Changes in Emergency Department Encounters for Vomiting After Cannabis Legalization in Colorado

Wang, George Sam; Buttorff, Christine; Wilks, Asa; Schwam, Daniel; Tung, Gregory; Pacula, Rosalie Liccardo

doi:10.1001/jamanetworkopen.2021.25063

Cited by 23 publications

(30 citation statements)

References 33 publications

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“…While prior studies have broadly found that legalization is associated with increases in CHS presentations, our results suggest that regulatory approaches may influence these changes. 9 , 10 , 11 , 12 We found that legalization with strict controls over retail store access and product type was not associated with large changes in CHS. In contrast, allowing the commercialization of recreational cannabis may be associated with substantial increases in heavy and regular cannabis use, leading to CHS.…”

Section: Discussionmentioning

confidence: 76%

“…First, there is currently no diagnostic code for CHS, and our study infers CHS from a combination of diagnostic codes previously used in the literature. 9 , 10 Importantly, the specificity and sensitivity of this coding combination are currently unknown, and our study may underestimate the burden of CHS, which is often not considered as a cause of vomiting in ED visits. 19 Second, the observed increases could be from a greater awareness of CHS by ED physicians or the willingness of patients to disclose cannabis use.…”

Section: Discussionmentioning

confidence: 95%

“… 7 , 8 To date, several studies have found increases in emergency department (ED) visits owing to vomiting or CHS after the legalization of medical or recreational cannabis. 9 , 10 , 11 , 12 However, the characteristics of individuals with CHS have only previously been described in small studies or case series, limiting our understanding of who is at risk of this condition. In addition, there is limited information on how recreational cannabis legalization and different regulatory policies (eg, access to retail stores and product types) are associated with the frequency and severity of CHS or the clinical characteristics of individuals with CHS.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Emergency Department Visits for Cannabis Hyperemesis Syndrome Following Recreational Cannabis Legalization and Subsequent Commercialization in Ontario, Canada

et al. 2022

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IMPORTANCE Prior research suggests that the legalization of recreational cannabis is associated with increases in cannabis hyperemesis syndrome (CHS), but it is unclear how cannabis commercialization (ie, greater retail store access as well as increased variety and potency of cannabis products) may be associated with these changes.OBJECTIVES To examine changes in the number and characteristics of CHS emergency department (ED) visits from before to after legalization of cannabis in Ontario, Canada. DESIGN, SETTING, AND PARTICIPANTSThis repeated cross-sectional study used interrupted timeseries analyses to examine immediate and gradual changes in ED visits for CHS in Ontario, Canada, during 3 time periods: prelegalization (January 2014-September 2018), legalization with product and retail store restrictions (October 2018-February 2020), and commercialization with new products and expanded stores, which coincided with the COVID-19 pandemic (March 2020-June 2021). Data were obtained from routinely collected and linked health administrative databases. All individuals aged at least 15 years and who were eligible for Ontario's Universal Health Coverage were included. Data were analyzed between March and July 2022. MAIN OUTCOMES AND MEASURES Monthly counts of ED visits for CHS per capita.RESULTS There were 12 866 ED visits for CHS from 8140 individuals during the study. Overall, the mean (SD) age was 27.4 (10.5) years, with 2834 individuals (34.8%) aged 19 to 24 years, 4163 (51.5%) females, and 1353 individuals (16.6%) with a mental health ED visit or hospitalization in the 2 years before their first CHS ED visit. Nearly 10% of visits (1135 visits [8.8%]) led to hospital admissions.Monthly rates of CHS ED visits increased 13-fold during the 7.5-year study period, from 0.26 visits per 100 000 population in January 2014 to 3.43 visits per 100 000 population in June 2021. Legalization was not associated with an immediate or gradual change in rates of ED visits for CHS; however, commercialization during the COVID-19 pandemic period was associated with an immediate increase in rates of CHS ED visits (incidence rate ratio [IRR], 1.49; 95% CI, 1.31-1.70). During commercialization, rates of CHS ED visits increased more in women (IRR, 1.49; 95% CI, 1.16-1.92) and individuals older than the legal age of cannabis purchase (eg, age 19-24 years: IRR, 1.60; 95% CI, 1.19-2.16) than men (IRR, 1.08; 95% CI, 0.85-1.37) and individuals younger than the legal age of purchase (IRR, 0.78; 95% CI, 0.42-1.45). CONCLUSIONS AND RELEVANCEThis cross-sectional study found large increases in CHS ED visits during the period of time when the market commercialized and the COVID-19 pandemic occurred.Greater awareness of CHS symptoms by ED staff in regions where legal commercialized cannabis markets exist is indicated.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Changes in Emergency Department Visits for Cannabis Hyperemesis Syndrome Following Recreational Cannabis Legalization and Subsequent Commercialization in Ontario, Canada

et al. 2022

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“…10 CHS remains a poorly studied disorder, with very little data available globally on incidence trends. Increased emergency department visits for vomiting in the US 12 and France, 13 as well as anecdotal clinical impressions from the authors' gastroenterology and emergency medicine practices suggest the prevalence may be widespread. Conversely, a questionnaire-based study from North America and the UK suggests that CHS is uncommon when strict Rome IV criteria are used.…”

