly believe that I too have this. Can a person just cut back on their pot intake and cure themselves or is stopping it all together the only answer. I love coming home on a Friday after a long hard week and having a beer and a joint to unwind. It’s like my treat. Just wondered if anyone has had any luck with just cutting back?

  19. Tom M. on August 31, 2012 at 8:14 pm

    I recently (less than 2 months ago) was in the ER twice in three days with this condition. I had been smoking pot every day, multiple times per day, for over 4 years. For myself, I cannot smoke pot at a decreased level; I am addicted to it, and over 12 years, my use has only increased. I was able to lower my use for small amounts of time, two weeks to a few months, but inevitably always regained my previously highest level of use, and then surpassed it. I have known I have a problem with pot for 10 years (since I was 16), and have been in rehab 11 times attempting to get clean and sober. Until I experienced hyperemesis, though, I could not bring myself to honestly see the severity of my marijuana addiction. Had it not been for the love of my family and girlfriend, I probably would have just let myself die of dehydration. I am now 38 days sober, 40 days off of pot. My stomach no longer hurts, and I no longer have the pre-episode feeling in my stomach that I came to learn would lead to hyperemesis if I ate solid food with it. Today, I can eat breakfast, lunch, and dinner, without fear of triggering an episode. My life is exponentially better without marijuana in it.

    I view weed as one of the truly insidious drugs on the planet, as in the rooms of recovery, most people think it benign and harmless, and non-addictive. In fact, I’ve been in the rooms of a 12-step program on and off for 10 years, with probably over a thousand meetings attended, and I’ve never met a single person who’s heard of hyperemesis, much less experienced it. Weed addiction is real! :)

  20. Mel on August 31, 2012 at 11:05 pm

    My son is 17 years old and has been in and out of the hospital multiple times over the past year and a half. He started out smoking pot for the first couple years but switched to spice so he could pass a drug test. (I’m 100% against drug use) He is in CHKD as I type this. He has been diagnosed with this illness. I’m here to tell you SPICE can cause this and it can kill you. My son lost soo much weight he looked like a skeleton and he cried to God because he wanted to die because he was in so much agony. He is 5’11″ and was down to 120, originally weighed 160ish. He had a ton of tests done and they found yeast in his GI track. They treated him for that and he got better. We didn’t know it was not just the yeast that made him sick. My son was living with his dad when he got sick for the first few times. He has had episodes of vomiting and not being able to keep water down let alone food. He has a pain in his stomach that center around his belly button. He has taken several hot baths in the hospital which ironically started because I recommend it to him. He does feel better after a hot bath but I have not seen him feel any relief from hot baths to the extent that some of you are talking about. However, I think HTC affects people differently and he definitely has this illness. So even if you’re not getting total relief from hot showers or baths I think you can still have this illness. After he got better the second time I took him straight home from the hospital and he lived with me for a year (and only had smoked two times a small amount). He recently went to stay at his dad’s house and picked up his spice smoking again. The week before he got sick he was smoking it every day this time. On Wednesday he vomited so hard he fell and hit his head on the toilet and blacked out. He was admitted to the CHKD 3 days later on the following Saturday at 8am and released 3 days later on Tuesday after getting the patch for nausea behind his ear and keeping down a cup of water. He was admitted back in to the hospital (after a day and half) Thursday with the same symptoms. I want to note that second endoscope test (one year apart) reviled that he now has ulcer that have developed in his esophagus (but the yeast is gone) I can only wonder if the poisons in the spice eroded parts of his esophagus. The doctors said it is definitely possible.

  21. Anthony on October 24, 2012 at 6:35 pm

    After searching the web for 4 weeks to figure out what was wrong with me I finally found Cannabinoid Hyperemesis Syndrome today – bingo! I am a daily pot user of 20 years – never had a problem until a month ago. I have many of symptoms described in this thread – stomach pain, burping, bloating, occasional nausea, heartburn, chest pains. I instinctively took warm showers to feel better. When I walked outside, I felt pain, most likely because it was a few degrees colder outside. Now it all makes sense.

    I suspected initially that I have H Pylori (the bacteria that causes ulcers) so I stopped smoking pot and cigarettes and ordered Matula Tea – great stuff – kills H Pylori and made me feel better immediately. Then a few days later I smoked a joint – I had slight stomach pain within 1 hour of smoking, but it went away quickly. Then I did not smoke for 2 days – felt good. Then I smoked 2 joints and had another relapse – this time I had a stomach ache for the whole day and half the night. The pot seems to have a cumulative effect, not
    necessarily immediate in my case.

    Part of my problem, and possibly your problem, is H Pylori. 2 3rds of people have this ulcer-causing bacteria, but most do not get ulcers. I suspect I have a small ulcer. If you have H Pylori, with or without ulcers, and you smoke pot, I suspect that you will be more susceptible to Cannabinoid Hyperemesis Syndrome – just my theory.

    While I am disappointed that I must give up pot, possibly forever, I am happy to have pinpointed the cause. For those sad to give up pot, as I am, perhaps this will help; I will tell myself when I am craving a pot buzz, that the best buzz is being healthy, pain free, knowledgeable, free of fear, and in control of my life again. : )

  22. Red Riding Hood on November 21, 2012 at 11:16 pm

    Well, I have a 17 year old son who, six weeks ago suddenly started cyclic vomiting, lost 17 pounds and couldn’t eat until noon every day. After a battery of blood tests that came back normal, and a scope down his stomach that showed everything normal, I happened to be at the front door one evening as he walked in with bloodshot eyes. He admitted to smoking marajuana 3 times a day for the last few weeks since the symptoms started and occasionally before that. That night I googled” cyclic vomiting, smoking marajuana” and BINGO! I found this condition, which I’m pretty convinced he had. It’s now been 3 weeks of no smoking and he feels almost back to normal! I’m hoping he continues to improve so as to avoid a CT scan of lower abdomen and head.

