Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Aug 25;17(8):e90961.
doi: 10.7759/cureus.90961. eCollection 2025 Aug.

Unraveling the Enigma of Cannabinoid Hyperemesis Syndrome: A Narrative Review of Diagnosis and Management

Shemyia A Smith  1 , Mayar A Safwat  1 , Brian J Piper  1   2 , Maame A Addison  1
Affiliations
Review

Unraveling the Enigma of Cannabinoid Hyperemesis Syndrome: A Narrative Review of Diagnosis and Management

Shemyia A Smith et al. Cureus. .

Abstract

Cannabinoid hyperemesis syndrome (CHS) is a serious condition primarily seen in chronic cannabis users, characterized by persistent cycles of severe nausea and vomiting, often leading to frequent emergency room visits. Accurate diagnosis is crucial due to the overlap with other gastrointestinal disorders. The traditional use of antiemetics such as ondansetron often fails to alleviate symptoms, making CHS difficult to manage. More effective treatments, such as haloperidol and topical capsaicin, have shown promise in reducing symptoms. Comprehensive management, including cannabis cessation, is essential. This narrative review explores current and emerging treatments for CHS, emphasizing the need for tailored therapeutic strategies and further research to improve patient outcomes. Pressing research needs include being able to predict who will develop CHS and optimizing interventions to reach those who are resistant to stopping cannabis use. As a narrative review, this study does not include statistical summary methods but emphasizes current knowledge and gaps to inform future studies.

Keywords: cannabis marijuana; droperidol; emergency medicine; haloperidol; ondansetron; topical capsaicin.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Brian J. Piper declare(s) a grant from Geisinger Academic Clinical Research Center. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Phases of cannabinoid hyperemesis syndrome with associated clinical findings.
Original image created by the authors using data from sources [23,27].
Figure 2
Figure 2. Effects of THC on different regions of the brain.
Original image created by authors using data from sources [18,32,34-42]. THC: tetrahydrocannabinol
Figure 3
Figure 3. Treatments and home remedies used for cannabis hyperemesis syndrome, including manipulating temperature (red), over the counter drugs (black), medicines (blue), foods (green), and alternative medicines (yellow), based on Reddit posts (N = 69) with at least 30 upvotes.
Original image created by the authors using data from source [68]. PPI: proton pump inhibitors
Figure 4
Figure 4. The four different phases of CWS.
Original image created by the authors using data from source [68]. CWS: cannabis withdrawal syndrome
Figure 5
Figure 5. Overview of CBT.
Original image created by the authors using data from authors and source [71]. CBT: cognitive behavioral therapy
See this image and copyright information in PMC

References

    1. United Nations Office on Drugs and Crime. World Drug Report 2021. Vienna: United Nations; 2022. World Drug Report 2021 booklet 3; pp. 11–56.
    1. Marijuana use and use disorders in adults in the USA, 2002-14: analysis of annual cross-sectional surveys. Compton WM, Han B, Jones CM, Blanco C, Hughes A. Lancet Psychiatry. 2016;3:954–964. - PubMed
    1. Changes in self-reported cannabis use in the United States from 1979 to 2022. Caulkins JP. Addiction. 2024;119:1648–1652. - PubMed
    1. Examining the influence of rurality on frequency of cannabis use and severity of consequences as moderated by age and gender. Schell C, Godinho A, Cunningham JA. Addict Behav. 2022;133:107385. - PubMed
    1. Trends in cannabis use disorders among racial/ethnic population groups in the United States. Wu LT, Zhu H, Swartz MS. Drug Alcohol Depend. 2016;165:181–190. - PMC - PubMed

LinkOut - more resources