Cannabis Hyperemesis Syndrome Explanations

The cannabinoid hyperemesis syndrome is a result of years of high cannabis use and manifests itself in months of vomiting with nausea and abdominal pain. The active ingredient THC seems to be responsible for the syndrome, but the exact pathomechanism remains unclear. In the therapy, the emergency administration of infusions is in the foreground.

What is cannabis hyperemesis syndrome?

Cannabis hyperemesis syndrome is a disorder that corresponds to a paradoxical reaction after years of heavy cannabis use. Cannabis is a genus within the hemp family and is one of the oldest useful plants. Hemp is used as a fiber and oil dispenser.

In the form of hashish and marijuana, cannabis is also used as an intoxicant and medicinal product. Marijuana is obtained from the dried, crushed resin flower clusters and the small leaves of female cannabis plants close to the flower. Hashish, on the other hand, corresponds to the extracted resin of the plant.

In Germany, cannabis is considered to be the most widely consumed illegal drug. The intoxicating effect is due to the psychoactive cannabinoid THC. This substance shows the influence of THC on the central nervous system, has a central nervous depressant effect and thus has a relaxing and slightly sedating effect on the consumer.

Although cannabis is already used as a remedy in Germany under certain circumstances, the plant with its psychoactive ingredients can also show highly pathological effects under certain conditions. It is relatively unclear how many people in Germany have already developed cannabis hyperemesis syndrome. Presumably there is a high number of unreported cases.


Cannabis hyperemesis syndrome is preceded by cannabis use. In most cases the syndrome only occurs with really high consumption that has been carried out for several years. Often times, patients report having smoked between three and up to five joints a day on a regular basis. Some sufferers report even higher consumption.

The exact pathomechanism of cannabis hyperemesis syndrome is so far unknown. Habitually high doses of THC are believed to be the cause of the patient’s symptoms. The mechanism of action of THC has not yet been clarified. At least biochemistry now agrees on the effect on two different types of receptors.

The receptors CB1 and CB2 are located in the central nervous system and in the immune cells. C1 modulates the release of neurotransmitters in the nervous system. On the other hand, CB2 receptors regulate the release of cytokines. THC presumably binds to the CB1 receptors, where it affects signal transmission. Little is known about the role of the CB2 receptor. Cannabis hyperemesis syndrome, for example, could be related to the long-term effects of THC on the C2 receptors.

Symptoms, ailments & signs

Patients with cannabis hyperemesis syndrome go through cyclical phases, each characterized by different conditions. In the first phase, patients experience nausea and vomiting. In addition, concomitant symptoms in this phase are often abdominal pain. The first phase is characteristically followed by two further phases.

The first phase is also called the prodromal phase and can last extremely long. In some patients, the prodromal phase comes to an end after a few months. Others suffer from mild pain and morning vomiting for years. The second phase of the syndrome is relapsing and is also known as the hyperemetic phase. This phase is far less long than the first phase.

For 24 to 48 hours, the patients suffer from increased nausea and vomit up to five times an hour. Due to the high fluid and nutrient losses, dehydration or weight loss often occurs. These symptoms are associated with mild pain in the abdominal area. In the last phase the symptoms subside.

Diagnosis & course

The diagnosis of cannabis hyperemesis syndrome can only be made on the basis of the anamnesis. This can lead to problems, as many patients do not want to admit the consumption. Since many other diseases of the gastrointestinal tract have to be considered in the differential diagnosis, the doctor is sometimes lured on the wrong track.

The prognosis for patients with cannabis hyperemesis syndrome is relatively favorable. The improvement may take a long time, but the symptoms will at least eventually subside.

When should you go to the doctor?

Cannabis hyperemesis syndrome is a common withdrawal symptom, but it can lead to various complications and complaints. For this reason, a doctor should definitely be consulted if cannabis is discontinued after a long period of use and the person concerned goes through withdrawal.

A doctor should always be consulted, especially in the case of withdrawal without medical observation. The doctor should be consulted if the cannabis hyperemesis syndrome causes vomiting and persistent nausea in the patient.

Severe abdominal pain can also indicate the syndrome and should be examined. Furthermore, weight loss and nutrient deficiencies are also possible. These complaints must also be examined by a doctor. Furthermore, a doctor should be consulted if severe psychological complaints or depression occur. A visit to a psychologist is advisable. The syndrome itself can usually be diagnosed and treated by a general practitioner. However, it is advisable to go to a clinic for drug withdrawal.


Due to the cannabis hyperemesis syndrome, various complaints can arise, which primarily depend on the level of cannabis consumption by the patient and the duration of use. Most of the time, however, there is severe vomiting and associated nausea. The symptoms occur permanently and can put a heavy strain on the everyday life of the person affected and reduce the quality of life.