    Prior to this discovery, I had only googled “vomiting at at the same time every morning” and I found loads and loads of people with this same problem who have no idea whats wrong. The only thing they think that helps them is smoking marajuana! This needs to be put on Facebook or something. People need to know. There are lots of people out there who, in my opinion, have the same thing! Good luck to all of you!

  23. ay on December 17, 2012 at 3:04 pm

    For those of you who have had success in abstaining and are cured any helpful tips/ coping mechanisms that helped you make it through the first few weeks until symptoms are relieved… my husband is currently on day 3 after receving his diagnosis. he is in agonizing pain also crying to god to end his suffering and pain. Any suggestions on how I can comfort him through this would be appreciated. Thank you and good luck to anyone else who is suffering

  24. Very Relieved on December 29, 2012 at 3:47 pm

    God bless all of you for fessing up to your problem and being honest about this. Had I not found the articles on this I would still be smoking and going to doctors to try and figure out why I can’t eat. I’m currently recovering from my second bout of this (the first time wasn’t enough to convince me), and there is no doubt. Just three days after quitting I’m already feeling better again. I smoked about a gram a day for two years, but was a frequent smoker for two years before that. Recently I smoked all day every day. I have vaporized and used bongs for the most part, and, no, vaporizing doesn’t keep you from developing CHS. That was my last theory, and now I’m suffering from testing it. I should have learned my lesson the first time around. I also tested another common question, as to whether cutting back can be enough. I found that taking a hit would temporarily make me feel better, but after an hour or less I would be much worse. So, it appears to be an issue of toxicity, not withdrawl, or at least that the effect of the withdrawl is minor compared to that of the toxic effect of the cannabinoids. Being high all the time will eventually lead to problems. I have friends who have mild symptoms on and off, but most are not willing to even have this conversation. One friend even accused me of spreading “propaganda.” I’m sorry, I love pot, but this is simply too airtight, and I must reach the conclusion that it’s not for me. What is it they say about the definition of insanity and expecting different results for the same actions? I guess in that regard cannabis causes a little insanity in its users. I think the main thing here to note is that cannabis is the only drug that sticks around for so long, and chronic use will essentially cause an “overdose-like” effect where the body reaches a toxic state and tries to get rid of the toxic compound. We need to realize that after the psychoactive effects are gone that it still has long-lasting secondary effects. Fittingly, cannabis resembles all compounds in that its secondary effect is the opposite of its primary effect. It makes me a little nauseous right now just to think about something hanging around in my body for that long. I’ll bet there’s resin in my tissue from months ago! Yuck! I mean, honestly, would you ever eat something if I told you it would still be in your gut three weeks later? We need to be proactive in getting this information out there. As we sit here, there are probably hundreds of people out there unwittingly smoking medical marijuana for its anti-emetic effect. Had I known these things ten years ago I never would have touched the stuff and been much better off for it. At the same time, though, we all need to count our lucky stars that chronic marijuana use is something we can recover from, which is not the case with any other drug, especially alcohol. Let’s face it, if we had abused other drugs or alcohol to the point we have abused cannabis we would all be dead ten times over, or, even worse, wishing we were… I hope this is something I can look back on as a learning experience without too much regret, though I will always lament losing so much of my youth to this addiction. I hope that in the future we can be more realistic about the effects of cannabis and stop telling lies to our children that will cause them to distrust our advice and do something harmful they might not have even thought about had we been honest with them. It won’t kill you outright, but it will have a negative impact on your life.

  25. laura c on February 2, 2013 at 11:32 am

    I am so pleased i found out about this.
    I found info on this after googling male morning sickness.As a mother of 3 the nearest illness i have experienced to this is extreme morning sickness.
    my symptons come on suddenly always at 6am. I am woken out of my sleep with the urge to be sick,then i get extreme epigastric pain like a constant pluse.
    This goes on for exactly 12 days, no food or water can stay down,no meds help.All i can do is lie still between vomiting praying for health.
    As noted by others the only relief is hot water,one time after using all the hot water in my tank i walked to my mums house with a sheet wrapped round me at 5am because i just couldent wait for my own supply to heat up thats how desperate you become.
    I have had every test known to man all say im healthy.
    Im in Scotland and the docs have prescribed amitryptaline for 6months.
    I havent told them im a smoker,its illegal here.At leasti now know im not dying.
    I find i can smoke solid (hash) with no problems. On thinking about it, its every time i smoke a bit of green(grass etc)that the symptoms begin.

    It truly is a terrible thing to suffer, for the sufferer and their families.

