Cannabinoid Hyperemesis Syndrome (CHS) in the Context of Eating Disorders
Nausea and vomiting are common symptoms in patients with eating disorders. However, these symptoms can also indicate cannabinoid hyperemesis syndrome (CHS), a condition that is increasingly relevant as cannabis use becomes more prevalent due to legalization and rising THC concentrations. Given that individuals with eating disorders are significantly more likely than the general population to also struggle with substance use disorders, recognizing and differentiating CHS is crucial for effective treatment.
The Importance of Screening for CHS in Eating Disorder Treatment
CHS shares symptomatic overlap with eating disorders, including cyclical episodes of severe nausea and vomiting. This can complicate treatment, as misdiagnosing CHS may lead to ineffective care strategies. Clinicians treating eating disorders should be knowledgeable about CHS and incorporate screening to ensure targeted, appropriate interventions.
Key Characteristics of Cannabinoid Hyperemesis Syndrome
CHS typically presents with:
A history of cannabis use, often spanning several years before symptoms emerge.
Cyclical episodes of severe nausea and vomiting, recurring every few weeks or months during ongoing cannabis use.
Symptom relief following cannabis cessation, confirmed by a negative urine drug screen.
Hot baths or showers alleviating symptoms, a nearly pathognomonic feature of CHS that aids diagnosis.
Challenges
Diagnosing CHS is frequently delayed, with patients often waiting 1–2 years for an accurate clinical diagnosis. This is partly due to the lack of formal diagnostic criteria and partly because many patients are resistant to the idea that cannabis use could be causing their symptoms. This resistance can make adherence to treatment recommendations challenging.
Treatment Approaches
Patients with CHS are at high risk for dehydration and electrolyte imbalances, and common antiemetic medications like ondansetron are typically ineffective. The only definitive treatment for CHS is complete cessation of cannabis use. In my experience, achieving full symptom resolution often requires over a month of abstinence to allow the body to clear THC fully.
