Spanish ER study finds CHS incidence of 4.4 per 10,000 visits, with capsaicin resolving vomiting in about 18 minutes | Research

The takeaway

In a Spanish emergency department, cannabinoid hyperemesis syndrome occurred at a rate of 4.4 per 10,000 visits, half of patients returned for repeat episodes, and topical capsaicin 0.075% resolved vomiting in an average of about 18 minutes.

Emergency physicians, cannabis users experiencing recurrent vomiting episodes, and public health researchers.

Capsaicin resolved vomiting in ~18 minutes; 50% of patients returned

What the researchers found

Across 59 ED visits from 29 patients, CHS incidence was 4.4 per 10,000 visits. Fifty percent of patients returned for repeat episodes, with returners having higher rates of tobacco and cocaine use. Capsaicin 0.075% was used in 74.6% of visits and resolved vomiting in a mean of 17.87 minutes.

Why it matters

This is one of few studies providing incidence data for CHS in a European emergency department and demonstrates the rapid effectiveness of topical capsaicin as a first-line treatment.

The numbers in context

59 visits from 29 patients; 4.4 cases/10,000 visits (95% CI 2.8-4.7); 50% returned; capsaicin used in 74.6% of visits; mean time to vomiting resolution: 17.87 minutes.

How the study worked

Retrospective study of patients over 14 years old seen in a hospital emergency department during 2018-2019 with CHS diagnosis based on compatible clinical picture, cannabis use within 48 hours, and positive urine cannabis test.

What this study cannot tell us

Single hospital, likely underdiagnosed cases. Retrospective design. Small patient number. Two-year timeframe may not capture seasonal variations. No comparison group for treatment effectiveness.

How to read the evidence

Retrospective single-center study with useful incidence and treatment data, but likely underestimates true incidence.

When this study was published

Published in 2022 with data from 2018-2019.

The bigger picture

The high recurrence rate (50%) confirms that CHS is a chronic condition when cannabis use continues, and the rapid effectiveness of capsaicin cream suggests it should be a standard ED treatment for CHS.

Questions still open

Is CHS truly rare or just underdiagnosed? Would higher capsaicin concentrations work faster? Could capsaicin cream be used by patients at home for early symptom management?

Common questions

How common is CHS in the emergency department?

This Spanish study found about 4.4 CHS cases per 10,000 ER visits, but the researchers note CHS is probably underdiagnosed, so the true rate may be higher.

How does capsaicin cream work for CHS?

Applied topically to the abdomen, 0.075% capsaicin cream resolved vomiting in an average of about 18 minutes. It was used in nearly 75% of visits and appears to work by activating TRPV1 receptors involved in CHS pathophysiology.

Read the original research

Cannabis hyperemesis syndrome: Incidence and treatment with topical capsaicin.

Medicina clinica, 159(4), 183-186

View on PubMed ↗Publisher’s paper ↗

Citation

Burillo-Putze, Guillermo; Trujillo-Burillo, David; García-Hernandez, Jose Carlos; López-Hernández, M Angeles; Hernández-Ramos, Iván; Ramos-Suárez, Isabel; Richards, John R. (2022). Cannabis hyperemesis syndrome: Incidence and treatment with topical capsaicin.. Medicina clinica, 159(4), 183-186. https://doi.org/10.1016/j.medcli.2021.07.028