THC Withdrawal and Cannabinoid Hyperemesis Syndrome (CHS)

Alternative to Meds Editorial Team
Medically Reviewed by Dr John Motl MD

What is THC withdrawal?

THC withdrawal, known medically as cannabis withdrawal syndrome, is a set of symptoms that can start after someone stops heavy, long-term cannabis use. The most common are irritability, anxiety, trouble sleeping, strange dreams, low appetite, restlessness, and low mood.³

It is a real diagnosis in the DSM-5, the manual clinicians use to diagnose mental health conditions. It is diagnosed when at least three symptoms appear within about a week of stopping.³ A review of studies covering more than 23,000 people found that about 47% of people who use cannabis regularly or are dependent on it have withdrawal when they stop.¹

Withdrawal is a sign your brain has adapted to THC, not a personal failing. For most people, it passes within a couple of weeks.

Looking for help? See how our residential addiction treatment program in Sedona works, or call (888) 907-7075.

Why today’s THC hits harder

Short answer: cannabis is much stronger than it used to be. Average THC in cannabis seized by law enforcement rose from about 4% in 1995 to about 16% in 2022, and dispensary flower and concentrates can go above 40%.⁷ Some legal products contain more than 70% THC.²

Higher potency matters. A review of 20 studies linked high-potency cannabis to a greater risk of cannabis use disorder and psychosis.⁸ In a large European study, people who used high-potency cannabis daily had nearly five times the odds of a psychotic disorder compared with people who never used.⁹ Vapes, dabs, and edibles make it easy to take in a lot of THC throughout the day.

How often you use matters most. NIDA estimates that 22% to 30% of people who use cannabis have cannabis use disorder, and frequency of use is the strongest predictor.⁷

What about delta-8 and hemp THC?

Delta-8 THC and other hemp-derived THC products are intoxicating, and the FDA has not evaluated or approved them for safe use.¹⁰ Poison centers logged 2,362 delta-8 exposure cases between January 2021 and February 2022, and 41% involved people under 18. The FDA warns these products may be made with unsafe chemicals.¹⁰ The CDC has also warned about children needing intensive care after eating delta-8 gummies.¹¹

The federal rules are changing. A law passed in November 2025 narrows the definition of hemp so that most intoxicating hemp THC products will no longer qualify. After a delay passed in September 2026, part of the change is scheduled to start November 12, 2026, and the rest on December 11, 2026.¹² Dates could move again, so check current rules.

Delta-8 has intoxicating effects similar to regular (delta-9) THC, so heavy daily use of either may lead to dependence and withdrawal.¹⁰

Cannabis withdrawal symptoms

Short answer: the DSM-5 lists seven symptoms. Mood and sleep changes are the most common. Physical symptoms happen too, but are usually milder.^3,5

Emotional and sleep symptoms:

• Irritability, anger, or aggression³
• Nervousness or anxiety³
• Trouble sleeping, including insomnia and vivid or disturbing dreams^3,6
• Restlessness³
• Depressed mood³

Physical symptoms:

• Low appetite or weight loss³
• Stomach pain, shakiness or tremor, sweating, fever, chills, or headache³
• Nausea, which is common though not part of the DSM-5 list^3,5

Withdrawal is more likely with daily use, cannabis use disorder, tobacco use, and use of other drugs. It is especially common in people being treated in a hospital or residential setting.¹

Withdrawal or a mental health condition? Anxiety, low mood, and poor sleep are also symptoms of anxiety disorders and depression. If these were there before you started using, or they don’t ease after a few weeks, talk to a clinician.

THC withdrawal timeline

Short answer: symptoms usually start 1 to 3 days after the last use, peak during the first week, and fade over 1 to 2 weeks. Sleep problems and mood changes can last longer.^2,3,4

Sleep problems in withdrawal are real and measurable, not just a feeling.⁶ Many people relapse to get relief from poor sleep, so a plan for sleep matters.

