People have described the hot water relief as "temperature-dependent," meaning that hotter temperatures provide greater relief. Recovery phase
The recovery phase begins after the patient abstains from cannabis consumption, but the time for resolution of symptoms is unclear: it has been reported to occur within two weeks, or to take one to three months. Lost weight can be regained due to a restoration of normal oral intake, and compulsive bathing/showering can give way to normal patterns of behavior. If a person in this phase consumes cannabis again, their symptoms tend to come back. Relapses are common due to reinitiation of cannabis consumption, following which many people use or increase their use of cannabis due to concerns about nausea. Increased patient education may be necessary. Complications
Two deaths were reported as complications of associated kidney failure and electrolyte disorders. Pathogenesis
Cannabis contains more than 400 different chemicals, of which about 60 are cannabinoids. The chemical composition of cannabis may vary between cannabis products, making it difficult to identify the specific chemical(s) responsible for the syndrome. The pathophysiology of CHS is complicated by the complex action of these chemicals throughout the body, both in the central nervous system and in the gastrointestinal system. Cannabis-related factors, such as the amount of THC in the cannabis, the amount of use, and the duration of use likely play a role, but are not yet well understood.
Specifically, CHS takes the pattern of cyclical nausea, vomiting, and abdominal pain in the setting of chronic cannabinoid use. The abdominal pain tends to be mild and diffused. There are three phases of CHS: the prodromal phase, the hyperemetic phase, and the recovery phase. Prodromal phase
The prodromal phase is characterized by mild symptoms of CHS, including nausea, anxiety, mild discomfort, sweating, and increased thirst; symptoms are more severe in the morning. Prior to the use of compensatory exposure to hot water to treat symptoms, people sometimes increase their intake of cannabinoids in an effort to treat the persistent nausea they experience. This phase can last for months or even years. Hyperemetic phase
The hyperemetic phase is characterized by the full syndromal symptoms of CHS, including persistent nausea, vomiting, abdominal pain, and retching. Retching can occur up to 5 times per hour. Acute episodes of cannabinoid hyperemesis typically last for 24–48 hours. The symptoms experienced in this phase are cyclical, and can recur unpredictably in intervals of weeks to months. It is very difficult to take food or medicine by mouth during this stage, and patients may develop a fear of eating. Weight loss and dehydration due to decreased oral intake and vomiting are possible. It is during this hyperemetic phase that people with CHS are likely to present to the emergency department of the hospital for treatment.Treatment via hot water, sometimes for hours at a time, relieves symptoms for many patients, which can result in compulsive bathing or showering.