Young woman wearing backpack in hallway for blog post about Cannabis Hyperemesis Syndrome and the Risks of Cannabis Misuse Disorder

Cannabis Hyperemesis Syndrome (CHS): What You Need to Know about this Rare Condition and the Mental Health Impact of Cannabis Use Disorder

Est. reading time: 10 mins
Posted Under: Interviews, Treatment Insights

Clinically Reviewed by: Amanda Fialk, PhD, LCSW, LICSW


In recent years, the widespread debate surrounding the legalization and recreational use of cannabis has dominated headlines and discussions. And while the legalization of cannabis is a step forward for racial justice, particularly for communities of color that have been disproportionately impacted by the war on drugs and the shame and stigma associated with use, it is crucial to address the very real and significant mental health risks associated with cannabis consumption, especially among teens and young adults. Among these risks lies a lesser-known condition called Cannabis Hyperemesis Syndrome (CHS) as well as rising cases of cannabis-induced psychosis.

We recently spoke with Robert L. Johnson MC, MCAP, LPC, Washington, D.C. Site Director at The Dorm, and Ray Estefania, MS, LMHC, CAP, CIP of R&A Therapeutic Partners, both seasoned mental health experts with a combined decades of expertise at the forefront of young adult recovery and mental health treatment. During our conversation, we discussed cannabis hyperemesis syndrome, trends they are seeing in young people in the wake of changing laws and evolving consumption habits, and what they recommend and offer in terms of comprehensive treatment support.

First, what is cannabis hyperemesis syndrome (CHS)?

Robert: Cannabis hyperemesis syndromes or (CHS) is diagnosed if an individual experiences cyclical episodes of nausea, vomiting, and abdominal pain after using cannabis. This condition is characterized by:

  • Several years of cannabis use that pre-dates the onset of illness
  • A cyclical pattern of hyperemesis (every few weeks to months) while the patient continues to use cannabis
  • A resolution of symptoms after patient stops cannabis use, as confirmed by a negative urine drug screen

Ray: U.S. emergency departments are reporting an increase of CHS cases over the last decade, yet there is still much that remains unknown about this condition.

Robert: It’s important to understand that cannabis can linger in your system for extended periods of time as THC is heavily lipid-soluble, meaning it remains in fatty tissues throughout the body, including the brain. Consequently, unlike other drugs, even if you’ve discontinued use, you may continue to test positive for cannabis for a month, and in some cases, up to six weeks. Therefore, a CHS overdose is often associated with the cumulative buildup of cannabis in the body’s fatty tissue cells over many years.

Ray: Exactly – CHS does not happen to individuals after a few weeks or even two or three months of use. It happens to individuals who are chronic long-term users. And the only way for symptoms to stop is total cessation. 

What do you see among teens and young adults with CHS at The Dorm and R&A Therapeutic Partners?

Ray: CHS first became a notable issue at my practice five or six years ago. Now, we’re seeing a few more instances every year. What makes this condition so serious is that some individuals can’t seem to stop smoking marijuana, even after such adverse effects. In fact, most patients deny even having an issue but that is the definition of dependency. They continue to use cannabis despite even the most severe physical and mental consequences. 

I remember one case in particular, a young woman who was around 21 or 22 years old. She was diagnosed with CHS and ended up in the hospital after repeatedly becoming violently ill after smoking marijuana. She was extremely dehydrated and struggling to function with basic life activities. But no matter how much she suffered, she always found a justification to continue smoking. It was an example of the addictive power of this substance and how some people truly cannot stop using it even when faced with very serious health effects.

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Robert: There have only been two or three cases at The Dorm, but each has been striking. One case I recall was an individual who was hospitalized; they were testing them for everything and couldn’t figure out what the issue was. Eventually, we realized that they hadn’t mentioned their long-term and intensive marujuana use. Honestly, they didn’t even think to mention it — but that ended up being the root cause. That points to a general issue of education, both from a young adult/client perspective and a parent/family perspective. People don’t know that cannabis use can really cause serious health issues. 

Why do you think families and young adults don’t take cannabis use seriously?

Ray: I think for the populations we serve, and many families in general, the common response is, “Well, it’s not a real drug, not a hard drug like heroin or cocaine.” And my answer to that is, “That’s true – it’s not. But it’s also not harmless.” Marijuana is addictive, particularly for a young brain and it can have damaging consequences for the user. 