Cannabinoid hyperemesis syndrome (CHS)

Short answer: CHS is a condition in some long-term, heavy cannabis users that causes repeated bouts of severe nausea, vomiting, and stomach pain. Many people find hot showers or baths ease the symptoms. The only lasting treatment is stopping cannabis completely.^13,14

CHS is not the same as withdrawal. It happens during ongoing heavy use, often after years of near-daily use. Clinical guidance describes it as repeated vomiting episodes in someone who has used cannabis more than four times a week for over a year.¹³ It often goes unrecognized at first, partly because cannabis can seem to ease the nausea early on.¹⁶

ER visits for CHS are being counted more accurately since a new diagnosis code took effect in October 2025. The CDC counted almost 200,000 emergency visits involving CHS from January 2023 to May 2026, with the highest rates in people aged 15 to 24.¹⁸

CHS often comes in three phases:

• Early phase: morning nausea, fear of vomiting, and stomach discomfort. Many people use more cannabis because it seems to help.¹⁶
• Vomiting phase: intense, repeated vomiting and stomach pain, often with anxiety and a strong urge to take long hot showers.¹⁶
• Recovery phase: eating returns to normal after cannabis is stopped.¹⁶

In a review of published cases, 92% of people said hot showers or baths eased their symptoms. Of those who stopped cannabis, almost 97% had their symptoms go away, while everyone who kept using continued to have symptoms.¹⁴ Recovery is not instant. Clinicians confirm the diagnosis when symptoms stay gone after about six months without cannabis.¹³

Is CHS dangerous?

It can be. Repeated vomiting can cause dehydration, kidney injury, and low potassium, which can affect heart rhythm. Some people burn themselves with scalding water, and forceful vomiting can tear the lining of the esophagus.^14,15,16 Deaths are rare but have been reported.^17,18

In the emergency room, doctors usually give IV fluids and replace electrolytes, and may use medicines that work better for CHS than standard anti-nausea drugs, as well as capsaicin cream on the skin.^15,16 These treatments ease an episode. They don’t prevent the next one if cannabis use continues.¹⁴

CHS: when to go to the ER

Short answer: go to the ER or call 911 if you are vomiting blood or material that looks like coffee grounds, pass out, or become confused.^19,23

Get medical care the same day if you:

• Can’t keep any fluids down for 12 hours or more¹⁹
• Have been vomiting for more than 24 hours¹⁹
• Haven’t urinated in 8 hours or more¹⁹
• Have severe belly pain¹⁹
• Have signs of dehydration: dry mouth, strong thirst, sunken eyes, dark urine, dizziness, or a fast heartbeat^19,23
• Notice an irregular heartbeat, since repeated vomiting can lower potassium and affect heart rhythm^15,16

Tell the ER team how much cannabis you use. It helps them recognize CHS faster and avoid tests and treatments you don’t need.

How to quit THC

Short answer: for most people, cannabis withdrawal is not medically dangerous, but quitting is easier with support. Counseling has the best evidence. There is no FDA-approved medicine for cannabis use disorder.^2,7

What helps:

• Counseling. Cognitive behavioral therapy, motivational enhancement therapy, and contingency management are effective treatments for cannabis use disorder.^2,7
• A sleep plan. Regular sleep and wake times, less caffeine, and daytime activity can help while sleep resets. Ask a clinician before taking sleep aids.
• A trigger plan. Clear out vapes, carts, and edibles, and plan for the times and places you used to use.
• Treatment for mental health. If anxiety, depression, or trauma is part of why you use, treating it lowers the pull to go back.

