By Max Sargent


Cannabis boasts a good safety profile. Thousands of years of use and virtually zero deaths tied to cannabis alone mean users face considerably low risk when using the herb. Most people enjoy cannabis in peace and use the plant to relax, enhance creativity, and socialise. But for a small minority, using cannabis causes some seriously nasty symptoms. Cannabis (or cannabinoid) hyperemesis syndrome (CHS) results in vomiting, pain, and strange, compulsive behaviour.

What Is Cannabis Hyperemesis Syndrome (CHS)?

Revered cannabis scientist Dr Ethan Russo describes CHS as “an enigmatic constellation of signs and symptoms[1]” that show up in some people following heavy and prolonged cannabis use. Medical professionals in Australia first identified the condition in nine patients back in 2004, but researchers eventually traced the first (known) case back to a man who exhibited the symptoms in 1996.

People that experience CHS often use cannabis for years before experiencing any signs of the condition. But eventually, constant exposure to high levels of THC triggers symptoms to emerge. The term “hyperemesis” means “severe or prolonged vomiting”. People with CHS experience nausea and vomiting in a cyclic fashion over several months, to the degree that the condition results in frequent hospitalisation.

But patients can make several trips to the emergency room before receiving a diagnosis, as practitioners frequently misdiagnose CHS as cyclic vomiting syndrome (CVS), a condition often treated with medical cannabis!

With that said, doctors are likely to start identifying the condition much earlier. Some researchers believe CHS goes massively underreported but poses a burgeoning issue. The ever-increasing THC levels in modern cannabis varieties will also likely contribute to the emergence of more frequent cases.

CHS has also put the myth that “cannabis can’t kill you” to rest. At least two deaths have been documented[2] from this toxic reaction to THC.

  • What Are the Symptoms of CHS?

Cannabinoid hyperemesis syndrome symptoms are divided into three key stages.

Prodromal Phase
The prodromal phase marks the period between the initial symptoms and the full-blown development of the condition. The length of these early symptoms[3] varies between patients and can take place over several weeks or even over several years. The symptoms during this phase include:
Early morning nausea
Abdominal pain
Fear of vomiting
Hyperemetic Phase
The hyperemetic phase refers to the point where the symptoms begin to peak. These symptoms include:
Ongoing nausea
Repeated episodes of vomiting
Abdominal pain
Dehydration
Reduced food intake and weight loss
Recovery Phase
The recovery phase begins when a patient with CHS stops using cannabis. The symptoms gradually begin to fade, and patients start to tolerate food normally again. The recovery period lasts from several days to several months.
  • But Doesn’t THC Help To Reduce Nausea and Vomiting?

Many CHS patients are shocked to find that cannabis causes them to vomit. After all, aren’t several cannabis-based medicines used to treat nausea and vomiting?

While true, cannabinoids such as THC display a biphasic dose response, meaning they produce one of two effects based on the amount consumed. Whereas ongoing studies are exploring the antiemetic (drugs that reduce nausea and vomiting) effects of small doses of THC, larger doses are known to promote vomiting.

- Compulsive Bathing: A Strange Behaviour Seen in Most CHS Patients

Vomiting aside, CHS also causes odd behaviour in patients. Many of them find themselves compulsively bathing in hot water. We’re not talking about the occasional dip here. Around 92% of CHS patients report taking frequent hot baths or showers to relieve their symptoms. This technique appears so effective that some patients even report spending most of their day sitting in the tub.

What Causes Cannabis Hyperemesis Syndrome?

We know that large doses of THC can cause vomiting in anyone. But many CHS patients consume the same amount of cannabis as other people that don’t experience these symptoms. So, what’s going on?

Some cannabis users refuse to accept that THC is behind their symptoms, and for good reason. Many depend on medical cannabis to help alleviate certain symptoms, whereas others use the herb recreationally and highly value the effects.

This denial led to a theory that something else must be at play. Some users pointed a finger at the contamination of cannabis flowers, suspecting that residual pesticides underpinned the constant vomiting of CHS. But Dr Russo has refuted this claim, stating that it holds no water. The symptoms of pesticide poisoning don’t correlate with CHS symptoms.

Unfortunately for CHS patients, their toxic reaction to THC likely stems from genetic factors. Dr Russo and colleagues released a paper in July 2021 titled “Cannabis Hyperemesis Syndrome Survey and Genomic Investigation”[4]. The study found five genetic mutations that distinguish CHS patients from other cannabis users that don’t vomit after THC exposure. The team also point to changes in the endocannabinoid system that might underpin the symptoms of the condition. Check out some of these factors below.

