Cannabis Hyperemesis Syndrome: An Increasing Challenge in Emergency Care

项目摘要 大麻剧吐综合征（CHS）是一种经常被忽视的周期性恶心综合征 和呕吐发生在日常慢性大麻使用的背景下。CHS的特征和 在急诊科治疗的CHS病例与医疗和 娱乐用大麻在科罗拉多，医用大麻的自由化导致急诊增加了两倍。 周期性呕吐的部门访问;在新墨西哥州-当大麻合法化-事件CHS病例 增长了400%。CHS患者经常有多次急诊（艾德）就诊， 住院，并接受非诊断先进的成像，如CT和内窥镜检查，这是高成本 可能对患者有害并导致不必要的医疗支出的做法。患者常有 由于社区卫生服务的门诊治疗资源极其有限，因此别无选择，只能到艾德就诊。 尽管CHS的患病率越来越高，但在根本原因上没有医学共识， 对为什么这种综合征最近才出现或为什么CHS发生在一些人身上缺乏了解 每天吸食大麻的人，而不是其他人自20世纪70年代以来，大麻的平均效力（THC浓度） 大麻素制剂的浓度稳步增加，而其他大麻素如CBD的浓度下降。 此外，消费者可以从越来越多的高THC浓度产品中选择，如油和 蜡，其THC含量可以> 75%。高效能大麻产品与增加 生理依赖水平，情感障碍和大麻使用障碍（CUD）的发展。 CHS发生在CUD高风险的每日大麻使用者中，导致CHS可能与以下假设相关： 长期接触高效力大麻 鉴于美国长期使用大麻的年轻人数量庞大， CHS的流行，迫切需要更好地了解CHS的病因和疾病进展。一 在一项从艾德招募的40例活性药物治疗患者的队列中进行的定量和定性混合方法研究 将进行CHS症状检查。在索引艾德访视的180天内，我们将描述 大麻产品和使用模式与症状和疾病进展的关系，并探讨动机 以及改变大麻使用和治疗参与的障碍。这将伴随着毒理学 评估全血大麻素和代谢物，以评价毒理学差异 CHS患者在不同情况下的大麻素谱， 周期性呕吐发作这项基础性工作将指导未来的大麻政策，并支持发展 一个以病人为中心的ED为基础的行为干预，重点是预防和治疗方案。

Project Summary Cannabis hyperemesis syndrome (CHS) is a frequently under-recognized syndrome of cyclic nausea and vomiting occurring in the context of daily chronic cannabis use. The characterization of CHS and rise in CHS cases treated in emergency departments correlates with increasing availability of medical and recreational cannabis. In Colorado medical cannabis liberalization led to a twofold increase in emergency department visits for cyclic vomiting; in New Mexico - when cannabis was legalized - incident CHS cases increased by 400%. Patients with CHS frequently have multiple Emergency Department (ED) visits, hospital admissions, and undergo non-diagnostic advanced imaging, such as CT and endoscopy, which are high cost practices that can be harmful to patients and result in unnecessary healthcare expenditure. Patients often have no choice but to visit the ED as there are extremely limited outpatient treatment resources available for CHS. Despite the increasing prevalence of CHS, there is no medical consensus on the root cause and there is a lack of understanding as to why this syndrome only recently emerged or why CHS occurs in some people who use cannabis daily, but not others. Since the 1970s the average potency (THC concentration) of cannabis preparations has steadily increased while concentrations of other cannabinoids, such as CBD, declined. Additionally, consumers can choose from a growing list of high THC concentration products, such as oils and waxes, with a THC content that can be >75%. High potency cannabis products are associated with increased levels of physiologic dependence, affective disturbances, and development of cannabis use disorder (CUD). CHS occurs in daily cannabis users at high risk of CUD, leading to the hypothesis that CHS may be associated with chronic exposure to higher potency cannabis. Given the large, demographic of young people with chronic cannabis use in the US and rising prevalence of CHS, there is an urgent need to better understand CHS causation and disease progression. A quantitative and qualitative mixed method study in a cohort of 40 patients recruited from the ED with active CHS symptoms will be performed. Over the 180-day period surrounding an index ED visit we will characterize cannabis product and use patterns in relation to symptoms and disease progression and explore motivations and barriers to change cannabis use and treatment engagement. This will be complimented with a toxicological assessment of whole blood cannabinoids and metabolites to evaluate differences in the toxicological cannabinoid profile in patients with CHS on separate occasions when experiencing versus not experiencing a cyclic vomiting episode. This foundational work will guide future cannabis policy and support the development of a patient-centered ED-based behavioral intervention focused on prevention and treatment options.