Droperidol Cuts ER Time by 36% for Cannabinoid Hyperemesis Syndrome | Research

The takeaway

Emergency department patients with cannabinoid hyperemesis syndrome who received droperidol had 24% shorter stays, needed fewer total medications, and were 84% less likely to receive opioids.

Emergency physicians, cannabis users experiencing cyclic vomiting, toxicologists

409 vs. 641 minutes ER stay with droperidol

What the researchers found

Among 211 CHS encounters, droperidol use (36.5% of cases) was associated with a 24% reduction in length of stay (mean ratio 0.76, p = 0.01), 66% lower odds of receiving additional medications (OR 0.34, p < 0.001), and 84% lower odds of opioid use (OR 0.16, p < 0.001). Median stay was 409 minutes with droperidol vs. 641 minutes without.

Why it matters

Cannabinoid hyperemesis syndrome is an increasingly common ER presentation with no established standard treatment. Finding an effective first-line therapy that also reduces opioid use addresses two problems at once.

The numbers in context

211 encounters; 158 unique patients; droperidol in 36.5% at median 1.25 mg; LOS 409 vs. 641 minutes; 84% reduction in opioid use (OR 0.16); 2 mild adverse reactions.

How the study worked

Retrospective study of 211 CHS encounters among 158 unique patients at two tertiary academic emergency departments in Atlanta from March-August 2024. Patients stratified by droperidol use with adjusted analyses.

What this study cannot tell us

Retrospective design with potential selection bias in who received droperidol. Single health system in one city. CHS diagnosis based on ICD codes and chart review. Cannot establish causation.

How to read the evidence

Retrospective cohort from two academic EDs with adjusted analyses, but without randomization or blinding.

When this study was published

2025 publication with data from March-August 2024

The bigger picture

As cannabis use increases, so do CHS presentations. Emergency departments currently use a grab bag of medications. Droperidol, an older antiemetic that fell out of favor due to QTc concerns, may be finding new relevance in the cannabis era.

Questions still open

Would a randomized trial confirm droperidol as first-line for CHS?
What is the optimal droperidol dosing regimen for CHS?

Common questions

What is the best treatment for cannabinoid hyperemesis syndrome in the ER?

This study found droperidol (a potent antiemetic) was associated with 24% shorter ER stays and 84% fewer opioid prescriptions compared to standard care. The authors suggest it may be considered as a first-line treatment, though randomized trials are still needed.

Does droperidol have side effects when used for CHS?

In this study of 211 encounters, only 2 mild adverse drug reactions occurred in the droperidol group. The typical dose was 1.25 mg. Historically, droperidol raised QTc prolongation concerns, but modern usage at lower doses appears well-tolerated.

Read the original research

Droperidol is associated with reduced length of stay in the treatment of cannabinoid hyperemesis syndrome.

Clinical toxicology (Philadelphia, Pa.), 63(8), 550-555

View on PubMed ↗Publisher’s paper ↗

Citation

Kelly, Geoffrey S; Meeks, Gavin; McCoul, Bradley; Doshi, Vidhi K; Moran, Tim P. (2025). Droperidol is associated with reduced length of stay in the treatment of cannabinoid hyperemesis syndrome.. Clinical toxicology (Philadelphia, Pa.), 63(8), 550-555. https://doi.org/10.1080/15563650.2025.2516128