What Causes Cannabis Hyperemesis Syndrome?

  • Shifts in the Endocannabinoid System

You've probably heard of the endocannabinoid system (ECS) by now. This system regulates many physiological processes. Researchers have found that CHS patients display the following changes in this vital system.

- Downregulation of CB1 Receptor

The ECS comprises two primary receptor types: CB1 and CB2. The former occurs abundantly throughout the brain and nervous system, and helps to regulate neurotransmitter firing. THC binds to these sites to produce its psychotropic effect. In cases of CHS, researchers have discovered a downregulation of the CB1 receptor in patients following chronic THC use.

- TRPV1 Mutations

The team also found genetic mutations in the TRPV1 receptor. Some researchers label this site as the third cannabinoid receptor, or CB3. Why? Because the primary endocannabinoids—anandamide and 2-AG—and CBD bind to this site.

TRPV1 plays a key role in heat and pain detection, anxiety, and gut motility (the movement of food through the GI tract). Mutations in this receptor likely contribute to the anxiety, pain, and gut issues faced by CHS patients, and it might also explain why many of them often retreat into a hot bath. Activation of TRPV1 may help to reduce nausea and vomiting[5] in CHS.

  • Liver Enzyme Deficiency

Dr Russo and his team also found changes in the liver enzymes of CHS patients. The enzyme CYP2C9 is the main protein responsible for breaking down THC and its potent metabolite 11-hydroxy-THC. Because CHS patients exhibit a deficiency in this enzyme, high levels of THC likely accumulate in the brain, resulting in toxicity.

  • Dopamine Signalling Issues

Mutations in genes that code dopamine receptors also showed up in the study. Substances that stimulate this receptor have an effect on both gut motility and vomiting. The dopamine system also underpins reward-seeking behaviour and addiction. Many CHS patients consume large amounts of cannabis in their daily lives, and many of them continue to return to cannabis despite such unpleasant symptoms. Genetic mutations revolving around dopamine signalling probably play a role here.

  • Does CBD Cause Cannabinoid Hyperemesis Syndrome?

Possibly. While THC seems like the main culprit, researchers state that cannabinoids such as CBD and CBG could conceivably play a role in CHS[6]. Both cannabinoids exhibit pro-emetic (a medicine that induces vomiting) effects at high doses. But we need more research to find out for sure.

How To Diagnose Cannabis Hyperemesis Syndrome?

There are numerous presenting signs[7] that clinicians look for when making a CHS diagnosis, these include:

History of regular cannabis use of over 1 year Severe nausea and vomiting
Vomiting recurring in cyclic patterns over months Symptoms end after a patient stops using cannabis
Compulsive hot bathing or showering Abdominal pain

How To Treat Cannabis Hyperemesis Syndrome?

There are several different treatments available for CHS patients. After they stop consuming cannabis, clinicians may offer the following cannabinoid hyperemesis syndrome treatments:

Capsaicin Topical capsaicin (the spicy molecule in hot peppers) activates TRPV1, and research suggests it may help to reduce nausea and vomiting through this mechanism.
Antipsychotics The antipsychotic medicines haloperidol and olanzapine seem to relieve some of the symptoms of CHS.
Intravenous solutions These help to combat the dehydration associated with the condition.
Pain medications These help to take the edge off of the abdominal pain experienced by 85% of CHS patients.

Is Cannabinoid Hyperemesis Syndrome Permanent?

Unfortunately, it seems like it. Researchers are still untangling CHS, but the findings detailed above point to the genetic basis of the condition. This means that CHS patients almost always experience these symptoms every time they return to the herb. But upon quitting, symptoms should fade.

External Resources:
  1. Cannabinoid Hyperemesis Syndrome Survey and Genomic Investigation https://www.liebertpub.com
  2. Cannabinoid Hyperemesis Syndrome Survey and Genomic Investigation https://www.liebertpub.com
  3. Cannabinoid hyperemesis syndrome (CHS) https://www.uhs.nhs.uk
  4. Cannabinoid Hyperemesis Syndrome Survey and Genomic Investigation https://www.liebertpub.com
  5. Emerging Role of Aprepitant in Cannabis Hyperemesis Syndrome https://www.ncbi.nlm.nih.gov
  6. Cannabinoid Hyperemesis Syndrome https://www.ncbi.nlm.nih.gov
  7. Cannabinoid Hyperemesis Syndrome Survey and Genomic Investigation https://www.liebertpub.com
  8. Emerging Role of Aprepitant in Cannabis Hyperemesis Syndrome https://www.ncbi.nlm.nih.gov
Disclaimer:
This content is for educational purposes only. The information provided is derived from research gathered from external sources.

