I'm working on a story about cannabinoid hyperemesis syndrome (CHS), and am looking for a medical expert who can give some context about this condition such as their experiences with it from patients, symptoms, known causes, and more.

I'm a triple board-certified surgeon in general surgery, surgical critical care, and internal medicine, so I approach GI emergencies from multiple angles. What's interesting from my bariatric surgery perspective is that I've seen CHS present in post-operative weight loss patients who turned to cannabis for nausea management--creating this terrible cycle where they're using the exact substance causing their symptoms. The pattern I notice in my practice is that CHS patients often have pristine colonoscopies and endoscopies because referring doctors suspect IBD or Crohn's. I had a 28-year-old male patient who'd spent $40,000 on workups before his bariatric consultation, where I asked about daily habits. He was using edibles 4-5 times daily and had developed this compulsive bathing behavior--spending hours in scalding showers. His BMI was 42, but he'd lost 18 pounds in six weeks just from the vomiting. From an internal medicine standpoint, the metabolic derangements can be severe--I've seen patients with significant electrolyte imbalances and acute kidney injury from the dehydration. The hyperemesis is relentless, worse than what I see in my wound care patients on heavy opioids. What concerns me most is when patients resume use thinking "it was just that batch" or "I'll try a different method"--the syndrome returns within days, sometimes more severe than the initial presentation.

CHS is becoming increasingly common as a topic of discussion when a client approaches you as an individual who smokes cannabis regularly but who cannot understand the cause of their nausea, vomiting, or stomach aches. It is also confused with a gastrointestinal problem thus prolongs the wrong way it is not supposed to. The only difference with CHS is the paradox, and this is consumption of cannabis to alleviate conditions, yet it is the long-term use that triggers. As part of my work, I do not cure the condition but I support the clients with the medical system when it strikes. Most of them find themselves in my hands when they have gone through several ERs where most of the time they are dehydrated, frustrated, and confused as to why they are not responding to the basic treatments. After CHS has been diagnosed, a majority of the doctors advise full withdrawal of cannabis. That is what some have difficulties with particularly when they were using it to treat anxiety or pain. In the insurance perspective, CHS has been being coded in different categories, such as in cyclic vomiting syndrome or gastritis that complicates the claims, or even with reimbursements where postponements in payment have been witnessed. It is important to know how to write it and order the appropriate specialist referrals. It is among such conditions whereby the awareness among the patients and carriers is yet to catch up. When the only thing that helps a person in and out of the emergency care with unexplained symptoms and hot showers as the only way of relief, it is worth mentioning CHS as the possibility.

For many patients, Cannabinoid Hyperemesis Syndrome feels like a betrayal by their own body. They start using cannabis to relax or treat a nervous stomach, only to end up trapped in a cycle of debilitating sickness. I recently saw a patient who had lost twenty pounds and been to the ER three times before we connected the dots. He couldn't believe the cannabis was the cause because, in the short term, smoking actually settled his stomach. That is the trap of CHS: the immediate relief masks the long-term cause. The condition is often misdiagnosed as a stomach bug or anxiety, but the "hot bath" sign is usually what gives it away. If a patient tells me they are taking five hot showers a day just to function, I know we are likely looking at CHS. The heat provides a unique neurological distraction that settles the gut in a way medicines often can't. We believe this happens because chronic, high-dose exposure to THC eventually scrambles the body's autonomic nervous system—the system that controls things like digestion and temperature regulation. It's essentially a toxicity issue. The body loses its ability to maintain balance, and the gut stops moving things forward properly, leading to violent rejection of food. Recovery is physically straightforward but psychologically complex. The symptoms vanish when the cannabis use stops, usually within days or weeks. But for someone who has built their lifestyle or anxiety management around daily use, "just stopping" is a heavy lift. My role as a psychiatrist is often helping them find new, healthier tools to manage the anxiety that drove the cannabis use in the first place.