New ER Algorithm Helps Distinguish Cannabis Hyperemesis from Cannabis Withdrawal Syndrome | Research

The takeaway

A literature review proposed a novel therapeutic algorithm for emergency departments to distinguish between cannabis hyperemesis syndrome and cannabis withdrawal syndrome, which present similarly but require different treatments.

Emergency physicians; triage nurses; gastroenterologists; patients experiencing recurrent vomiting who use cannabis.

CHS occurs during active use; CWS occurs after cessation; treatments differ

What the researchers found

CHS and CWS both present with abdominal pain and vomiting but arise from different pathophysiology. CHS occurs during active heavy use while CWS occurs after cessation. Distinguishing between them is essential for appropriate treatment. The authors proposed a clinical algorithm for ER decision-making and emphasized long-term outpatient follow-up.

Why it matters

Cannabis-related ER visits are increasing. Many clinicians conflate CHS and CWS or miss both diagnoses entirely. A clear clinical algorithm can improve accurate diagnosis, appropriate treatment, and reduce repeat ER visits.

The numbers in context

CHS occurs during active heavy cannabis use. CWS occurs after cessation. Both present with abdominal pain and vomiting. The review synthesized treatment options for each condition and proposed a decision algorithm.

How the study worked

Literature review of PubMed, Google Scholar, and Cochrane databases up to November 2021, using keywords related to cannabis, hyperemesis, withdrawal, and emergency medicine. Synthesized findings into a novel therapeutic algorithm.

What this study cannot tell us

The proposed algorithm has not been prospectively validated. The underlying evidence base consists primarily of case reports and observational studies. Individual presentations may not fit neatly into the algorithm.

How to read the evidence

Moderate: thorough literature review with practical clinical application, though the proposed algorithm is not yet validated.

When this study was published

Published in 2022.

The bigger picture

As cannabis use increases globally, emergency departments need practical tools for cannabis-related presentations. This review fills a gap by providing a structured approach to a diagnostic challenge that is becoming increasingly common.

Questions still open

Would prospective validation of the algorithm improve ER outcomes? Could the algorithm be integrated into electronic health record decision support systems? What is the optimal duration of outpatient follow-up?

Common questions

How can you tell CHS from cannabis withdrawal?

CHS occurs while someone is actively using cannabis heavily, while CWS occurs after stopping. Both cause nausea and vomiting, but CHS is often accompanied by compulsive hot bathing and resolves only with sustained abstinence, while CWS resolves as the body adjusts to absence of cannabis.

Why do cannabis users keep going to the ER?

Both CHS and CWS cause severe symptoms that mimic other conditions. Without correct diagnosis, patients may receive treatments that provide only temporary relief, leading to recurrent ER visits. Correct identification and outpatient follow-up can break this cycle.

Read the original research

Cannabinoid hyperemesis syndrome and cannabis withdrawal syndrome: a review of the management of cannabis-related syndrome in the emergency department.

International journal of emergency medicine, 15(1), 45

View on PubMed ↗Publisher’s paper ↗

Citation

Razban, Mohammad; Exadaktylos, Aristomenis K; Santa, Vincent Della; Heymann, Eric P. (2022). Cannabinoid hyperemesis syndrome and cannabis withdrawal syndrome: a review of the management of cannabis-related syndrome in the emergency department.. International journal of emergency medicine, 15(1), 45. https://doi.org/10.1186/s12245-022-00446-0