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Privacy Policy - Royal Queen Seeds

To ensure a safe online environment and guarantee adequate data protection, we strictly comply with all legal requirements. In this privacy statement, we provide information about how and for what purpose data is collected, safety measures, storage periods and contact details.


COMPANY NAME: SNORKEL SPAIN, SL (hereinafter ROYAL QUEEN SEEDS)

C/ Vilar d'Abdelà, 5 (nave 1) CP: 08170 de Montornès del Vallès

+34 937 379 846

support@royalqueenseeds.com


The present Privacy Policy sets out the terms on which we will treat personal data at ROYAL QUEEN SEEDS; this includes any personal data collected through our website https://www.royalqueenseeds.com/ as well as any other data we process in the course of our business activities.

ROYAL QUEEN SEEDS collects the following personal data for the purposes listed below:

SECTION 1 – PERSONAL INFORMATION WE COLLECT

1.1 Account purchases

Account purchases can only be made if you are in possession of a personal account. When you create an account or purchase something from our shop, as part of the buying and selling process we collect the following personal information that you provide to us:

This information is required for delivery. In addition, when you browse our shop, we automatically receive the Internet Protocol (IP) address of your computer. Based on this information, we can optimise your online experience and at the same time protect our online environment.

Purpose of data collection

We collect and store account-related data for the following purposes:

(a) to carry out obligations arising from any contracts between you and us, and to provide you with information, products and services that you may request from us;

(b) to set up, manage and communicate with you about your account and your orders;

(c) to conduct market research and analysis;

(d) to confirm your age and identity, and to detect and prevent fraud.

1.2 Newsletters

With your explicit permission, we may send you newsletters about our shop, new products and other updates. We send newsletters based on your explicit consent. In the event that you purchase a product, and in accordance with current regulations, we may send you commercial communications in accordance with the legitimate interest of our company, always about products or services similar to those you have purchased or contracted. In any case, you may exercise your right of opposition through the channels announced in this Privacy Policy. The following information is collected in relation to the newsletter:

We do not need to know the sex of the person in order to send the newsletter (data minimisation: by law we must ask for data that is strictly necessary to provide the service, and in this case knowing the sex is not necessary to send the newsletter).

Purpose of data collection

The data collected is used to:

(a) personalise our emails, including your name and gender;

(b) provide gender-specific content.

You can withdraw your consent at any time by using the link provided in the newsletter or the contact information provided in section 2.

1.3 Customer service and contact form

In order to provide appropriate support, our customer service employees have access to information related to the account. Consequently, their support will be highly effective and friendly. The data provided in our contact form is used by our CRM provider, SuperOffice. We will only use your details to respond to your message.

SECTION 2 – LEGITIMATE INTEREST

If you have purchased any of our products, please note that we may process your personal data for promotional purposes, based on Royal Queen Seeds' legitimate interest only to offer you products or services from our company and about products or services similar to those you have purchased. You may exercise your right to opt out of future messages by the means set out in this Privacy Policy or through any notification you receive.

2.1 How do you withdraw consent?

If you change your mind, you can withdraw your consent for us to contact you for the purpose of collecting, using, or disclosing your data at any time by reaching out to us at: support@royalqueenseeds.com.

SECTION 3 – DISCLOSURE

We may disclose your personal information if we are required to do so by law or if you breach our Terms of Service.

SECTION 4 – HOW LONG DO WE KEEP YOUR DATA?

At Royal Queen Seeds, we will not retain your data for longer than is necessary for the purposes described in this Policy. Different retention periods apply for different types of data; however, the longest period we will normally hold any personal data is 10 years.

4.1 Account information

Data relating to the account remains relevant for as long as the consumer is in possession of an account. Therefore, the data remains documented for as long as the account exists. When our customers delete an account, the associated data will be deleted within a reasonable period of time. Requests regarding the inspection or correction of stored personal data or the deletion of an account can be sent to support@royalqueenseeds.com.

4.2 Newsletters

In the event that you give us your consent to inform you about our products or services, we will keep your data until you express your wish not to receive any further communications from us. However, we regularly (every month) carry out a relevance check. Registered customers (and their personal information) will be deleted whenever customers do not reply to our request. In addition, our newsletter mailing has an opt-out feature. Consumers can withdraw their consent by using this opt-out feature.

