The World Health Organization (WHO) has formally added Cannabinoid Hyperemesis Syndrome (CHS) to its International Classification of Diseases (ICD-10), a move that reflects a dramatic surge in cases over the past decade. The update, effective October 1, provides a standardized diagnostic code for CHS, enabling better tracking and treatment of the condition. This recognition is a crucial step toward addressing what is rapidly becoming a significant public health issue.
The Rise of CHS: A Growing Crisis
Cannabinoid Hyperemesis Syndrome is characterized by severe, cyclical episodes of nausea, vomiting, and abdominal pain in chronic cannabis users. Ironically, sufferers often find temporary relief through extremely hot showers or baths—a behavior now recognized as a key symptom. The syndrome has exploded in prevalence since 2016, with emergency department (ED) visits increasing by roughly 650% during that period, peaking during the COVID-19 pandemic.
This increase isn’t just about more people using cannabis; it’s about how they’re using it. Modern cannabis products contain dramatically higher levels of THC than those available in the 1990s. Today’s strains routinely exceed 20% THC, with some reaching 90% – a sharp contrast to the 5% potency common decades ago. This concentrated potency appears to be a major driver of the CHS surge.
Impact on Young People: A Critical Concern
The most alarming trend is the rapid increase in CHS cases among adolescents and young adults. Studies reveal that ED visits for the syndrome among 13- to 21-year-olds have increased almost 50% per year from 2016 to 2023. This spike is independent of cannabis legalization status, meaning the problem transcends policy changes.
Dr. Michael Toce of Boston Children’s Hospital and colleagues found that CHS-related ED visits rose from 160 per million in 2016 to nearly 2,000 per million in 2023—a more than ten-fold increase. This suggests that early and heavy cannabis use is a significant risk factor.
Why This Matters: Beyond Vomiting
The WHO’s recognition of CHS isn’t just about categorizing a medical condition; it’s about acknowledging a growing public health crisis. Prolonged vomiting can lead to dehydration, electrolyte imbalances, and even esophageal damage. Furthermore, CHS often goes undiagnosed because patients don’t connect their symptoms to cannabis use.
Dr. Andrew Meltzer, a professor of emergency medicine at George Washington University, highlights that chronic users often fail to realize that cannabis is the root cause of their recurrent vomiting episodes. Early-onset, heavy use is particularly dangerous.
Treatment and Prevention: A Challenging Path
The most effective treatment for CHS is complete cannabis abstinence. However, quitting can be incredibly difficult for chronic users, requiring personalized interventions. While temporary relief can be found in hot showers, capsaicin creams, or ED-administered medications like haloperidol, these are stopgaps.
Long-term solutions may involve cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), and, in some cases, antidepressants or benzodiazepines to manage cravings and withdrawal. Despite the need, no medications have yet been FDA-approved specifically for Cannabis Use Disorder (CUD).
The rise of CHS underscores the urgent need for education, screening, and harm reduction strategies, particularly among young people. Preventing early and heavy cannabis use may be the most effective way to curb this growing epidemic.
The increasing potency of cannabis, coupled with rising rates of anxiety, depression, and other mental health concerns among young users, makes this trend all the more troubling. The WHO’s action is a first step toward addressing this crisis, but sustained efforts in prevention, diagnosis, and treatment are essential.
