Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases

J Forensic Sci. 2019 Jan;64(1):270-274. doi: 10.1111/1556-4029.13819. Epub 2018 May 16.


Cannabinoid hyperemesis syndrome (CHS) is one of the more clinically challenging effects of cannabis consumption. It is characterized by cyclic attacks of nausea and vomiting in chronic cannabinoid users and learned behavior of compulsive hot bathing. The deaths of a 27-year-old female, a 27-year-old male, and a 31-year-old male with a history of CHS are reported. The decedents had a history of cyclical nausea and vomiting, chronic cannabinoid use and negative laboratory, radiological and endoscopic findings. All presented to the emergency department with nausea and vomiting in the days preceding death and were treated symptomatically. Toxicological analysis revealed tetrahydrocannabinol in postmortem blood. The cause of death of two of the three cases was attributed to CHS. CHS was appreciated in the third case but was not the cause of death. These three cases demonstrate the importance of recognizing CHS as a potential cause or contributing factor to death in cannabinoid user.

Keywords: cannabinoid hyperemesis syndrome; cannabis; forensic pathology; forensic science; hot bath; marijuana; nausea; postmortem; toxicology; vomiting.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Baths
  • Cannabinoids / adverse effects*
  • Chlorides / analysis
  • Creatinine / analysis
  • Dronabinol / analogs & derivatives
  • Dronabinol / blood
  • Fatal Outcome
  • Female
  • Hot Temperature / therapeutic use
  • Humans
  • Male
  • Marijuana Abuse / complications*
  • Nausea / chemically induced*
  • Nausea / prevention & control
  • Sodium / analysis
  • Urea / analysis
  • Vitreous Body / chemistry
  • Vomiting / chemically induced*
  • Vomiting / prevention & control


  • Cannabinoids
  • Chlorides
  • 11-nor-delta(9)-tetrahydrocannabinol-9-carboxylic acid
  • Dronabinol
  • Urea
  • Sodium
  • Creatinine