SECTION 5 – COOKIES

Cookies are small information files that notify your computer of previous interactions with our website. These cookies are stored on your hard drive, not on our website. Essentially, when you use our website, your computer displays its cookies to us, informing our site that you have visited before. This allows our website to function more quickly and remember aspects related to your previous visits (such as your username), making your experience more convenient. At Royal Queen Seeds, we use two types of cookies: functional and analytical.

5.1 Functional Cookies

Functional cookies are used to enhance your online experience. Among other things, these cookies track what is added to your shopping cart. The use of these cookies does not require prior authorization.

5.2 Analytical Cookies

Analytical cookies are used for research and market analysis. The data collected with these analytical cookies is anonymous, making it unusable for third parties. The use of these cookies does not require prior authorization.

SECTION 5 – THIRD-PARTY SERVICES

Third-party services are required to conduct transactions and provide our services. In general, the third-party providers we use will only collect, use and disclose your information to the extent necessary to enable them to perform the services they provide to us.

However, certain third-party service providers, such as payment gateways and other payment transaction processors, have their own privacy policies regarding the information we must provide to them for your transactions.

We encourage you to read the privacy policies of these providers so that you can understand how these providers will handle your personal information.

In particular, certain suppliers may be located or have facilities located in a different jurisdiction than yours or ours. Therefore, if you choose to proceed with a transaction involving the services of a third party, your information may be subject to the laws of the jurisdiction in which that service provider or its facilities are located.

Once you leave our website or are redirected to a third-party website or application, you are no longer governed by this Privacy Policy or the Terms of Service of our website.

Web analytics service (anonymous data)

On this website we have integrated an element of a web analytics service (with anonymisation functionality). Web analytics can be defined as the gathering, processing and analysis of data about the behaviour of visitors to websites. An analytics service collects, among other things, data about which website a person came from (the so-called referrer), which sub-pages they visited or how often and for how long they visited a sub-page. Web analytics is mainly used for website optimisation and for a cost–benefit analysis of internet advertising.

Courier service

To complete deliveries we use a courier service. This courier service carries out the delivery between our company and the consumer's home. To complete these logistics, the company requires access to the consumer's name and address information.

Mailing service

Royal Queen Seeds uses a third-party mail service provider to send its newsletter. This provider has access to limited account information related to opt-in consent (e.g. email address).

Marketing services

Royal Queen Seeds has the support of a company that specialises in marketing and communication activities. Their access to personal information is very limited and mostly anonymous.

Payment services

At Royal Queen Seeds we use external payment services to handle our transactions (e.g. credit card payments).

SECTION 6 – SECURITY

To protect your personal information, we take reasonable precautions and follow industry standard best practices to ensure that it is not inappropriately lost, misused, accessed, disclosed, altered or destroyed.

If you provide us with your credit card information, the information is encrypted using secure socket layer technology (SSL) and stored using AES-256 encryption. Although no method of transmission over the internet or electronic storage is 100% secure, we follow all PCI-DSS requirements and implement additional industry standards that are commonly accepted. Information related to the account is protected with a hashing method. This method transforms the information into a generated hash. As a result, confidential information is protected and invisible, even to us. In addition, our databases are exceptionally protected against unauthorised access. For example, access to the database is only possible and permitted via approved IP addresses (e.g. from Royal Queen Seeds headquarters). Other attempts and addresses are rejected at all times.

Furthermore, data is anonymised as much as possible, so it cannot be directly linked to a specific consumer. With this data, however, we may be able to carry out market research and analysis. In addition, the third parties concerned (e.g. mailing service) are examined prior to our collaboration, comply with the GDPR from the EU and receive a processing agreement. Within Royal Queen Seeds, employees are assigned different access permissions. Specific permission provides access only to information that is strictly required to perform a task. Digital security measures are subject to change and must meet high requirements to ensure the safety of online customers. That is why, at Royal Queen Seeds, we appoint a security officer. Regular verification and improvement of security measures (where necessary) are part of the role.

SECTION 7 – CHANGES TO THIS PRIVACY POLICY

We reserve the right to modify this Privacy Policy at any time, so please check back regularly. Changes and clarifications will be effective immediately upon being published on the Website. If we make substantial changes to this policy, we will notify you here that it has been updated so you will know what information we collect, how we use it and under what circumstances, if any, we use and/or disclose it.

SECTION 8 – YOU HAVE THE RIGHT TO: