Emergency department guidelines for managing cannabinoid hyperemesis syndrome
New GRADE-based guidelines recommend haloperidol, droperidol, or topical capsaicin for CHS symptom management in the emergency department.
Quick Facts
What This Study Found
The GRACE-4 panel issued two CHS-specific recommendations: use of haloperidol or droperidol alongside standard antiemetics, and offering topical capsaicin as an additional option, both graded at very low certainty of evidence.
Key Numbers
Two CHS-specific recommendations issued. Both rated at very low certainty of evidence. Guidelines also covered alcohol withdrawal and alcohol use disorder across 6 total priority questions.
How They Did This
A writing team of emergency physicians and addiction medicine experts applied the GRADE framework to assess evidence and formulate recommendations on six priority questions, including two focused on CHS management in adult ED patients.
Why This Research Matters
CHS is increasingly common in emergency departments, but until now there were no widely adopted evidence-based guidelines for its management. These recommendations give ER clinicians a structured approach to a condition that can be difficult to treat.
The Bigger Picture
As cannabis use increases, CHS cases are rising in emergency departments. Having standardized clinical guidelines helps ensure consistent treatment and signals growing recognition of CHS as a distinct clinical entity.
What This Study Doesn't Tell Us
Both CHS recommendations carry very low certainty of evidence, meaning future research could substantially change these suggestions. The guidelines are also specific to adult ED patients and may not apply to other settings.
Questions This Raises
- ?How effective are haloperidol and capsaicin compared head-to-head for CHS?
- ?What is the optimal duration of CHS treatment in the ED?
- ?Are there patient subgroups who respond better to specific interventions?
Trust & Context
- Key Stat:
- Very low certainty of evidence for both CHS treatment recommendations
- Evidence Grade:
- Based on GRADE methodology, the panel rated both CHS recommendations at very low certainty, meaning confidence in the estimated effect is limited and future studies may change conclusions.
- Study Age:
- Published in 2024. Represents the most current emergency medicine guidelines for CHS management.
- Original Title:
- Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department.
- Published In:
- Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 31(5), 425-455 (2024)
- Authors:
- Borgundvaag, Bjug, Bellolio, Fernanda, Miles, Isabelle, Schwarz, Evan S, Sharif, Sameer, Su, Mark K, Baumgartner, Kevin, Liss, David B, Sheikh, Hasan, Vogel, Jody, Austin, Emily B, Upadhye, Suneel, Klaiman, Michelle, Vellend, Robert, Munkley, Anna, Carpenter, Christopher R
- Database ID:
- RTHC-05152
Evidence Hierarchy
Frequently Asked Questions
What is cannabinoid hyperemesis syndrome?
CHS is a condition seen in regular cannabis users involving cyclic episodes of severe nausea, vomiting, and abdominal pain. It typically resolves with cannabis cessation.
What treatments do these guidelines recommend for CHS?
The guidelines suggest haloperidol or droperidol in addition to standard antiemetics like ondansetron, and also suggest offering topical capsaicin as an add-on option.
How strong is the evidence behind these recommendations?
Both CHS recommendations are based on very low certainty evidence according to the GRADE framework, indicating the need for more research.
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Cite This Study
https://rethinkthc.com/research/RTHC-05152APA
Borgundvaag, Bjug; Bellolio, Fernanda; Miles, Isabelle; Schwarz, Evan S; Sharif, Sameer; Su, Mark K; Baumgartner, Kevin; Liss, David B; Sheikh, Hasan; Vogel, Jody; Austin, Emily B; Upadhye, Suneel; Klaiman, Michelle; Vellend, Robert; Munkley, Anna; Carpenter, Christopher R. (2024). Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 31(5), 425-455. https://doi.org/10.1111/acem.14911
MLA
Borgundvaag, Bjug, et al. "Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department.." Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2024. https://doi.org/10.1111/acem.14911
RethinkTHC
RethinkTHC Research Database. "Guidelines for Reasonable and Appropriate Care in the Emerge..." RTHC-05152. Retrieved from https://rethinkthc.com/research/borgundvaag-2024-guidelines-for-reasonable-and
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.