Cannabis Hyperemesis Syndrome Drove 134,000 ER Visits Over Nine Years

CHS accounted for 134,059 of 248,293,507 ED encounters (0.05%). Mean patient age was 32 years. Admission rate remained steady at ~13.5% with mean 3.8-day hospital stay. Ondansetron was the most common treatment (58.7%), followed uniquely by haloperidol (32.6%) rather than the metoclopramide used for gastroparesis and cyclic vomiting.

Retrospective cohort study of all ED presentations for gastroparesis, cyclic vomiting syndrome, and CHS from 2016-2024 in the Epic Cosmos database (248 million encounters). ICD-10 codes identified cases. Outcomes included incidence, admission rates, medications, and length of stay.

This is the largest dataset ever analyzed for CHS emergency department visits. The steady admission rate and distinctive treatment patterns (haloperidol for CHS vs. metoclopramide for other vomiting disorders) confirm CHS as a clinically distinct entity requiring different management than other vomiting syndromes.

The emergence of CHS as a condition generating over 134,000 ED visits in less than a decade underscores the real-world health burden of heavy cannabis use. The distinctive haloperidol treatment pattern reflects clinical learning about what actually works for CHS versus other vomiting disorders.

ICD-10 coding may undercount CHS (misdiagnosed as CVS) or overcount it (coding errors). Epic Cosmos captures only participating health systems. Cannot determine cannabis use patterns or product types. Admission rates and treatments reflect clinical practice variation, not evidence-based guidelines.