  26. snocker on May 24, 2013 at 4:01 am

    I probably have this disease. My first “experience” with this disorder hit me in my early twenties. I was a champion mountain biker and rock climber with extremely low body fat. I was married and smoked quite a few b’s every day. I woke up one night with indigestion and threw up and got in the shower to relieve the terrible headache that I had accompanying the nausea. I’d been sick plenty of times in my youth but the difference this time was I continued to throw up for two weeks. I was forced to go to the hospital. Iv’s saved my life because my blood had congealed and the nurses couldn’t pull any blood because it was so thick. I didn’t sleep a wink for the two weeks prior to being hospitalized. The pain was EXTREME! No amount of pain meds or anti-nausea meds worked. Even a whiff of food sent me into extreme vomiting. Seeing any pic or commercial with a food image made me gag. I begged my wife to not cook on her lunch breaks. I threw up bowl after bowl full of acid, bile, and the water I was trying to keep down. I drank gatorade some because it tasted better than bile coming back up. My pulse raced at 120 bps. It was exhausting. I became delusional with pain and sleep depravation. I talked to God to ask him what I had done to cause this – no answer. I really thought it was punishment for drinking. The cycle was something like this: throw up, break out into sweats, then chills, then b-line to the bathtub. I’d bring a big bowl to puke in with me. I’d stay in until I ran out of hot water. Then quickly I’d dry off and get into bed. The heat from the bath would make me sweat and I’d lay there for an hour or so until I could almost relax and then, boom, serious vomiting would hit me so hard that I would barely make it to the bowl, sink or toilet I was closest to. This repeated the entire two weeks until and during the hospitalization.I was hooked to the IV tubes but begged the nurses to let me shower with tubes sticking out of the shower. They let me a couple of times. I believe I was in the hospital a week. My gastroenterologist was considered to be the best in my city….he was old and mean. I had upper gi scope done and other than swelling in my stomach, there were no ulcers or serious problems. My doctor discovered I had H-pyloric stomach bacteria that can cause ulcers in the gut. He treated me with what he called a triple antibiotic therapy. I was release and I recovered and fought back into shape (I had dropped to 120 lbs. from 155). After two or so weeks I had a follow up appointment. The doc looked into my eyes and thought he saw something wrong. Of course, I was paranoid that he was seeing marijuana use but no, he dismissed it and declared me “well”. I had resumed smoking during the recovery…it worked wonders for helping me get my appetite back. Life returned to normal for two or so years and then the #2 attack hit. This time, being that I had no insurance I didn’t seek medical help. I began to learn ways of getting through with enemas, hydrotherapy (baths/showers/hot tubs). These episodes would hit every two or so years. Generally after about a week to two of vomiting I could start the process of running water in at both ends to try to meet in the middle. I could definitely tell that there was some blockage, obstruction or kinking of my small intestine. It would take drinking about a gallon of water, all at once after putting two or three big enema bags of water in my rectum. It would feel like a dam breaking in my gut and the most foul black tar and diarrhea would come out. I would have to manually push the fluid around my gut with my hands to work it out. I would cry my eyes out with joy when the bowels would exit and I would drop from ten level pain to more like a two. I could tell the substance or chemical properties of this tar like bowel were very toxic because wherever it would be in my intestines I would cramp and have pain. And not just in my intestines, my rectus abdomens muscle would cramp so hard that it would look like a scene from Alien.

    Some of the things I tried:

