Cannabis hyperemesis syndrome: Pharmacological and toxicological perspectives

Cannabis hyperemesis syndrome (CHS) is a disorder of gut-brain interaction with symptoms of nausea, severe episodic vomiting, and abdominal pain. The primary pathways implicated in CHS are the endocannabinoid system and the transient receptor potential vanilloid-1 pathway. The lack of cannabis standardization and Fusarium mycotoxin contamination may also play a role in the development of CHS. Hot showers, capsaicin, and antipsychotics – but not traditional anti-emetics – have been shown effective for symptom management. Until recently, there has not been a specific diagnosis code for CHS, making it difficult for healthcare providers to document CHS in electronic health records. This hindered proper surveillance and epidemiology studies. Further research is needed to characterize the cannabis composition, mechanism of action, and genetic susceptibility associated with CHS.