When you need medical supervision: if you also drink heavily or use benzodiazepines, opioids, or other drugs, if you have a serious mental health condition, or if you have CHS.⁵ Stopping alcohol or benzodiazepines suddenly can cause seizures, so never quit those on your own.²⁴

Helping a loved one quit THC

Because cannabis is legal in many states, families often aren’t sure when to worry. These signs suggest it’s time to talk:

• Daily use that keeps growing, or using first thing in the morning
• Irritability, poor sleep, or loss of appetite when they go without
• Repeated vomiting and long hot showers, which can point to CHS
• Paranoia, hearing voices, or unusual beliefs, which need a medical evaluation soon⁷
• Talk of suicide. Call or text 988 any time, or 911 in an emergency.²⁰

Keep THC edibles and vapes locked away from children and pets.¹⁰ Family members are welcome to call. Our admissions team can answer your questions confidentially at (888) 907-7075.

Quitting THC at home vs. at ATMC

When to get help right away

• Call 911 or go to the ER for vomiting blood, passing out, confusion, a seizure, or severe paranoia or hallucinations.^7,19,23
• Call Poison Help at 1-800-222-1222 if a child or pet eats a THC edible, or with questions about any cannabis exposure.^10,22
• Call or text 988 for the Suicide and Crisis Lifeline, free and open 24/7.²⁰
• Call the SAMHSA National Helpline at 1-800-662-4357 for confidential treatment referrals at no cost, 24/7.²¹

Get help with cannabis dependence

Alternative to Meds Center is a residential treatment center in Sedona, Arizona, with about 20 years of holistic residential care. Marijuana is one of the substances we treat, and many of the people who come to us use cannabis along with alcohol, other drugs, or prescription medication.

Detox at ATMC happens under the observation of trained medical staff, who watch your vital signs and overall health. If acute withdrawal from another substance needs hospital-level care first, we refer you to an acute care facility, then help you transition into our program.

Every resident gets lab testing and a medical assessment on arrival. From there, your plan may include holistic detox, neurotransmitter repair with an individualized supplement plan, whole-food nutrition, individual and group counseling, and peer support. Many people use THC to manage anxiety, sleep, or low mood. Our dual diagnosis program treats those symptoms and the cannabis use together.

Our Medical Director describes how the team watches over each client:

“Our medical and nursing teams collaborate closely to monitor each client’s tapering plan, assess progress, and make adjustments as clinically indicated. The team regularly evaluates symptoms, sleep patterns, mood, and overall well-being to support a safe and individualized process.”
Kimberli Galloway, PMHNP-BC, Medical Director

Learn more about our addiction treatment program, marijuana addiction and recovery, why cannabis causes psychosis in some people, and mixing cannabis with antidepressants.

THC withdrawal FAQs

Sources:

1. Bahji A, Stephenson C, Tyo R, Hawken ER, Seitz DP. Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(4):e202370. doi:10.1001/jamanetworkopen.2020.2370. PMID: 32271390. [cited 2026 Oct 20]

2. Connor JP, Stjepanović D, Le Foll B, Hoch E, Budney AJ, Hall WD. Cannabis use and cannabis use disorder. Nat Rev Dis Primers. 2021;7(1):16. doi:10.1038/s41572-021-00247-4. PMID: 33627670. [cited 2026 Oct 20]

3. Bonnet U, Preuss UW. The cannabis withdrawal syndrome: current insights. Subst Abuse Rehabil. 2017;8:9-37. doi:10.2147/SAR.S109576. PMID: 28490916. [cited 2026 Oct 20]

4. Budney AJ, Moore BA, Vandrey RG, Hughes JR. The time course and significance of cannabis withdrawal. J Abnorm Psychol. 2003;112(3):393-402. doi:10.1037/0021-843x.112.3.393. PMID: 12943018. [cited 2026 Oct 20]

5. Cleveland Clinic. Marijuana (Weed) Withdrawal. Last reviewed October 4, 2024. [cited 2026 Oct 20]

6. Bolla KI, Lesage SR, Gamaldo CE, Neubauer DN, Funderburk FR, Cadet JL, et al. Sleep disturbance in heavy marijuana users. Sleep. 2008;31(6):901-908. doi:10.1093/sleep/31.6.901. PMID: 18548836. [cited 2026 Oct 20]