    My first attack was nearly 25 years ago. I became convinced it had to be a liver problem (or at least part of the problem). I did a liver flush and passed hundred of gall stones. I passed one slightly smaller than a golf ball. I led a very organic, almost pure vegetarian lifestyle for most of 90s. I had a colonic and passed a HUGE tapeworm. I took neem oil pills to kill parasites. I could always get back into my athletics and compete at the highest local levels. I went to acupuncture school. I studied Tradition Chinese Medicine and became familiar with 350 Chinese/Indian/Native American herbs. I made formulas for myself and others (until mice got into them and I stopped working with them.) I received lots of massages and acupuncture. I practiced yoga and meditation. I bought out a naturopathic doctors inventory of supplements, herbs and extracts. I could list a lot of the things I tried medicinally but that would be ridiculous. I would still have an episode of vomiting every year or so. I had to go to the er several times for IVs. They gave a Xanax on one visit that was like a gift from heaven because I could sleep for a change. The IVs saved my life several times. Other that during an episode, I continued to smoke (and even during if it was a light attack). My parents live in another state. They were perplexed and seemed to think I was doing something to myself i.e. hard drugs or heavy drinking. In truth, I cut down further and further on beer and weed. They had not seen me go through this. I went to visit and spent the night. I was sober and not high and they could see I was healthy. I then had an attack in front of their eyes. About 5 in the morning my father made me get out of the tub because he was sick of water running all night . It was a typical horrific attack with massive vomiting. They were shocked. My brother had to drive my vehicle and they had to lay me in a van and drive me home. we stopped many times on the highway to empty the gallon bowl. Anybody who has witnessed my attacks has said they have never seen anyone as sick. After that, they got behind me a lot more. Family and friends would give me very powerful meds or tranks during my attacks (i never took scripts, pills, or anything between episodes unless it was natural or herbal based partially because my stomach seemed hypersensitive to anything dissolving in my stomach and I’ve always gone natural). We were all so confused how quickly I could go from 100 to 0 so quickly. I had to dissolve all pills under my tongue because of the vomiting. I cut out all caffeine (coffee). I then cut out ALL drinking for several years. I cut smoking weed, as well. Since this was about a dozen years ago I can’t remember how long I went without both but I did. I really felt about the same as when I was using as when not (except I didn’t need as much sleep). I assumed it was the booze and probably decided to have a puff instead. It seemed to work so I though the problem was solved and then boom, another attack. So, I ruled out the booze at that point. It never occurred to me it could be something in the smoke because usually your body will have an instant reaction to a substance it rejects. I then went to a local college of medicine and the did very detailed questioning of my condition. The doctor ask me about an hours worth of questions, many about my bowel consistency. I told him the closer I got to an attack the smaller the diameter of my feces would become. It was an indicator that my heath was slowly going south. Also, brushing my teeth would cause a gag reflex if I brushed my tongue. I would try to ignore it because what could I do? Laxatives and fiber could throw me into an attack I discovered. The doctor set me up for tests. Upper and lower gi, gall bladder scan, x-rays, ultrasound, etc. I didn’t have to have my gall bladder taken out because I had done the flush (saw that one coming). I did the scopes on April 30, 2001. As I type, I have the pictures from the gi scopes in front of me. I had a normal stomach, normal duodenum, another section of normal stomach, mild esophagitis/erosion, a sessile polyp (removed), two sections of normal colon and an amebiasis ulcer. The amebiasis is a amoeba that causes dysentery. It kills 70,000 people a year. Now, this seemed like a more probable explanation of my condition. They gave me a powerful chemotherapy prescription to deal with it. After taking about 2/3 of the chemo, I was thrown into another attack (one of the huge reasons I hated taking any pills). I assume I had enough chemo run through me to kill the amoeba, Got through another one and got back to my life. Incidentally, I went to another doctor, an old bootcamp D.O. who would treat people for next to nothing (no insurance). He wanted a urine sample. I was so dehydrated I told him I couldn’t pee. He told my wife behind my back that he suspected cocaine use because I wouldn’t/couldn’t pee. Ha! I told him I could squeeze a little puss out of the tip but nothing else. He determined I had a massive staph infection, the worse he had ever seen. After moving on from his coke theory he said he thought I had Crohn’s Disease. I figured I had Irritable Bowel or some variation of it, as well. Then one day I saw a commercial for a class action suit against a pharm company for the complications being associated with taking Acutane, the drug I was prescribed as a teen for acne. I almost fell out of the chair. I quickly called my parents with news. What else could it be, right? People who took this drug had been having massive problems with their GI and had to have parts removed. It gave them Crohn’s and IBD problems and some were awarded millions in the suit. I (of course) took the Acutane so long ago that I couldn’t get in on the suit, but at least I had a plausible theory about myself. Acutane was developed as a strong chemotherapy. I didn’t know that until I did research. So, I had been on chemo twice in my life and never had cancer (you see why modern medicine and I don’t get along). The D.O. doctor died and my original gastro doc retired, I still didn’t have insurance or a doctor. I then went through an unexpected divorce. I’m sure she was getting pretty tired of witnessing over a decade of my roller coaster ride and the financial problems it caused from not being able to work. I started dating and drinking again, the old wine and dine. I looked good, was healthy and had fun dating. I went for about three years of great heath. My parents assumed it was all caused by stress associated with the marriage. I started drinking more with the ladies and smoking less (didn’t want some knowing I smoked and kissing is kinda a giveaway). I met a special lady after a couple of years and we’ve been together six. After three years I then became very very sick and had to go to the hospital once again. I broke down and went because I knew I would die if not. They asked me upon admission if I drank and I stupidly said yes. The nurse made kind of an “aha” sound and I knew I was screwed. They discovered I was in full renal kidney failure. This was very bad for me because I only have one kidney (from birth). They said my blood was the worst they had ever seen and every spec was backwards from normal. They assigned a nephrologist and he told me I would die. I said “bullshit” to myself and wanted water! He told me if I did pull through that I’d be on dialysis for the rest of my life and they scheduled me for three dialysis treatment over three days. They did one and I started producing urine and they were shocked. I was in for five days and three in ICU. The nurses were terrible because they thought I was some hobo drunk (having not shaven for weeks). I pleaded for them to listen but they scoffed and told me alcohol was going to kill me. At one point I showed my closed minded doctor a small light scar on my stomach where I had pressed so hard with a wood rod to try to get the pain to stop that it left a scratch scar. I showed her to demonstrate the main area of pain and that it was not an esophagus problem (they theorized that drinking messed it up and made me vomit). She wrote in my chart that I was self mutilating. That was a terribly frustrating experience and they based all this on NOTHING other than me saying I drank. They never even got me a gastro doctor. They did save my life but I’m sure they really screwed me on my med chart. They handed me a $35,000 bill and I went on my way. Now, after this hospital stay things have been different. I have some slight waves of numbness that go down my left arm on about a five minute cycle. My eyes have gotten so tired from sleep deprivation that it’s been hard to focus. My energy level has been down. I went from an athletic lifestyle to focusing on music. I helped start a country band as the lead guitarist and started staying up late practicing. I theorized that if my health didn’t improve that I would have to find multiple ways to make a living. I knew I might have to contend with a stage fright problem so I cut way back on smoking (was afraid of freezing up). I began to drink more because I started to have terrible problems sleeping and wanted to be loose to play for crowds. For the next year I had no attacks. Then I quit drinking and smoked more. Then came the attacks again. I actually started to drink myself to sleep because of the symptoms. My symptoms have been less severe since my hospital stay three years ago. They have been more constant, though.

    Other things:

    The pain and anxiety of the 10/10 scale attacks is horrible. The other peoples testimonies show me where their pain is in relation to mine. During a 10, I can’t sleep, see food, smell food, or get comfortable I can’t talk more than a sentence, my stomach pain is horrid, the back pain is just as bad, and I’m spending as much as 20 hours a day in the tub. My muscles cramp to the point that my hands gimp up and I have to use my opposite hand to jerk my finger straight. Any muscle can cramp at any time and constantly does. I become beaten down by charlie horses. I begin to lightly hallucinate, I set up stations on couches and beds and next to the tub with gallons of water, barf bowls and blankets. I can’t focus or text, watch tv, or keep track of time. My house plants begin to die and I can barely feed my dog and often don’t. I often ponder when other people would have thrown in the towel and killed themselves. I become highly manic and confused. After it’s over it’s a blur. At a pain level of five I’ll roll around on the floor for hours on rubber balls to push into my sore back (my back feels broken). If I arch my back and hold my breath and squeeze my diaphragm and lungs I pass out. I’ve passed out on my couch and reflexively kicked everything of my coffee table, bong included. Interestingly, this gives a minute of relief until the blood goes back to my brain. At a level three I barf every day or so but it’s mostly back pain that keeps me from working. I maybe take four or five baths a day. I can do short tasks. I take a bite or two of food a day or every other. I can maybe get in four hours sleep. As I type this, I’m at a level two and can watch tv, go to the store and talk on the phone. My level has not been over a five since my hospital visit three years ago. I can’t quench my thirst and my mouth feels like cardboard. My taste buds don’t work well and I shake making typing and touch pads difficult. I recently checked myself for diabetes and I’m ok there. Most of these symptoms are due to dehydration, electrolyte imbalance and potassium deficiency. The epicenter of the problem is about two inches above my naval. It feels like there is a softball sized ball of tension and pain there radiating to both sides but nothing has shown on an x-ray. I threw up today and yesterday and a few days before. I didn’t work today.

