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However, it has actions in the brain and gut that can modulate the effects of THC, and it is a known antiemetic in animals.3537 Understanding of the ECS has now been broadened to include an expanded repertoire of signaling molecules and receptors, through the inclusion of the endovanilloids and the transient receptor potential vanilloid-1 (TRPV1).38 Since the endovanilloids are also involved in the regulation of emesis, the TRPV1 agonist, capsaicin, is a potential therapeutic for CHS.3840 The paradox of chronic heavy cannabis use: increased risk of hyperemesis Heavy chronic cannabis use, in some people, leads to recurrent nausea and vomiting and abdominal pain, and presumably to CHS