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Is It Just Me or Are We Seeing More Cannabis Hyperemesis?

September 30, 2022

Written by Aaron Lacy

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Legalization of cannabis in Ontario was not associated with an increase in ED visits for cannabis hyperemesis syndrome (CHS); however, after legislation passed allowing commercialization of cannabis, there was a large increase in visits for CHS.

Why does this matter?
Nausea and vomiting are a common symptoms that prompts a visit to the emergency department. If the underlying cause of the nausea and vomiting is not addressed, it can lead to decreased quality of life for patients and additional healthcare utilization. If widespread legalization and commercialization of cannabis continues, should we expect an increase in patients presenting with CHS?

Mary J is a 24-year-old who presents with intractable nausea and vomiting…
This was a cross-sectional study using interrupted time-series to examine changes in ED visits for CHS in Ontario, Canada. The three time-series were all related to cannabis legislation: pre-legalization (January 2014-September 2018), legalization with product and retail store restrictions (October 2018-February 2020), and commercialization with new products and expanded stores (March 2020-June 2021).

During the study period (January 2014 to June 2021), there were 12,866 ED visits from 8,140 people for CHS; 1,135 (8.8%) visits led to hospital admission. Overall, monthly rates of CHS ED visits increased from 0.26 visits per 100,000 population to 3.43 visits per 100,000 population, a 13-fold increase. The authors note that even prior to legalization, CHS-related ED visits were increasing over time. This rate of increase did not change in the period after the legalization of cannabis (October 2018-February 2020). However, there was a large, immediate increase in CHS visits per capita after commercialization (IRR 1.32; 95%CI 1.07-1.63). The authors postulate this is because cannabis was available in more potent forms, and commercialization was associated with more individuals trying the drug. As legal regulations relax and cannabis use increases, keep this cause of nausea and vomiting in your differential diagnosis.

Changes in Emergency Department Visits for Cannabis Hyperemesis Syndrome Following Recreational Cannabis Legalization and Subsequent Commercialization in Ontario, Canada. JAMA Netw Open. 2022 Sep 16. Doi:10.1001/jamanetworkopen.2022.31937

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