    Even stranger things:

    Most of my attacks seem to be during cold times of the year. They seem to happen during dry spells. My feet are very important in all of this. If I step onto a cold floor I’ll start choking and gagging. I bathe so much that I often am drying towels. When I walk out into my cold garage to do so I heave. I have to keep the perfect balance of clothing on to fight these differences in temp. Heavy socks work wonders when it’s cold. Congestion seems to be a problem because of cough/gag reflex. Sinus drainage does the same, as well. Walking into any room with a temp change can cause this. If I dry heave even once or gag and squeeze my gut it is as if something is released into my blood that makes me shake and tremble. My veins disappear in my arms. My jaw completely realigns to where my front teeth start to touch and my molars wont at all making eating, even if I could, very hard and strange. The shift in my skull causes compression around my left ear that makes it feel like there is water in there and reduced hearing. My lower body feels disconnected from the top. I sometimes have cloudiness in my urine which I’m sure is staph. I’ve sat in apartment whirlpools for so long I’ve seen the seasons change before my eyes. I often practice taking hot showers and then switching to ice cold for as long as I can bear. I do this to conserve hot water, to pump blood around my body and to keep from sweating as much. Remember, it’s about keeping my body temp consistent. Sex and female touch speeds up the healing process when I finally can.

    On a positive note:

    It has led me to an extensive look into my body mind and spirit. It has helped shape my career path. I look a decade younger than my mid-forties age (so I’m told). I have never been overweight. After I recover, my senses are superb, especially smell. My ability to think improves dramatically as does my singing voice, artistic side and guitar/music as if something that has locked down opens back up. I’m happier, joyous, talkative and very emotional and thankful to be alive. My anxiety drops and I slow down. I can eat anything and almost never have problems. I feel the way I was designed to feel in my natural state and I feel like I have extra perception. Then, I slowly start going south with constipation and diarrhea alternating.

    Why write this:

    I love cannabis. I think it has wonderful properties and has and will help many people. I do not advocate quitting if it is helping with pain or other problems. I have had great luck with it in the past, even while sick. I think breeding and testing and isolating its chemical properties might be huge in the field of medicine in the future. I am not a disinformation agent. I don’t work for any agency and have been self employed for over twenty years. I am not trying to scare monger. I have nothing to gain anything by writing this but the sharing of information and the thought that it may help someone figure out there own puzzle. If you read the above, you should realize how many things I have tried. This disorder has wrecked my life. I plan to post this on forums and send it to doctors who might figure out what others are going through. That is why this information is so lengthy because I don’t want to write this over and over.

    Dispelling some notions:

    I have only just recently quit. It wasn’t until I bumped into an article like so many other have. I am going to use myself as an experiment. I hope that anybody that is curious can follow along with my progress. As you could probably guess, having known people who smoke TONS more than me and not have problems has led me to believe (in the past) that it could not be a problem. I considered smoke trapped in the stomach as a potential reason. I’m sure I have had some other theories but I can’t think of them right now.

    1.It is not a pesticide problem unless pesticides stay in your body for decades. I’ve smoked the full spectrum of weed but have not had to touch anything with a pesticide for probably 15 years and what I have had was almost all organic. When I was younger we mainly got Mexi stuff that probably did but the amount of cleansing I’ve done should have gotten rid of it by now. I’m sure veggies have the same pesticides.
    2.It’s not exclusive to men. I’ve read plenty of female posts.
    3.It’s a cumulative effect. I, for the last several years, haven’t smoked every day. Probably .5 g (two or three hits before bed if I do).
    4.It has to be a chemical that is stored a long time, maybe filtered by the liver and released when the body starts to detox.
    5.It’s not a choke till you puke situation. I’ve had attacks far removed from actual smoking.
    6.It is a morning sickness but it can be an all day for weeks problem.
    7.It’s not a poor diet problem. I had better luck at times on a bachelors diet than a whole foods diet.
    8.Stress seems to coax it out faster but some terrible attacks have hit me while not being stressed.
    9.You don’t have to smoke tons if you are susceptible to this. I used to but haven’t for years.
    10.Bathing during symptoms is not an OCD. It’s survival.
    11.I could be wrong but I don’t think it’s an allergen as much as a toxin. I’ve known/heard of people who were allergic to it and had instant reactions to it, even in it’s unsmoked state. If it’s not a toxin it still has to be a chemical that shuts down or squeezes the intestines in some people. Maybe the combination of late night binge eating coupled with a tightening of the intestines is too much for some people handle by morning.
    12.I don’t think it is strain specific. I have changed it up enough to figure this one out. It may be a chemical that lesser quantities are produced in some strains.
    13.People that are suffering with this are not kooks. It is very real. I can’t explain the way the other testimonies and case studies have paralleled mine.
    14.People are not the same. If you don’t have a problem but your friend does it shouldn’t come as a surprise. People have lots of reactions to different substances. People have been killed by eating peanuts.

