ED visits for cannabinoid hyperemesis syndrome rose from 43 to 62 cases in comparable 8-month periods before and after Oklahoma's first medical cannabis sales, a statistically significant increase (P=0.026), with a prevalence far higher than previously reported in the literature.
Emergency physicians, gastroenterologists, cannabis policy researchers, medical cannabis patients.
CHS visits rose 44% after Oklahoma medical cannabis legalization
What the researchers found
CHS-related ED visits increased from 43 cases pre-legalization to 62 post-legalization (P=0.026), despite total ED visits decreasing from 30,437 to 28,362. The proportion of ED visits for CHS (220/100,000) was much higher than previously reported (13.3/100,000). No demographic differences between pre- and post-legalization groups.
Why it matters
CHS causes severe vomiting episodes that can lead to dehydration and kidney injury. The much higher prevalence found here compared to prior literature suggests CHS may be significantly underdiagnosed or that Oklahoma's medical cannabis market has unique characteristics.
The numbers in context
Pre-legalization: 43 CHS cases in 30,437 ED visits. Post-legalization: 62 cases in 28,362 visits (P=0.026). CHS proportion: 220/100,000 vs. 13.3/100,000 in prior literature.
How the study worked
Retrospective chart review comparing equivalent 8-month periods before and after the first legal medical cannabis sales in Oklahoma, at a single urban ED.
What this study cannot tell us
Single-center retrospective design. Cannot distinguish whether increase is from more CHS cases, better provider recognition, or increased cannabis use. Short comparison window (8 months). "Suspected CHS" inclusion may overestimate true cases.
How to read the evidence
Single-center retrospective chart review with significant finding, but limited by short timeframe and single location.
When this study was published
Published in 2023.
The bigger picture
Oklahoma's medical cannabis program expanded rapidly, becoming one of the largest per capita in the US. The high CHS rate found here could reflect this rapid expansion, high THC concentrations in Oklahoma products, or increased provider awareness of the diagnosis.
Questions still open
- Is the much higher CHS prevalence due to underdiagnosis elsewhere or unique factors in Oklahoma?
- Do high-THC products in Oklahoma contribute to higher CHS rates?
Common questions
Did medical cannabis legalization increase cannabinoid hyperemesis?
How common is cannabinoid hyperemesis syndrome?
Read the original research
Cannabinoid Hyperemesis Encounters After Medical Legalization in Oklahoma.
Cureus, 15(10), e46465
Citation
Riha, Randal; Winchell, Ryan; Safo, Danielle; Gentges, Joshua. (2023). Cannabinoid Hyperemesis Encounters After Medical Legalization in Oklahoma.. Cureus, 15(10), e46465. https://doi.org/10.7759/cureus.46465