This is where education really has to come into play because families and young people don’t seem to be aware of the real risks of long-term, continuous cannabis use. Teen cannabis misuse has risen by 245 percent over the last 20 years. Among this population and among young adults specifically, it’s becoming more popular than alcohol. It can come in many forms, a whole array of options and experiences from gummies and vaping cartridges to traditional smoking. In many instances it’s easier to access than alcohol for many young people  In vape or edible form it’s not easily detectable – it can hide in plain sight. Plus, there’s the glossy marketing, coupled with the ease of use and now expanding legalization. What’s missing is the widespread public health campaign about what it could mean to a person’s physical and mental health in the long-run. 

Given all of these circumstances, whenever I speak to a young person or family, I start the education process by talking about increased potency, which is very real. Cannabis today is not the marijuana that a lot of adults were smoking and consuming 25 or more years ago. In fact, research shows that the “potency of illicit cannabis plant material has consistently increased over time since 1995”

Then, I talk about the science-backed impact on the young, developing brain.  

Robert: Yes, and this point is something that can’t be underestimated. While cannabis is more psychologically addictive than physically addictive, there is continuing research into the full impact of cannabis use on the structure and function of the brain. Studies are supporting its negative effect of neurocognitive performance and how the brain builds connections for functions like attention, impulse control, memory, learning, retention, and judgment. 

Ray: Fortunately, at younger ages, there is still neuroplasticity in the brain. With the right support and treatments, the hope is that young people’s brains can rebound and heal, but there is still much research to be done on how much that’s possible and many factors to consider. What we do see in practice, however, is that for those individuals who are using long-term, especially throughout their preteen, teen and early adult years, the deficits can be considerable and long-lasting. 

What do these “deficits” of long-term cannabis use look like in a young adult?

Ray: Delayed or arrested development. Failure to launch. Whatever you want to call it — that’s a very typical profile for someone who is experiencing the effects of long-term cannabis use. In terms of emotional maturity, they are often acting like teenagers when they are young adults. They often do not have healthy coping skills, and they don’t appear to know how to regulate their emotions effectively. Their memory, sense of coordination, and cognitive thinking is not operating as it should compared to their peers. As a result, this individual may feel inadequate and “stuck,” which, of course, has its own ramifications. 

Robert: As always, it’s very individualized, but I would agree with Ray. We often see it linked to increased instances of anxiety (including social anxiety) and depression as well as a general sense of malaise and a perpetual lack of motivation and apathy. There is a lot of sitting around at home or in a dorm room not feeling “up for anything” – even if, when asked about their goals, that’s not what a young person wants from their life. 

What about the link between psychosis and cannabis use in young adults? 

Ray: Yes, this is important, as it’s something we are seeing more and more. Typically, it presents more among males than females and more among young adults than teens. There are young individuals showing up with schizophrenia-like symptoms, and the common denominator is that they all smoke marijuana or consume cannabis in some way. 

Robert: We have four individuals like this at The Dorm right now. It can also present as schizoaffective disorder. These individuals, again, are not causal users, but young adults who were or are engaged in heavy marijuana use. 

Ray: The research is still pending on whether or not this happens based on predisposition/genetic factors and the cannabis use just triggers a predisposition that may already be there, or if marijuana is causing these symptoms in the young person. After a psychotic break or first psychotic episode related to cannabis use, it’s also not totally clear which individuals will return to “baseline” once they stop smoking or using cannabis products: more research is needed. I will say that many of the individuals I have seen do go on to have a lasting clinical diagnosis of schizophrenia that needs to be managed with medication and treatment. It’s very difficult, not just for the individual but for the entire family.

Robert: Yes, denial is also a big issue. These are tremendously complicated clinical cases that we navigate regularly, and it’s not easy for anyone within the family system.  

Ray: I should also add that, if someone does have an existing schizophrenia diagnosis and is using marijuana, they tend to have poorer outcomes in treatment. They don’t find recovery as easily and are more difficult to treat. 

How do you handle young adults who say they benefit from cannabis medicinally?

Ray: Good question. I have had a young person I was working with say that marijuana really helped mitigate their ADHD symptoms. And who am I to say that it doesn’t? I don’t negate that experience or reality for them. Instead, I try to get them to focus on the substance’s benefits and side effects, like one would assess the benefits and side effects of any medication they take. 

And the negative side effects of cannabis? They often outweigh the positives. To use one individual’s case as an example, I would ask, “Is it worth also feeling unmotivated? Unable to graduate college or achieve the goals you have set for yourself? To continue to do poorly in school and instead sit at home in the dark and play video games all day?” The answer is generally no. It opens up the conversation that cannabis use might not be the answer, and that other options and therapeutic supports are worth exploring. 

