Cannabis 101 // April 8, 2021 // Darina

Living with Cannabinoid Hyperemesis Syndrome, or CHS

Living with Cannabinoid Hyperemesis Syndrome, or CHS
Living with CHS is a scary prospect for any stoner. Here's how one man learned to balance life, work and weed. According to the Cedars Sinai Hospital,Cannabinoid hyperemesis syndrome (CHS) is a condition that leads to repeated and severe bouts of vomiting. It is rare and only occurs in daily long-term users of marijuana.” Sounds like a true stoner’s nightmare, right? Only a very small percentage of long-term marijuana users develop CHS, but no studies have been able to demonstrate why.  What we do know is that there are molecules in your digestive tract that bind to the THC in marijuana (this is what causes the munchies). And, for reasons that are still not completely understood, long-term marijuana use can alter the way these molecules function, leading to the onslaught of the symptoms of CHS.  In the brain, marijuana tends to have the total opposite effects of CHS, which is why many people use the herb to prevent nausea and vomiting. The generally soothing effects of marijuana are flipped upside down with the onset of CHS. It’s like the anti-high: whereas everything is amazing on weed, everything turns awful when weed triggers a CHS episode. 

Living with CHS

I sat down to speak with Pat “Drastik,” a 39-year-old DJ from Canada, about living and coping with CHS. It all started in 2011, back when Pat and I were roommates in Ottawa. One night after we had gone out he became really, really sick. At first we thought it was just a nasty hangover. I remember me and our other two roommates going into the bathroom to bring him water and checking on him, but then it rolled over into a second day, and a third. Ultimately, Pat was sick for a whole week, something that a doctor at the time diagnosed as the stomach flu. He was given anti-nausea meds and that was the end of that, at least for a couple of years.  Around 2013, the big extract trend hit Canada and Pat started smoking shatter and vaping. It was around this time that his symptoms happened again. But because so much time had passed since the first bout, it didn’t even occur to him that it could have been triggered by weed. And this time there hadn’t been any partying, so he was acutely aware that this wasn’t just any old stomach bug.

A Mysterious Illness

Even though puking is never fun for anyone, there’s usually a sense of relief after we are able to empty our stomachs of whatever is ailing us. But this wasn’t like that. This was throwing up, still feeling awful, still needing to vomit — for three days straight. Pat wasn’t able to hold down any food or water, which only exacerbated the hopelessness of the situation.  This happened sporadically over the next few months, never seemingly triggered by the same thing. At this point Pat had just accepted that he had an overly sensitive stomach, and that he was just going to have to live with these random spells of misery. During one particularly bad episode, a doctor made a house visit while Pat was laid up. They prescribed chemotherapy-level anti-nauseants, which did absolutely nothing “It was like having a mint,” says Pat. He knew something was wrong — he just didn’t know what. Later that same year, Pat and Tom, the other half of their DJ duo THUGLI, were set to go on a west coast tour, with gigs scheduled from Vancouver all the way down to LA. They had just boarded the airplane, and Pat felt that all-too familiar feeling creeping in. He told Tom that he had to get off the plane, even if it meant that Tom would have to play the tour dates alone. He knew that if he stayed on that plane he’d spend the whole time in the bathroom, and that probably miss most of the tour dates anyway, puking in strange hotel rooms. Pat got off the plane, and just as he had suspected, he spent 4 days being violently ill to the point where he had to be placed on an IV drip. When Tom came back to Toronto, he spoke to his girlfriend about Pat’s mysterious condition. As it turned out, she had a friend who had been going through the same thing and had recently been diagnosed with CHS.

Seeking Relief from CHS

Pat began to investigate, and the more he read into it, the more his symptoms seemed to align with CHS. He came across a Facebook group, which was a support group of sorts. It was full of people who had CHS of varying severity — some got it every time they smoked, while others, like Pat, had no idea when it was going to hit and could go months, even years, without an episode. It was a relief to finally be able to put a name to his personal hell. Through visits with doctors, Pat has learned that the symptoms are different for everyone. Pat knows how to hone in on the warning signals. He usually has pretty low energy in the days leading up to an episode, and he knows that if he wakes up with gut rot and feeling sluggish, it’s time to slow things down and take a break from marijuana. When discussing the symptoms, he stresses that has never felt anything like this. The non-stop physical sickness is accompanied by a delirium of sorts. As he puts it, “Since the vomiting and feeling the need to vomit are pretty relentless, there are zero moments of relief. Your brain starts playing tricks on you. You’re naked most of the time. You’re in complete fucking disarray. You’re sleep deprived. You pass out a while out of sheer exhaustion but it’s extremely hard to sleep for more than an hour a time. And when you wake up, you actually feel worse. You’re confused and then you puke up again.” Just like many others in the Facebook group, Pat found that his only relief when his CHS was flaring up came in the form of long, hot showers and baths. This eases the nausea, and provides temporary relief from the constant vomiting. The theory is that hot temperatures affect a part of the brain called the hypothalamus, which is responsible for both temperature regulation and vomiting.  Alternately, Pat would fill up jugs with cold water and pour them over his head just to feel something other than the constant onslaught of nausea. It sucked, but at least it was a different kind of agony, providing momentary relief from days on end of feeling sick.

Managing Cannabis Consumption

Although he knows that the only way to fully eradicate the symptoms is to give up weed completely, Pat still smokes — just a lot more carefully. He sticks to light sativas, and smokes far less than he used to, usually just when making music (which happens to be almost daily). He’s more than aware that he’s susceptible to another episode flaring up, and he’s still gambling with the possibility of spending days being very ill. But years of trial and error, feeling out his symptoms, and living a healthier lifestyle than he used to all makes a huge difference. It gives Pat the confidence he needs to be able to balance his love for that sweet herb with maintaining a clean bill of health.  And it seems to be working — his last episode was two years ago. Now when he wakes up and feels the symptoms coming on, he makes a point of drinking tons of water and cutting the smoking out for a few weeks He admits that it’s harder to get into the zone for work when he’s not smoking. As for many of us, smoking weed is a bit of a creative crutch for him, and it also helps soothe his anxiety. And as I’m sure many stoners out there can relate, the vivid dreams and nightmares when he’s off the weed can be super annoying. But overall, he’s really happy to take a break if it means he won’t be curled up in the shower for days on end.  The medical literature on CHS only goes back about 10 years, so hopefully as more people are diagnosed with this illness, and it gains visibility, we will be able to better understand this very rare disease and — just like Pat — learn how best to manage it.

Do you think you might have CHS?

It’s tricky to diagnose CHS, since there are myriad possible causes for repeated vomiting. Usually the procedure would be to eliminate some of these other possibilities by testing for things like anemia, pregnancy and infections, and doing scans of certain parts of the body to rule out any physical causes. And since CHS was only discovered so recently, it’s totally possible that your health care provider may not know about it. It can often be mistaken with other disorders that have similar symptoms. If you suspect that you may have it, try and see a gastroenterologist, but since there are no official tests, the only confirmation of diagnosis is if you feel improvement upon taking a break from marijuana.