Increase in Emergency Department Visits for Cannabis Hyperemesis Syndrome — Evidence Review
Published by researchers at University of Washington School of Medicine
Researched by
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Table of Contents
A new study from the University of Washington School of Medicine highlights the addition of a formal diagnostic code for cannabis hyperemesis syndrome (CHS), a condition marked by recurrent vomiting in chronic cannabis users. This finding aligns with previous research documenting a rise in emergency department visits for cannabis-related vomiting, supporting the need for standardized recognition and tracking of CHS.
- The creation of a specific ICD code for CHS is consistent with earlier studies reporting increased emergency visits and recognition of cyclic vomiting linked to cannabis use, particularly following greater cannabis accessibility and liberalization policies 1 5 11.
- Related literature emphasizes the diagnostic challenges and recurring healthcare costs tied to CHS, underscoring the importance of improved clinical awareness, documentation, and patient education about the syndrome 2 4 11.
- Consensus exists in the literature that cessation of cannabis is the most effective treatment for CHS, though symptom relief strategies such as hot showers and capsaicin cream are often used; pharmacologic treatments remain an area needing further research 11 12 13 14.
Study Overview and Key Findings
The formal recognition of cannabis hyperemesis syndrome with a dedicated ICD code marks a significant development for clinicians and researchers tracking cannabis-related health outcomes. This change addresses a growing clinical challenge as emergency departments report increasing cases of severe vomiting among chronic cannabis users. The study highlights not only the clinical features and diagnostic difficulties of CHS but also the implications for public health surveillance and patient care, particularly in regions with expanding cannabis access and use.
| Property | Value |
|---|---|
| Organization | University of Washington School of Medicine |
| Authors | Beatriz Carlini, Chris Buresh |
| Population | Patients with cannabis hyperemesis syndrome |
| Outcome | Recognition and documentation of cannabis hyperemesis syndrome |
| Results | Emergency departments see a rise in cannabis-related vomiting cases. |
Literature Review: Related Studies
To situate the new study within the broader research landscape, we searched the Consensus database—which includes over 200 million papers—using the following queries:
- cannabis emergency room vomiting cases
- cannabis use health outcomes
- cannabis hyperemesis syndrome studies
Related Studies by Key Topic
| Topic | Key Findings |
|---|---|
| How has the prevalence and recognition of cannabis hyperemesis syndrome changed? | - Emergency department visits for vomiting associated with cannabis use have increased as cannabis use and liberalization have expanded 1 5. - The lack of a standardized diagnostic code previously hampered tracking and recognition of CHS, leading to underestimation and delayed diagnosis 2 4 11. |
| What are the clinical features, challenges, and treatments for CHS? | - CHS is characterized by cyclic vomiting, abdominal pain, compulsive hot bathing, and symptom resolution with cannabis cessation 4 11. - Standard antiemetic therapies often fail; alternative options include topical capsaicin, haloperidol, and patient education on cannabis cessation, with some evidence supporting their use 2 12 13 14. |
| What are the broader health outcomes and risks associated with chronic cannabis use? | - Chronic cannabis use is linked to increased risk of dependence, negative mental health outcomes, and other adverse physical effects, including vomiting and, rarely, severe toxicity 6 7 8 9 10. - Adolescents and young adults are particularly vulnerable to psychosocial and mental health consequences of regular cannabis use 7 8 9. |
| How do changes in cannabis policy and product potency affect CHS incidence? | - Increases in cannabis access and higher-potency products may contribute to greater incidence and recognition of CHS, though causality is not fully established 1 5 11. - Post-liberalization, patients with cyclic vomiting are more likely to report cannabis use and be recognized as CHS cases, suggesting policy shifts influence clinical patterns 1 5. |
How has the prevalence and recognition of cannabis hyperemesis syndrome changed?
Recent research demonstrates a steady increase in emergency department visits for vomiting related to cannabis use, particularly following increased legalization and use of cannabis products. The lack of a standardized diagnostic code prior to the recent update hindered accurate tracking, making it difficult for clinicians and researchers to fully understand the scope of CHS. The new study's emphasis on the formal recognition of CHS directly addresses calls from earlier research for improved documentation and surveillance.
- Emergency department presentations for cyclic vomiting nearly doubled in regions after the liberalization of cannabis laws, with a notable rise in cases linked to cannabis use 1 5.
- Previous studies highlighted diagnostic challenges, with patients often undergoing multiple visits and unnecessary investigations before CHS was recognized 2 4.