Robert: I agree with Ray. As a clinician, I also always investigate further into why someone might be using cannabis medicinally. For example if they received authorization from their physician to acquire a medical marijuana ID card, I follow up to better understand the clinical rationale and determine what other therapies could be used to address the adverse symptoms they might be struggling with. And if a client is not willing to sign a release for us to delve into this issue more thoroughly, this is a “red flag” that merits a deeper exploration. It could point to problematic use and dependency issues. 

Ray: And I always come back to the research and the data — does cannabis actually support symptom benefits? For example many clients might come to be saying they are taking cannabis for pain, but the data doesn’t actually support that it’s as effective as other medical options. 

Finally, what treatment approaches do you each find most effective for young adults navigating cannabis use disorder? 

Robert: At The Dorm, we take a holistic approach to intensive outpatient treatment for any substance use-related disorder with a focus on getting to the root of factors contributing to an individual’s mental health challenges. As part of our 360° assessment process, for example, we would conduct a thorough clinical history to determine whether the issues related to cannabis use may be co-occurring with other conditions or serving as a coping mechanism for symptoms of trauma, anxiety, or depression. 

Our treatment offerings are also integrative and individualized, allowing us to always tailor support to the unique individual in front of us and offer interdisciplinary, evidence-based care that approaches needs from every angle. 

That means that a client struggling with cannabis use disorder would likely receive a mix of 1:1 individual therapy to explore issues and life patterns that might be related to their use, alongside 1:1 clinical coaching support which would help them develop and practice the skills they’d need for managing triggers, sustaining abstinence and relapse prevention in real-time with the guidance of a licensed clinician. They would benefit from weekly group therapy (we offer many specific to substance use disorders and cessation) and engage in ongoing family therapy. 

If a young person was experiencing cognitive deficits as a result of their use, they might also participate in cognitive remediation therapy, a data-driven treatment that has proven to be effective at improving the functioning of individuals who struggle with cognitive impairment. We’ve seen incredible results for clients participating in this structured group setting including: 

  • 23% improvements in executive functioning
  • 11% improvement in reasoning
  • 19% improvement in cognitive flexibility
  • 18% improvements in complex attention

Last but certainly not least, any client with us navigating substance use issues would participate in a rich array of 12 step groups, and in-person community support programming. Clients’ ability to participate in and build supportive, sober, peer-based networks can provide a tremendous amount of emotional support that bolsters the recovery process.

Ray: We usually recommend some level of treatment for those individuals that are struggling with cannabis use disorder. This could be some form of outpatient treatment but sometimes a young person needs a more intensive program like The Dorm in order to make progress and effectively deal with their problem. It is important to educate the young person but also the family. Often parents minimize the impact marijuana use may be having on their teen or young adult child. They are looking for answers as to why their son or daughter is not functioning at the level they should be and they often don’t recognize the role cannabis may be playing in their child’s struggles. 

It would also be important to conduct a thorough assessment where we can evaluate any other mental health issues, learning challenges or other stressors they may be experiencing and also examine their relationship with marijuana and other substances. It really is so important to educate the entire family and to work with the young person to help them understand how marijuana may be impacting their functioning and their ability to achieve their own goals. We take a motivational interviewing approach with clients to help them gain insight into their possibly self-destructive relationship with substances and encourage them to do things differently. It is always difficult because the use of marijuana often comes with a level of denial we don’t necessarily see with other substances. It is so much a part of the culture now among our young people and they often don’t want to admit that marijuana is interfering in their ability to function, be happy and succeed in life. 

Thank you, Robert and Ray for your insights, expert information and detailed notes on what effective treatment might look like for young people struggling with problematic cannabis use. 

For more information on getting in touch with The Dorm, please contact us here, and to access expert support at R&A therapeutic partners, you can reach them here. 

About R&A Therapeutic Partners:Ray Estefania and Ana Moreno have more than 40 years of combined experience in working with individuals and families suffering from complex substance misuse disorders and mental illness. R&A Therapeutic Partners serves families throughout the South Florida area, as well as nationally and internationally. Their mission is to provide honest, ethical, compassionate, concierge-level support to families who are struggling with these issues. R&A provides evaluations, customized outpatient treatment, individual and family therapy, interventions and therapeutic/educational consulting services to adolescents, adults and families.

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