    What am I going to do now:

    STOP!! I’m going to give myself plenty of time to clear my system and find out once and for all. It’s about the only thing I haven’t tried. If it doesn’t work then I guess I’ll shift back to thinking it has to be a Constant Vomiting Syndrome, Crohn’s, IBD or dysentery. I will have to keep looking. If I do have Cannabinoid Hyperemesis then I’ll be cured and be able to help others. I am sure there is someone out there that has been misdiagnosed and suffering longer than me, but I am perhaps the longest case study of anyone who has come foreword on the internet.

    In conclusion:

    I just found out that others have been suffering in a similar way. I used to think I was the only one on the planet until three days ago. I was incredibly shocked. The kicker was hot baths. I guaranty (with no way to prove) that I have thrown up more than anyone you will ever meet. I have had more attacks over the last 25 years than anyone I have read about. I am so thankful to see some hope and to know I’m not alone in this. Please feel free to contact me if you have questions.

  27. countessarcadius on June 13, 2013 at 1:32 am

    I have recently been diagnosed with possible cannabinoid hyperemesis, the ONE thing I have not seen been said in ANY of this, is the fact that, there are some very serious chemicals that marijuana are being filtered with when they are using hydroponics, etc, this has to have something to do with happening to so many people recently, as they are not filtering these chemicals out properly before cutting the marijuana, and THIS is why we are getting sick, WE’RE BEING POISONED, literally,i am sure there is also bioaccumulation of these poisons in our bodies over chronic use of pot, there are many reports of people getting sores in their mouths etc, all different symptoms because of the different people growing it, and how they do it,the only thing I have NEVER done is this compulsive bathing, I HAVE NEVER FELT THE NEED TO EVER TAKE A HOT SHOWER,i keep reading about this shower thing,there would be NO SHOWER that would ever help my symptoms, problem with me is that THERE IS NO POTASSIUM in my body, and it’s not disappearing because of vomiting? for some reason the potassium is slowly being depleted over time, my potassium depletion is NOT from the vomiting, as it’s low before, my potassium at critically low levels, the last two episodes I was give some kind of steroid for the stomach, and WOW THAT REALLY HELPED! as much as I feel like crap, I am not having the episode ONCE THEY PUT THE POTASSIUM BACK, AND GIVE THE STOMACH REMEDY, but I do take over a month to recover, when I say recover I mean,i am only 95lbs.I CAN’T GO 2 DAYS WITHOUT FOOD OR LIQUID, EVEN ONE DAY, within hours of waking like that, I am IN THE EMERGENCY DEPARTMENT, I can’t screw around,
    i think if they could pinpoint what chemicals are being used people could be treated for toxicity or poisoning, my body completely rejecting your muscles, it feels like you’re being electrocuted,sometimes over 18 hours,you cannot control the muscles when there is no potassium, I keep reading how some people feel sick and vomit for 3hrs? yet, I have been 2 days of being DEATHLY ill, EVEN BEING TREATED IN HOSPITAL,WITH FLUIDS, AND POTASSIUM,THEY LOAD ME UP WITH INTERVENOUS POTASSIUM, only to be DEPLETED BY MORNING?EVEN WITH NO MORE VOMITING, the wretching is the WORST, there is nothing really being thrown up, but BILE, sometimes nothing at all, just the wretching, they said I could have a heart attack with the potassium levels being so low, now I go for regular weekly blood tests, to try and keep my potassium levels at bay,i am just starting to do some reading about this,I know everyone is different, I am hoping that THIS IS ALL IT IS, I will completely quit marijuana, I guess I’ll have to wait and see if it happens again without me smoking, with me THERE IS NO STAYING HOME? JUST FEELING SICK? I HAVE TO GO TO THE EMERGENCY, I AM BOUNCING AROUND MY ARMS AND LEGS, THE MUSCLES ARE INSANE, I am not really conscious, but I am? it’s very hard to describe, there is no diarrhea, but I have to admit constipation has been a problem all my life, but I am extremely underweight, which is why I smoke in the first place, to help me have an appetite,this has literally now really started to affect my life, the episodes are happening more frequently, this last two episodes I have gone to emergency, go home after over 24hrs in, only to go right back the next day? FOR MORE POTASSIUM, AND I AM NOT STILL VOMITING? in between episodes I am not sick, I don’t feel ill at all, and there is no warning when the episode will take place, I feel extremely lucky when I hear people spending 35 000 dollars for TREATMENT? surely I would be dead if I had to PAY to get well, we get FREE HEALTHCARE, THANK GOD! I HAVE HAD fluoroscopy, and endoscopy, with biopsies, they found mild inflammation in the stomach, nothing to warrant the severity of the symptoms, I don;’t have heartburn, diarrhea, the shaking, muscle spasms, ETC, I must admit I feel terrible hearing the above comment, when at first, the emergency department thinks you’re a drug addict because of the muscle convulsions, etc, MY HUSBAND HAD TO GET ANGRY AND TELL THEM TO CHECK MY POTASSIUM, TAKE BLOOD WHATEVER YOU HAVE TO, and told them I AM NOT SOME opiate user, or serious drug user, I never EVER denied smoking pot when asked, I DON;T LIE, my potassium level was at 2.1, and they thought I was going to have a heartattack, after it’s over, you remember it like a nightmare, your subliminal mind doesn’t forget, but the conscious does, they had mercy on me and gave me an Ativan during the episode( which didn;’t even help)but once potassium given,stomach remedy,they would give me an Ativan again before I went home,all I wanted to do was sleep, and my body felt like I had been hit bya truck,I don’t have constant pain in my stomach or intestines, ONLY during the episodes,
    reading other people’s experiences I can sure see how similar it all is, and I truly believe that is has EVERYTHING to do with the chemicals being used to grow this stuff, and there is NEVER really a way of knowing unless you know personally what’s going on, and most people do not, I keep hearing propaganda, and I must admit when the doctor started talking about it, I was really just shaking my head, thinking WHAT? but then, when one takes a second to truly sit back and think, then you actually read more comments, and experiences, I think this is what’s happening to all of us, and of course because we’re all different, we all have similar but different experiences, this hot shower thing does puzzle me though? I am going to continue to check this site for more comments, I am actually intrigued, I have been smoking since I was a very young teen, and chronically smoking for over 20years,every single day, LOTS of pot, this has been happening to me for about 4 years, I have had 8 episodes, 2 in the last 3 months, this last one just last week, and it hit me really really hard, I don’t drink alcohol, or any other drugs, I drink tea, no coffee, take care everyone, I was so happy to find this, to feel that I;m not alone, if anyone has any questions please feel free to write here, I will check comments regularly to see any new comments, TAKE CARE EVERYONE, quit smoking, that’s what we have to do,