Section: Introductionmentioning

confidence: 88%

Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence

Andrews

Rehak

Woo

et al. 2022

Aliment Pharmacol Ther

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Summary Background Cannabinoid hyperemesis syndrome (CHS) is a poorly understood vomiting disorder associated with chronic cannabis use. Aims To characterise patients experiencing CHS in North America and to obtain a population‐based estimate of CHS treatment prevalence in Canada before and during the Covid‐19 pandemic Methods Internet survey of 157 CHS sufferers in Canada and the United States. Administrative health databases for the province of Alberta (population 5 million) were accessed to measure emergency department (ED) visits for vomiting, with a concurrent diagnostic code for cannabis use. Three time periods of 1 year were assessed: prior to recreational cannabis legalisation (2017–2018), after recreational legalisation (2018–2019) and during the first year of the Covid‐19 pandemic (2020–2021). Results Problematic cannabis use (defined as a CUDIT‐R score ≥8) was universal among the survey cohort, and 59% and 68% screening for moderate or worse anxiety or depression, respectively. The overall treatment prevalence of CHS across all ages increased from 15 ED visits per 100,000 population (95% CI, 14–17) prior to legalisation, to 21 (95% CI, 20–23) after legalisation, to 32 (95% CI, 31–35) during the beginning of the Covid‐19 pandemic (p < 0.001). Treatment prevalence among chronic cannabis users was as high as 6 per 1000 in the 16–24 age group. Conclusion Survey data suggest patients with CHS almost universally suffer from a cannabis use disorder, which has significant treatment implications. Treatment prevalence in the ED has increased substantially over a very short time period, with the highest rates seen during the Covid‐19 pandemic.

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“…Some of the consultation calls were seeking treatment advice for cannabis hyperemesis syndrome or acute psychotic reactions, two acute medical problems related to cannabis use. These problems are increasing in frequency ( 17 , 18 ) in association with policy changes that liberalize access to cannabis in Massachusetts and other states, and with increasing potency and variety of products available. These acute problems may cause patients to seek medical attention, and thereby shine a light on substance use in general for pediatric primary care providers.…”

Section: Discussionmentioning

confidence: 99%

A Phone Consultation Call Line to Support SBIRT in Pediatric Primary Care

et al. 2022

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BackgroundScreening Brief Intervention Referral to Treatment (SBIRT) is recommended as a routine part of pediatric primary care, though managing patients with positive screens is challenging. To address this problem, the state of Massachusetts created a call line staffed by pediatric Addiction Medicine specialists to provide consultations to primary care providers and access to a behavioral health provider specially trained in managing adolescent substance use.ObjectiveTo describe the uptake and outcomes of a consultation call line and virtual counseling for managing substance use disorders (SUD) in pediatric primary care.MethodsService delivery data from consultations and counseling appointments were captured in an electronic database including substance, medication recommendations, level of care recommendations and number of counseling appointments completed for each patient. Summary data is presented here.ResultsIn all, there were 407 encounters to 108 unique families, including 128 consultations and 279 counseling visits in a one-year period. The most common substances mentioned by healthcare providers were cannabis (64%), nicotine (20%), alcohol (20%), vaping (9%) and opioids (5%). Management in primary care was recommended for 87 (68%) of the consultations. Medications for SUD treatment were recommended for 69 (54%) consultations including two for opioid use disorder.ConclusionWe found that both a statewide consultation call line and virtual counseling to support SBIRT in pediatric primary care were feasible. The majority of consultations resulted in recommendations for treatment in primary care.

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Changes in Emergency Department Encounters for Vomiting After Cannabis Legalization in Colorado

Cited by 23 publications

References 33 publications

Changes in Emergency Department Visits for Cannabis Hyperemesis Syndrome Following Recreational Cannabis Legalization and Subsequent Commercialization in Ontario, Canada

Changes in Emergency Department Visits for Cannabis Hyperemesis Syndrome Following Recreational Cannabis Legalization and Subsequent Commercialization in Ontario, Canada

Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence

A Phone Consultation Call Line to Support SBIRT in Pediatric Primary Care

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