7. National Institute on Drug Abuse. Cannabis (Marijuana). Updated September 24, 2024. [cited 2026 Oct 20]

8. Petrilli K, Ofori S, Hines L, Taylor G, Adams S, Freeman TP. Association of cannabis potency with mental ill health and addiction: a systematic review. Lancet Psychiatry. 2022;9(9):736-750. doi:10.1016/S2215-0366(22)00161-4. PMID: 35901795. [cited 2026 Oct 20]

9. Di Forti M, Quattrone D, Freeman TP, Tripoli G, Gayer-Anderson C, Quigley H, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry. 2019;6(5):427-436. doi:10.1016/S2215-0366(19)30048-3. PMID: 30902669. [cited 2026 Oct 20]

10. U.S. Food and Drug Administration. 5 Things to Know about Delta-8 Tetrahydrocannabinol (Delta-8 THC). Content current as of May 4, 2022. [cited 2026 Oct 20]

11. Centers for Disease Control and Prevention. Increases in Availability of Cannabis Products Containing Delta-8 THC and Reported Cases of Adverse Events. Health Alert Network, CDCHAN-00451, September 14, 2021. [cited 2026 Oct 20]

12. Congressional Research Service. Changes to the Statutory Definition of Hemp and Implications for Agricultural Policy. IF13136, updated September 28, 2026. [cited 2026 Oct 20]

13. Rubio-Tapia A, McCallum R, Camilleri M. AGA Clinical Practice Update on Diagnosis and Management of Cannabinoid Hyperemesis Syndrome: Commentary. Gastroenterology. 2024;166(5):930-934.e1. doi:10.1053/j.gastro.2024.01.040. PMID: 38456869. [cited 2026 Oct 20]

14. Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment, a Systematic Review. J Med Toxicol. 2017;13(1):71-87. doi:10.1007/s13181-016-0595-z. PMID: 28000146. [cited 2026 Oct 20]

15. Levinthal DJ, Killian B, Issenman RM. Acute care of cyclic vomiting syndrome and cannabinoid hyperemesis syndrome in the home and emergency department. Neurogastroenterol Motil. 2025;37(3):e14901. doi:10.1111/nmo.14901. PMID: 39155452. [cited 2026 Oct 20]

16. Smith SA, Safwat MA, Piper BJ, Addison MA. Unraveling the Enigma of Cannabinoid Hyperemesis Syndrome: A Narrative Review of Diagnosis and Management. Cureus. 2025;17(8):e90961. doi:10.7759/cureus.90961. PMID: 41001336. [cited 2026 Oct 20]

17. Nourbakhsh M, Miller A, Gofton J, Jones G, Adeagbo B. Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases. J Forensic Sci. 2019;64(1):270-274. doi:10.1111/1556-4029.13819. PMID: 29768651. [cited 2026 Oct 20]

18. Vivolo-Kantor AM, Liu S, Tanz LJ, Mattson CL, Schier J. Trends in Emergency Department Visits Involving Cannabis Hyperemesis Syndrome Identified Using a New Diagnosis Code, United States, January 2023-May 2026. MMWR Morb Mortal Wkly Rep. 2026;75(30):391-396. doi:10.15585/mmwr.mm7530a2. PMID: 42560855. [cited 2026 Oct 20]

19. MedlinePlus, National Library of Medicine. Nausea and vomiting, adults. Reviewed July 22, 2025. [cited 2026 Oct 20]

20. 988 Suicide and Crisis Lifeline. 988lifeline.org. [cited 2026 Oct 20]

21. Substance Abuse and Mental Health Services Administration. SAMHSA’s National Helpline. [cited 2026 Oct 20]

22. Health Resources and Services Administration. Poison Help. [cited 2026 Oct 20]

23. MedlinePlus, National Library of Medicine. Dehydration. [cited 2026 Oct 20]

24. MedlinePlus, National Library of Medicine. Alcohol withdrawal. [cited 2026 Oct 20]

This content has been reviewed and approved by a licensed physician.

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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Diane Ridaeus

Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.