  28. Zach on October 3, 2013 at 8:12 pm

    Thank you all for the very helpful information. My fiancé possibly has this disorder. She has been diagnosed 1st with Gastroparesis, which is the paralysis of your stomach. But now that we have seen a new GI physician he believes that she is and has been suffering from CHS. My question is, she is trying to quit and she was on day 3 of no cannabis and then the epigastric pain/episode began again. My fist question is; when does the sickness stop after stop smoking? Second question, how do you treat the sickness and pain (mostly pain) while not smoking cannabis? To add due to my fiancé having the diagnosis of Gastroparesis (which she might not even have b/c of CHS) how can she treat the 10/10 abdominal pain? Thank you anyone for your answers which will greatly be appreciated.

  29. Andrea on January 24, 2014 at 3:19 am

    I am 22 years old, female, not a particularly active person but not a lazy person. Student, waitress, 100% normal person. When I was 19 I had my first round of this and was sick for a month straight. Unable to eat/drink/digest medication, had to be hospitalized a few times. I went from 160lbs to 130lbs. At that point, I’d only been smoking cannabis regularly for a few months. I’d tried it a few times and smoked occasionally with friends since I was 16, but it was never routine and I could usually pass a drug test. I was in the most inexplicable pain, what you others have said to be centered in the gut. It feels empty but cold, extremely uncomfortable. I found hot showers/baths could comfort me sometimes, but in my case, they weren’t “necessary” and sometimes even induced more vomiting (I’d assume due to a temperature imbalance). There were sporadic days within this first episode where I began to feel normal and thought I’d gotten over the incident, only to eat a normal meal and vomit everything, undigested as much as eight hours later. The first round of this was accompanied by all the normal tests and junk that everyone else is saying: CT, hidascan (gallbladder), blood tests of every kind, scope, stool samples, etc., all returning normally. The symptoms lessened and I remained symptom-free (practically) for almost 6 months (during the time I was very regularly smoking cannabis, about 1/8th of an ounce per week).

    The second time the symptoms flared up, I was in much more excruciating pain and such violent vomiting that my physician admitted me immediately to a hospital where they did another round of those regular tests I mentioned, except they did a surgeon-ordered something on my hidascan which ultimately showed that my gallbladder wasn’t functioning at all. It was removed, I was discharged from the hospital the next day and remained mostly symptom-free for another round of six months. Still smoking the cannabis at the same rate, possibly a little more here and there.

    Through both of these episodes, during every hospitalization I was given Zofran, Phenergan, and narcotic pain relievers intravenously. All of these medicines seem to work way better when they’re administered through an IV. Even the dissolvable Zofran pills only work sometimes during an episode, and I can’t even take them if they are the solid pill form because my stomach immediately rejects medication during an episode.

    I’ve had less flare-ups in the past year, and I’d contribute that to a few things. First, my life is a lot less stressful than it was when my body first ever attacked me; I was in the middle of an 18 hour semester at school and I was trying to juggle a failing relationship at the same time. I was somewhat overweight. I also hid the fact that I’d started smoking weed from that guy I was dating, which put excess stress on me. Additionally, I battle with anxiety problems (as I’m sure many of you also do). I now have a job with a steady income (although it is a very stressful job), a very supportive relationship, and a more solid relationship with my family (mainly my parents) than I’ve ever had. I’ve smoked weed through all of this shit because I was under the impression that it made my poor, trembling stomach feel even a little more at ease. While I’m having an attack, weed doesn’t always “magically” make me feel better, but it usually does at least make me want to try and eat, and think less about the possibility of being sick again tomorrow. It doesn’t always make me feel better–sometimes it seems like it does nothing for my stomach–so I’m not sure if that says anything.

    In fact, within the last year, I’ve only had two major flare-ups of this. The first in August 2013 was when I moved into my own place for the first time, and I wouldn’t say I was stressed at all. I was more excited than I’d ever been in my life, which made no sense (after all this time every doctor always said stress was the trigger for my attacks). It lasted 4 days and I did have to be taken to the ER for fluids. The most recent time, I just got over (as in three days ago I stopped throwing up). It lasted a week (longer than they have lasted since my gallbladder was removed), same symptoms and everything. No ER, but an urgent care clinic visit set me up with an IV and I felt better almost right away.

    I’m not exactly sure why or if all of these specific things even matter to my case, but at this point, I cannot lose any more weight and I really must do whatever possible to prevent these flare-ups from now on. I’m not totally convinced that quitting smoking will do it for me because my brain wants to assume my body will continue the pattern of episodes, but if it is what will stop them from occurring, I am willing to quit. I fucking love smoking weed. It’s made me feel better so many thousands of times, and I’m really sad that I have to take a trial period away from it to see if it’s the culprit. If it is, I’m extremely glad to know it’s something as simple as not smoking to keep me from feeling so terribly. If it isn’t, then I’ll be pretty disappointed, because almost every other disease/syndrome that shares symptoms with CHS is way more difficult to treat, if it’s treatable at all.