- The absence of a unique ICD code for CHS led to underreporting and made it difficult to study trends and outcomes 11.
- The new diagnostic code is expected to improve case identification, epidemiological tracking, and research into CHS prevalence 11.
What are the clinical features, challenges, and treatments for CHS?
The clinical literature consistently describes CHS as a syndrome seen in chronic cannabis users, marked by repeated episodes of severe vomiting, abdominal pain, and relief with hot showers or baths. Standard antiemetic therapies frequently fail, prompting the exploration of alternative treatments such as topical capsaicin and antipsychotics like haloperidol. However, the most reliable resolution of symptoms is achieved with cessation of cannabis use.
- CHS is typically associated with daily to weekly cannabis use, cyclic vomiting, abdominal pain, and compulsive bathing behaviors 4 11.
- Conventional antiemetics are often ineffective; capsaicin cream and haloperidol have shown symptom relief in some acute cases 12 13 14.
- Expert consensus guidelines recommend focusing on patient education about the need for cannabis cessation and avoiding unnecessary opioid use 2 11.
- Recurrence of symptoms is common if cannabis use resumes, highlighting the importance of sustained abstinence 4 11.
What are the broader health outcomes and risks associated with chronic cannabis use?
Chronic and heavy cannabis use has been linked to a range of adverse health outcomes beyond CHS, including increased risks of dependence, poor psychosocial outcomes, mental health disorders, and, less commonly, severe acute toxicity. Adolescents and young adults are particularly susceptible to the long-term negative effects of regular cannabis use.
- Epidemiological studies report that up to 10% of regular cannabis users develop dependence, and chronic use is associated with negative outcomes such as cognitive impairment, psychoses, and poor psychosocial adjustment 7 9.
- Cannabis use in adolescence is associated with higher risk of depression, suicidality, and potential for other substance use in young adulthood 8 9.
- Acute toxicity from cannabis can include neurobehavioral symptoms and vomiting, with rare cases of severe cardiovascular complications and death 3 9.
- Health risks may vary with the method of administration and product potency, with higher-potency products potentially increasing adverse effects 10.
How do changes in cannabis policy and product potency affect CHS incidence?
Several studies suggest that the incidence and recognition of CHS have increased in tandem with the liberalization of cannabis laws and the availability of higher-potency products. However, the direct impact of policy and product changes on CHS rates is still being investigated.
- After medical marijuana liberalization in Colorado, the prevalence of cyclic vomiting presentations nearly doubled, and patients were more likely to report cannabis use 1.
- National trends in the U.S. show rising emergency department visits for vomiting associated with cannabis use disorder, particularly among young adult men, in regions with greater cannabis access 5.
- Some studies speculate that higher THC potency or increased cannabis availability may contribute to CHS, but definitive causal links have yet to be established 11.
- Improved recognition and documentation, as enabled by the new ICD code, may clarify the relationship between policy changes and CHS incidence over time 11.
Future Research Questions
As cannabis use continues to rise and policies evolve, further research is essential to address remaining gaps in our understanding of CHS and its broader health impacts. Key areas for future investigation include the underlying mechanisms of CHS, optimal management strategies, the influence of cannabis potency and product types, and effective approaches to prevention and patient education.
| Research Question | Relevance |
|---|---|
| What are the underlying biological mechanisms of cannabis hyperemesis syndrome? | Understanding the pathophysiology of CHS is critical for developing targeted treatments and prevention strategies, as current knowledge is limited and largely speculative 11. |
| Which pharmacologic and non-pharmacologic treatments are most effective for acute CHS symptoms? | There is a lack of high-quality evidence on the comparative effectiveness of treatments such as capsaicin, haloperidol, and standard antiemetics, making it important to determine best practices for acute management 12 13 14. |
| How do cannabis potency and product types influence the risk of CHS? | The potential role of higher THC potency and novel cannabis products in CHS incidence is unclear, warranting further research to inform public health recommendations and regulatory policy 1 5 10 11. |
| What are the most effective strategies for preventing CHS recurrence in patients who resume cannabis use? | Many patients relapse due to addiction or disbelief in the diagnosis, leading to recurrent ED visits; finding effective prevention and education strategies remains an unmet need 2 4 11. |
| How does the implementation of a dedicated ICD code affect CHS diagnosis and clinical outcomes over time? | Tracking the impact of the new diagnostic code will help assess whether improved recognition leads to earlier diagnosis, reduced healthcare costs, and better patient outcomes 11. |