Study Findings on CHS Prevalence
The cross-sectional analysis, published in JAMA Network Open, used the Nationwide Emergency Department Sample (NEDS) to estimate CHS prevalence and trends.
- Sharp Rise in Visits: CHS visits rose dramatically from 4.36 to 22.33 per 100,000 ED visits between 2016 and 2022, peaking in the second quarter of 2020.
- Cyclic Vomiting Syndrome (CVS) Decline: During the same period, ED visits for CVS decreased from 300 to 186 per 100,000 visits, suggesting that clinicians are increasingly recognizing and correctly diagnosing CHS instead of misclassifying it as CVS.
- Conditional Probability: The likelihood of a patient with a CVS code actually having CHS rose sharply over time, particularly among younger adults, climbing from 3.3% in 2019 to 13.2% in 2021.
Sociodemographic Profile of CHS Patients
CHS patients exhibit a distinct profile compared to those with other diagnoses:
| Characteristic | CHS Visits | Comparison Group (No Cannabis/CVS) |
| Mean Age | 30.6 years | 48.1 years |
| Age Clustering | 67.2% were aged 18 to 35 years | - |
| Sex Distribution | Nearly even (50.8% female, 49.2% male) | Female predominance in overall CVS |
| Region | More prominent in the West and Northeast | South had the largest overall ED share |
The risk of receiving a CHS diagnosis was more than three times higher for patients aged 18 to 25 compared with those aged 36 to 50. Female sex was associated with a slightly lower CHS risk (relative risk ratio of 0.92).
Understanding Cannabinoid Hyperemesis Syndrome
CHS was first identified in 2004 and is now recognized as a syndrome tied to chronic, heavy cannabis use, with proposed causes including changes in cannabinoid receptors and disrupted body temperature regulation.
The three phases of CHS are
- Prodromal Phase: Months or years of mild symptoms like abdominal pain and morning nausea.
- Hyperemetic Phase: Lasts a few days, characterized by recurrent, severe vomiting that can escalate to "scromiting" (screaming in pain while vomiting).
- Recovery Phase: Symptoms diminish within days or months after abstaining from cannabis.
A key distinguishing symptom is the tendency for CHS sufferers to find temporary relief through compulsive hot water bathing, often for hours at a time.
Clinical and Public Health Implications
The researchers emphasize that the rise in CHS is concerning, especially as nearly half of U.S. residents now live in states with legalized recreational cannabis.
- Need for Awareness: The study authors urge ED clinicians to prepare for the consequences of increased cannabis use, arguing that underdiagnosis or misclassification may still be occurring, leading to unnecessary testing and ineffective treatments.
- Diagnostic Improvement: Clinicians need guidelines and decision-support tools to accurately differentiate CHS from other gastrointestinal issues. Key signs include recurrent severe nausea and vomiting, abdominal pain, and the unique symptom of compulsive hot bathing.
- Coding & Surveillance: A dedicated International Classification of Diseases, Tenth Revision (ICD-10) code for CHS, F12.188, became available in the 2025 update, which should help track the condition more accurately, provided clinicians consistently recognize and apply the code.
Disclaimer: This content is published only for health awareness and informational purposes. It's not a substitute for your professional medical advice. You must consult a doctor/healthcare professional regarding your specific health concerns.
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