Research highlights burden of cannabinoid hyperemesis syndrome

A new study analyzes the disease burden and the risk factors for severity among people who suffer from a condition called cannabinoid hyperemesis syndrome. Researchers at the George Washington University say the condition occurs in people who are long-term regular consumers of cannabis and causes nausea, uncontrollable vomiting and excruciating pain in a cyclical pattern that often leads to repeated trips to the hospital.

This is one of the first large studies to examine the burden of disease associated with this cannabis-linked syndrome. Our findings suggest that cannabinoid hyperemesis syndrome could represent a costly and largely hidden public health problem."

Andrew Meltzer, professor of emergency medicine, GW School of Medicine & Health Sciences and lead author of the study

While the exact prevalence of the condition is unknown, many experts say that the condition is on the rise as the number of daily or near daily users of cannabis has increased in the US.

To assess the burden of disease, Meltzer and his colleagues conducted a survey of 1,052 people who report suffering from cannabinoid hyperemesis syndrome. The researchers asked questions about frequency of use, duration of the habit, the age they started using the drug, and need for emergency department or hospital care. 

Key findings of the study:

• 85% reported at least 1 emergency department visit and 44% reported at least 1 hospitalization associated with the hyperemesis symptoms. 

• Early age of cannabis initiation was associated with higher odds of emergency department visits.

• Daily use of cannabis before the onset of the syndrome was nearly universal, with over 40% of respondents reporting they used marijuana more than 5 times a day.

• Prolonged use was common with 44% reporting using regularly for more than 5 years before onset of syndrome.

The new research suggests that the condition may impose a heavy burden on individuals who suffer from it as it often results in pain, vomiting and costly trips to the hospital. Emergency room doctors can stabilize the patient and help alleviate the acute symptoms but the only known way to stop the episodes of excruciating abdominal pain and repeated vomiting is to stop using cannabis, Meltzer says.

Although this study had some limitations, including self reported use of cannabis, Meltzer says it suggests a substantial risk of this painful and costly condition, especially for users who begin daily use of cannabis as adolescents. He says more research is needed to understand why some people suffer from the condition after prolonged cannabis exposure and others do not. In addition, it is unclear why cannabis changes from a drug that has been known to ease nausea and vomiting, especially among patients undergoing chemotherapy, to causing nausea and vomiting in a subset of people. 

Meltzer says it is important for clinicians to advise those with frequent cannabinoid use or hyperemesis about the risks and subsequent disease burden. He says many patients don't realize that the syndrome is connected with their use of cannabis. Physicians should explain that and advise patients on resources to help them quit, he says.