Sudden pain can also occur in different areas of the body. Due to the constant vomiting, patients experience a loss of fluids and nutrients, which negatively affects their weight. Underweight is a very unhealthy condition for a patient and should definitely be avoided. As a rule, only the symptoms are treated, as a causal treatment of cannabis hyperemesis syndrome is not possible.

The patient is given infusions to counteract the loss of fluids and nutrients. Likewise, the person concerned must withdraw from the drug or stop taking it for a long period of time. In most cases, the disease progresses positively and there are no further complications.

Treatment & Therapy

The treatment of cannabis hyperemesis syndrome is rather difficult because the pathomechanism is so far unknown. This means that the therapy cannot address the actual cause, but is purely symptomatic. The focus is on avoiding dehydration and high weight loss.

If necessary, in acute conditions, patients are given intravenous fusions that bypass the gastrointestinal tract. Interestingly, many patients with cannabis hyperemesis syndrome report the soothing effects that a hot bath or shower can have on their symptoms. Therefore, this procedure is recommended by a doctor in the acute phase.

However, the water should not be too hot to avoid scalding. In the hyperemetic phase, patients are given antiemetics. This conservative drug therapy directed against the nausea and want to vomit suppress. No other therapy steps are available.

In principle, patients are advised to abstain completely in order not to further burden the detoxification organs and to exclude a recurrence of the disease. As a rule, those affected regain their subjective well-being during the recovery phase.

Outlook & forecast

Since very little is known about the cannabis hyperemesis syndrome in medicine, usually only symptomatic treatment can take place to alleviate the symptoms. A causal treatment is not possible. However, the symptoms can be completely alleviated if the person concerned goes through withdrawal or otherwise stops using cannabis.

The treatment itself takes place with the help of medication and infusions to supply the body with important nutrients. If withdrawal is successful, the symptoms of cannabis hyperemesis syndrome no longer occur in most cases. However, no prediction can be made about the duration of the withdrawal, as this depends very much on the patient’s condition.

The symptoms of the syndrome can vary in severity, although the severity also depends on the duration of consumption. The longer the consumption, the more difficult it is often to withdraw. If the cannabis hyperemesis syndrome only occurs after a very protracted use of cannabis, the symptoms can possibly also be alleviated by reducing the amount consumed.


Cannabis hyperemesis syndrome can be prevented by abstaining from cannabis. Since the syndrome can only be expected with extremely high consumption and years of consumer behavior, absolute abstinence is not necessary to avoid it. Moderate use of cannabis can also prevent the syndrome.


The follow-up situation for the still relatively unexplored cannabis hyperemesis syndrome is not particularly good. Withdrawal alone often only helps in the medium term, as the symptoms of long-term cannabis use cannot be fully resolved until three months later. Many sufferers view hot baths as a reliever during the acute phase of vomiting, stomach pain, and inability to eat.

After a successful cannabis withdrawal, it depends very much on the amount and quality of the cannabis consumed over the years whether the patient will be permanently symptom-free or not. Differentiating the present symptoms from other illnesses or cyclical vomiting is also problematic. Therefore, in individual cases it can take several years before the problems described are even recognized as cannabis hyperemesis syndrome.

The ignorance among the orthodox doctors is still great. Without knowledge of the chronic cannabis consumption of his patient, the attending physician hardly has a chance to find the correct diagnosis, a suitable form of therapy or follow-up measures. Follow-up care for the regularly occurring cannabis hyperemesis syndrome only makes sense if the consumer refrains from using cannabis in the future.

It is also difficult that medical professionals do not yet know what causes cannabis hyperemesis syndrome. If you are dealing with symptoms of poisoning from neem oil, which is often used as an organic pesticide by cannabis growers, follow-up care should be different from other causes.

You can do that yourself

The cannabis hyperemesis syndrome is preceded by years of regular and very high cannabis use. People who regularly consume the drug should therefore consider starting therapy early on, also with a view to possible long-term effects.

Professional help is required at the latest when the first symptoms of addiction appear. There are free state drug advice centers in every state. There are also offers of help from the churches and secular charitable associations. Those affected can also find help and information on the Internet.

If cannabis hyperemesis syndrome is suspected, the attending physician must be informed about the consumption. Doctors in Germany are subject to strict confidentiality. Even if criminal offenses have occurred in connection with cannabis use, the doctor is obliged to remain silent and may not inform the police or the public prosecutor’s office or testify against a patient in the course of an investigation. The patient files are also taboo. So there is no reason to hide the substance abuse from the attending physician.

The therapy of cannabis hyperemesis syndrome is best supported by the patient himself by completely stopping the further use of the drug. Therapy is usually required for this. The attending physician, drug counseling center or health insurance company will provide information on such offers. If the patient belongs to a milieu in which cannabis use is considered normal, he should take steps to break away from these circles. For this, the help of therapists and social workers can be called upon.

Cannabis Hyperemesis Syndrome