TOPLINE: 

Emergency department (ED) visits for cannabinoid hyperemesis syndrome (CHS) increased from 4.36 to 22.33 per 100,000 visits between 2016 and 2022, peaking at 33.06 during the COVID-19 pandemic.

METHODOLOGY:

• Researchers conducted a cross-sectional study of 806 million ED visits (median patient age, 48 years; 54.4% women; 58.7% White individuals) related to the diagnosis of cannabis use disorder (CUD), cyclic vomiting syndrome (CVS), and CHS from 2016 to 2022.
• ED visits were categorized into four diagnostic groups: no cannabis-related diagnosis or CVS, cannabis-related diagnosis only, CVS only, and a CHS proxy defined as a primary CVS diagnosis with a cannabis-specific secondary diagnosis.
• The outcomes included the prevalence and quarterly temporal trends of CHS, CVS, and CUD diagnoses, sociodemographic and clinical factors associated with each diagnostic group, and ED disposition outcomes.

TAKEAWAY:

• Between 2016 and 2022, CUD cases increased from 1008 to 1465 per 100,000 ED visits; CHS cases increased from 4.36 to 22.33 per 100,000, peaked at 33.1 in the second quarter of 2020, and remained elevated at 22.3 in 2022.
• The survey-weighted probability of CHS among CVS visits increased from 3.3% in 2019 to 13.2% in 2021 (adjusted Wald F, 168.99; P < .001). CVS-only visits declined from 300 to 186 per 100,000 visits.
• Women had a lower risk for CHS diagnoses than men (relative risk ratio [RRR], 0.92). Young adults aged 18-25 years showed the highest risk for CHS ( RRR, 3.12) compared with adults aged 36-50 years. Regional differences were significant, with lower odds of CHS diagnoses in the South than in the Northeast (RRR, 0.46).
• Hospital admission was associated with a higher likelihood of CHS diagnosis compared with treatment and release (RRR, 1.73), and this probability increased over time (RRR, 2.10). Black patients had slightly higher odds of CHS diagnosis than White patients (RRR, 1.09), whereas Hispanic (RRR, 0.66) and Asian or Pacific Islander patients (RRR, 0.37) had significantly lower odds.

IN PRACTICE:

"This cross-sectional study found that nationally representative ED data indicated a sustained rise in CHS-related visits from 2016 to 2022, especially among young adults. CHS now accounts for a growing share of emesis-related ED presentations," the authors wrote. 

"There remains a need for education to enhance early recognition, coupled with improved reporting and tracking, particularly given the new ICD-10 coding. Efforts should also promote evidence-based interventions over traditional antiemetics," the authors of an invited commentary wrote.

SOURCE:

The study was led by James A. Swartz, PhD, Jane Addams College of Social Work, University of Illinois Chicago. It was published online on November 24, 2025, in JAMA Network Open.

LIMITATIONS:

The absence of a specific International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for CHS during the study period necessitated the use of proxy definitions, which increased the risk for misclassification. Case identification was complicated by underreporting of cannabis use and symptom overlap with other conditions. The requirement for CVS as a primary diagnosis may have led to underestimation of case counts. The Nationwide Emergency Department Sample captured visits rather than individual patients, which could have inflated counts due to repeat visits. Additionally, race and ethnicity data were available only for 2019-2022, limiting certain trend analyses.

DISCLOSURES:

This research was funded through an Institutional Government Agreement with the Illinois Department of Human Services, Division of Behavioral Health and Recovery. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.