Cannabinoid Hyperemesis Syndrome

Urgent first

NIDA says cannabinoid hyperemesis syndrome (CHS) can recur and often requires medical attention. [1] If vomiting is repeated and severe, or you are unsure what is happening, get medical care. In the US, NIDA says to call 911 or visit an emergency department for urgent needs. [1] Reviews describe CHS in adolescents as well as adults. [2] Telling the clinician about cannabis use is part of how CHS is recognized.

How to read this page

This is education, not medical advice. It describes what research found and does not recommend any self-treatment. Evidence labels: established, promising but limited, mixed, insufficient evidence. Most treatment studies on CHS are small, observational or case reports.

What CHS is

NIDA describes CHS as nausea, vomiting and abdominal pain after long-term, heavy cannabis use. [1] A 2017 systematic review of 183 articles called it a cyclic vomiting syndrome associated with cannabis use, and found that its mechanism is unclear. [3] The word "scromiting" is an informal term; it does not appear in the clinical sources read here.

NIDA notes that cannabis use may help manage nausea or vomiting from chemotherapy. [1] CHS is the opposite problem: in some long-term heavy users cannabis appears linked with severe repeated vomiting. NCCIH describes recurrent severe vomiting in some long-term users of high doses. [4] The reason is not known.

How it is recognized

In the 2017 review, the most frequent features across published cases were: regular cannabis use (100%), cyclic nausea and vomiting (100%), resolution after stopping cannabis (96.8%), compulsive hot baths with symptom relief (92.3%), abdominal pain (85.1%), male predominance (72.9%) and at least weekly use (97.4%). [3] These are descriptions of published cases, not a test. A 2022 review reports that the Rome IV diagnostic criteria require cannabinoid use and nausea and vomiting symptoms persisting for at least the past 6 months, and that symptom onset has followed cannabis use of 6 months to 11 years. [5] Diagnosis is made by a clinician after other causes are considered.

NIDA says people sometimes try to relieve CHS temporarily with hot showers or baths, but CHS resolves only when a person stops using cannabis completely. [1] Hot-water relief is an observation about patients, not a treatment recommendation.

What research says about treatment

• Stopping cannabis. The 2017 review concluded that cannabis cessation appears to be the best treatment. [3] A 2021 review of adolescent cases found complete cessation of cannabis use is currently the only known effective treatment. [2] Label: best-supported option, based on case reports and observational data.
• Hospital supportive care. In the acute setting, supportive care with intravenous fluids, dopamine-blocking medicines and topical capsaicin cream, and avoiding narcotic medicines, has shown some benefit. [3]
• Capsaicin and dopamine blockers in the emergency department. A 2024 systematic review of 7 studies (492 patients) found mixed evidence that capsaicin cream reduces nausea and vomiting, and that dopamine antagonists (haloperidol, droperidol) were potentially beneficial. It called the evidence limited because the studies were few, small, not standardized and at risk of bias. [6] Label: mixed to insufficient evidence.
• Common nausea medicines. A review of 63 published cases reported that capsaicin cream, antipsychotics and benzodiazepines improved CHS more effectively than usual anti-vomiting medicines such as promethazine, ondansetron and metoclopramide. The authors noted this rests on case reports. [7]

These are descriptions of what hospital teams have tried. Decisions belong to the treating clinician. Nothing here is advice to use a medicine or cream at home.

Who may be affected

CHS has been described in adults, and in adolescents; the earliest reported adolescent case was age 15, and 21% of adolescent cases in one review had a history of anxiety and depression. [2] How common CHS is among people who use cannabis was not established in the sources read.

Related

Other possible digestive effects are listed by NIDA, including acid reflux, pancreatitis and peptic ulcer disease. [1] For other harms see cannabis adverse effects and use disorder, dependence and withdrawal and when to seek urgent help after cannabis. For cannabinoid medicines used for chemotherapy nausea, see cannabinoids for chemotherapy-related nausea and vomiting.