Cannabis Hyperemesis Syndrome (CHS) is one of the subjects most likely to start a lively discussion in the cannabis community. The condition is thought to induce several cycles of vomiting, abdominal pain, dehydration and other adverse symptoms. 

While CHS has its share of support, some in the cannabis and medical communities disagree with the current narrative. Depending on who you ask, the syndrome could either be a legitimate medical condition, an over-reported occurrence, a misdiagnosis, or a hoax. 

With a slight uptick in research as of late, CHS may soon be on its way to being better understood. However, additional research is required to further understand CHS, or whatever it is that is causing people pain. Until then, a spirited debate continues among many.

Seeing CHS as a Valid Medical Condition

Those that endorse the validity of CHS often discuss the pain associated with the syndrome. The abdominal pain is reported to be immense and cyclical. Holding down food or liquids becomes a near-insurmountable task. In most cases, these symptoms are reported to last days or much longer. 

Little is reported to provide relief from CHS symptoms. Some claim capsaicin is effective. However, studies and patient feedback suggest hot showers or baths are the best remedies, though temporary. The cycle of symptoms is said to be halted only after cutting cannabis entirely out of one’s life. Some CHS patients have reported returning to consuming cannabis after a break. In contrast, others describe an inability to consume without their symptoms returning.

CHS proponents typically cite a 2004 study as its introduction to the public. The study provided a limited subject pool, focusing on 19 South Australia patients across numerous hospitals in 2001. The examination concluded that several years of ongoing consumption were required to trigger CHS. Of the patients evaluated, six returned to cannabis either right away or after an undetermined amount of time, with each experiencing similar symptoms once again. 

In the years since, additional studies have supported the claims made in 2004. However, in most cases, investigations are of limited subjects, or at one location over some time. While unable to provide conclusive findings themselves, these studies do provide glimpses into the possible reality of the condition. However, additional studies are required to verify any results. Like most subjects in cannabis lacking concrete lab research, anecdotal evidence from doctors has helped fill the void to a degree. While helpful in cases, self-reported evidence can only go so far in providing answers. 

Jessica Walters, the chief medical researcher for CannaMD, called the pathophysiology of CHS “poorly understood” at this time. Walters supports cannabis use as a medical option while acknowledges that it produces adverse effects in some. In that case, patients are typically recommended to abstain from consuming for at least seven to 10 days to find symptom relief, according to the medical researcher. 

The most notable CHS advocate and patient currently in the cannabis community is likely Alice Moon. A former edibles reviewer, Moon was diagnosed with ongoing symptoms for two years. She told High Times that doctors initially believed it was acid reflux, leading to her to quit drinking. With the symptoms persisting, a litany of tests would follow. Eventually, her doctor diagnosed Moon with CHS. “Everything showed up normal,” said the CHS advocate. “So, it was a process of elimination.” Eventually, she said, the doctor came back with a diagnosis, “Cannabis was making me sick.”

Moon has garnered a fair share of support in the cannabis community. That said, others continue its validity as a condition. 

Questioning and Denying CHS

While CHS has gained prominence in circles, skepticism and doubt remain. 

Doubts remain over the classification of CHS. In one case, Boston primary care physician Peter Grinspoon, MD expressed concerns regarding the condition’s similarity to cyclical vomiting syndrome (CVS). Other possibilities for the cause of the symptoms the doctor mentioned included an unknown source for the vomiting, namely a non-cannabis substance.

Of the notable non-medical professional names questioning the frequency of CHS is activist and Harborside founder Steve DeAngelo. In June 2019, DeAngelo voiced concerns over the syndrome, saying its occurrence was quite rare if it existed at all. In the months since DeAngelo spoke with Moon after the two clashed several times on social media. After speaking, DeAngelo would then say the condition did exist but noted its rarity. 

Those supporting a misdiagnosis have pointed towards a chemical found in the pesticide neem oil as a possible culprit. This theory suggests that the poison azadirachtin, a compound in neem oil, creates CHS-like symptoms, triggering a misdiagnosis. This occurs as some believe that the pest and mildew remover remains on particular strains of flower, causing consumers to become severely ill when consumed. 

CannaMD’s Walters noted that incidences of CHS are on the rise. While this could be attributed to previously undefined cases, the impact, if any, of neem oil deserves further research. Walters stated that “the suggestion that chemicals, involved with new cultivation methods and mass production of the plant, may play a part warrants further review.”

Others, like cannabis entrepreneur and activist Kyle Turley, say CHS is not a concern at all, because, according to him, it isn’t real. Recently, Turley tweeted, “CHS is a mythical condition that affects those who have yet to discover their strains and use CBD daily.” The month before, the CBD advocate tweeted, “CHS is a myth created by those against understanding the cannabinoid system, all day every day!” Like DeAngelo, Turley and Moon have tangled online over CHS and statements both have made. 

With numerous perspectives, the discussion around CHS, its validity and frequency are likely to be ongoing until additional research provides the community with clarity. Aside from maybe those subscribing to the myth theory, most agree that patients have some condition better worth understanding. Be it CHS, CVS, neem oil or another thing altogether, people deserve clarity and accurate diagnoses. 

With hope, further research from larger subject pools will help provide certainty one way or another.

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