An Addiction Team in the Emergency Department Helped Identify and Treat Cannabis Hyperemesis Syndrome | Research

The takeaway

A specialized addiction team in a French emergency department identified seven cases of cannabis hyperemesis syndrome over seven months, with five patients entering addiction follow-up care.

Read this if you work in emergency medicine or addiction treatment, or if you experience cyclical vomiting and use cannabis regularly.

5 of 7 CHS patients (71%) entered addiction follow-up through ED-based addiction team.

What the researchers found

Over a seven-month period, a specialized addiction team in a French emergency department identified seven cases of cannabinoid hyperemesis syndrome (CHS) among cannabis users admitted for vomiting or abdominal pain.

The patients were young adults (mean age 24.7 years, mostly male). Five of seven reported compulsive hot bathing to relieve symptoms. All patients had negative biological workups, imaging, and endoscopy, indicating prior unnecessary testing.

THC blood levels were measured in four patients, with a mean concentration of 11.6 ng/mL. Treatment was symptomatic. Five of the seven patients began follow-up with the addiction team, suggesting the ED encounter created a pathway to ongoing care.

Why it matters

CHS remains under-diagnosed more than a decade after it was first described. This study demonstrates that embedding addiction specialists in emergency departments can improve early recognition, reduce unnecessary testing, and connect patients with ongoing treatment. The 71% follow-up rate (5 of 7 entering care) is notable for a population that often does not engage with addiction services.

The numbers in context

7 patients identified over 7 months. Mean age 24.7 years. Mean THC blood level 11.6 ng/mL (4 patients tested). 5 of 7 (71%) compulsively used hot baths. 5 of 7 (71%) began addiction follow-up.

How the study worked

This was a retrospective pilot study conducted at a French emergency department from June 2014 to January 2015. Cannabis users admitted for vomiting or abdominal pain were evaluated by a specialized addiction team and diagnosed with CHS. Medical records were then reviewed retrospectively.

What this study cannot tell us

Very small sample size (7 patients). Retrospective design. Single center in France, which may not reflect practices elsewhere. The study cannot quantify how many CHS cases were missed during the same period. No control group to compare outcomes without addiction team involvement.

How to read the evidence

Preliminary evidence from a small pilot study at a single center. The model is promising but needs larger-scale validation.

When this study was published

Published in 2016. ED-based addiction consultation services have expanded since this study.

The bigger picture

Emergency departments are often the first point of medical contact for people experiencing cannabis-related complications. Having addiction specialists available in the ED transforms what would be a symptom-focused visit into an opportunity for diagnosis, education, and connection to ongoing care.

Questions still open

How many CHS cases go undiagnosed in EDs without addiction specialists? What is the long-term cannabis cessation rate for patients diagnosed with CHS through this model? Would training ED physicians to recognize CHS be as effective as embedding addiction teams?

Common questions

Why is CHS still being missed in emergency departments?

Because cannabis is known as an anti-nausea drug, many clinicians do not consider it as a cause of vomiting. Patients may also not disclose cannabis use. Without awareness of CHS, patients undergo extensive and unnecessary testing.

Does having an addiction team in the ED help?

In this pilot study, the addiction team identified CHS cases that might otherwise have been missed and connected 71% of patients with ongoing care, suggesting this model can both improve diagnosis and facilitate treatment.

Read the original research

Cannabis Hyperemesis Syndrome in the Emergency Department: How Can a Specialized Addiction Team Be Useful? A Pilot Study.

The Journal of emergency medicine, 51(5), 544-551

View on PubMed ↗Publisher’s paper ↗

Citation

Pélissier, Fanny; Claudet, Isabelle; Gandia-Mailly, Peggy; Benyamina, Amine; Franchitto, Nicolas. (2016). Cannabis Hyperemesis Syndrome in the Emergency Department: How Can a Specialized Addiction Team Be Useful? A Pilot Study.. The Journal of emergency medicine, 51(5), 544-551. https://doi.org/10.1016/j.jemermed.2016.06.009