    I don’t even know if this is a current thread. I hope all of you the very best in your endeavors and struggles with whatever GI problem you all may have. I feel very connected to all of the testimonies shared here because we all share that common train of thought: “why the fuck is this only happening to me?”At least, in this, we are not alone.

  30. Derek on March 8, 2014 at 1:22 pm

    I’ve also recently been diagnosed with cannabinoid hyperemesis. A lot of people don’t believe it exists and think it’s some sort of made up syndrome, but I can tell you it is very real. I suffered from all these symptoms for the last 7 years and was in and out of several hospitals for everything from pancreatitis to severe dehydration. I started smoking marijuana at age 18 and smoked until I was 27 (my current age). The hot showers were the only thing that would take the horrible sick feeling away and it’s hard to explain how awful you feel when the sickness hits in the morning. I was sleeping maybe 3-4 hours a night, lost 25lbs and my kidneys were in horrible shape because I couldn’t keep liquid down and was constantly in the hospital for dehydration. The doctors took out my gallbladder and appendix thinking that was the cause, and I still was waking up with horrible nauseau and abdominal pain. They then diagnosed me with Cyclic Vomitting Syndrome which is so close to Cannabinoid Hyperemisis that it is hard to tell the two apart. I was told there was no cure for that and I would just have to put up with being sick.. My health was deteoriating and during my last hospital stay a young doctor brought up Cannabinoid Hyperemisis and said “Lay off the Pot”. Like a lot of other people I thought he was crazy and thought to myself “doesn’t marijuana help nauseau”? All this time up until that point I was smoking to try and get rid of the nauseau because I thought it would help it and give me the munchies so I could try to gain weight back. I decided to stop smoking and after about 2 weeks I was not waking up sick and I was at the doctors last week and am up to 175 lbs (my original weight). I gained over 20 lbs just in 2 1/2 months and I cannot believe how much better I feel. I’ve never felt healthier, don’t wake up sick, am getting sleep, and am back to my old self. I’m not saying marijuana is a devil drug or anything, it’s just for some reason my body couldn’t handle it. Marijuana isn’t addicting like alcohol, cigarettes, or other hard drugs. I was able to stop smoking right away with no signs of withdrawl or any urges to smoke or anything. It’s just amazing that I could have saved all that money on hospital bills, surgeries, water/electric bills from all the hot showers I needed to take, and all the other expenses just by not smoking weed. I’d still have my gallbladder and appendix too, so I just wanted to type this little message to let everyone know it is legitimate and does unfortunately exist. Like I said, most people can smoke and be fine, but for some odd reason there is a select population of people who it makes deathly sick after chronic use. Hopefully someone who has these symptoms will come across this page and it will save them the time, money, and life by being able to diagnose what is wrong with them because it is a really unknown syndrome to a lot of people and doctors. I was missing work, lost my girlfriend because she was sick of me being sick, and lost 7 years of the best years of my life to this and it sucks, but I’m so glad to finally know what was causing it and to be feeling 1,000,000 x’s better than I was. If you experience these symptoms, smoke a lot of pot, or can relate to anything I wrote, you probably are suffering from Cannabinoid Hyperemisis and luckily all you have to do is quit smoking weed to feel better!

  31. Derek on March 8, 2014 at 1:42 pm

    Andrea,

    It sounds like you definitely might be suffering from CH. I think you will notice stopping smoking will help. I was also prescribed Zofran and Phenergan and can relate to it mostly helping only in the ER when it was through IV’s. I think if you stopped smoking you will feel so much better and get back to your normal weight. Don’t worry about ‘feeling fat’ or your image or what the hell else people say, your health is most important. You will feel so much more productive if you don’t already (since you wrote it in January). and once you realize how good you feel it makes you want to live your life to the fullest after feeling deathly sick and like a zombie for so long. I loved smoking weed too and smoked ‘all day errr-day’ it was fun, relaxing, and made my me feel very open minded and my imagination ran wild. I had some fun times smoking but trust me once you stop and feel better you won’t want to smoke just by knowing how sick you felt before. From what my doctor said if you stop for a few months it might not make you sick by smoking maybe once or twice a year on special occasions, but it’s up to you if you want to risk that. I stopped for 4 months and did smoke once the other week (when I was drunk), I didn’t wake up sick or anything (just hungover), but I don’t even want to risk it and regret smoking that night. It really sucked the first week not smoking but once your body is clean you feel so much better and look back and realize you could have avoided a lot of bad times if you just didn’t smoke. I really hope it’s only Cannabinoid Hyperemsis and I promise if it is you’ll feel so much better by just not smoking. Like I said, I love mary-jane just as much as you, but unfortunately our bodies can’t handle it, but luckily there is an easy cure. I was depressed from all the stress, friends passing away, and other shit in my life so maybe you are also suffering from depression and used marijuana as a crutch like I did to forget about all your problems and to just to feel better. If you were having relationship, image, and other stressful problems, then you might want to go see a psychiatrist. Don’t feel crazy by doing it, so many people go see them and you’d be surprised at the people you see in the waiting room. It’s normal professionals who just either have a lot of stress or had some bad things happen in their life. I always thought bad things about anti-depressants and medication like that, and still do about a few of them, but I was prescribed to Effexor and it has me thinking so positively and you feel like your old self. Maybe you don’t need any medication at all and that’d be awesome, but we seem to share a lot of very common similarities and symptoms so it might be worth looking into. Just know you aren’t alone and I really hope stopping smoking improved your health and life!!

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