Cannabis Hyperemesis Syndrome: An Increasing Challenge in Emergency Care

大麻剧吐综合症：紧急护理中日益严峻的挑战

• 批准号: 10346090
• 负责人: Rachel Wightman
• 金额: $ 25.55万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10346090
• 关键词: Accident and Emergency department; Address; Affect; Agonist; Ambulatory Care; Antiemetics; Back; Bathing; Behavior Therapy; Biological; Blood; CNR1 gene; Cannabidiol; Cannabinoids; Cannabinol; Cannabis; Capsaicin; Chronic; Colorado; Consensus; Dependence; Development; Diagnosis; Diagnostic Imaging; Disease Progression; Dopamine; Educational Status; Emergency Care; Emergency department visit; Employment Status; Endoscopy; Ethnic Origin; Etiology; Exposure to; Formulation; Foundations; Frequencies; Future; Gender; Geographic state; Health Care Costs; Health Expenditures; Healthcare; Hospitalization; Image; Individual; Interview; Knowledge; Legal; Maintenance; Medical; Medical Marijuana; Methods; Motivation; Nausea and Vomiting; New Mexico; Oils; Outpatients; Patient Recruitments; Patients; Pattern; Periodicity; Physiological; Plant Roots; Policies; Preparation; Prevalence; Prevention; Public Health; Race; Regulation; Reporting; Research; Resolution; Resources; Rewards; Role; Smoke; Standardization; Structure; Substance Withdrawal Syndrome; Symptoms; Syndrome; Testing; Tetrahydrocannabinol; Time; TimeLine; Toxicology; Treatment Cost; Visit; Vomiting; Water; Waxes; Whole Blood; Work; affective disturbance; base; behavioral health intervention; cannabigerol; cannabis cessation; cannabis withdrawal; cohort; cost; demographics; diaries; disability; emotional distress; experience; high risk; increased appetite; indexing; marijuana use; marijuana use disorder; marijuana user; patient oriented; profiles in patients; response; symptomatology; vapor

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.

项目摘要 大麻蛋白质综合征（CHS）是一种经常被识别的循环恶心综合征 并在每日长期使用大麻的情况下发生呕吐。 CHS的特征和上升 在急诊室治疗的CHS病例与医疗的可用性增加有关 休闲大麻。在科罗拉多州医用大麻的自由化导致紧急情况增加了两倍 部门访问循环呕吐；在新墨西哥州 - 大麻合法化时 - 事故CHS案件 增加了400％。 CHS患者经常有多个急诊科（ED）访问，医院 入院，并接受非诊断高级成像，例如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实践。患者经常有 别无选择，只能参观ED，因为CHS可用的门诊治疗资源极为有限。 尽管CHS的患病率越来越高，但根本原因尚无医学共识 是否缺乏了解这种综合症的原因，为什么直到最近才出现，或者为什么CHS发生在某些人 谁每天使用大麻，但不使用其他大麻。自1970年代以来，大麻的平均效力（THC浓度） 制剂稳步增加，而其他大麻素（例如CBD）的浓度下降。 此外，消费者可以从越来越多的THC浓度产品（例如油和）列表中进行选择 蜡，具有> 75％的THC含量。高效力大麻产品与增加有关 生理依赖性，情感障碍和大麻使用障碍（CUD）的发展水平。 CHS发生在每日大麻使用者中，CUD的风险很高，导致CHS可能与CHS相关的假设 长期暴露于更高的效力大麻。 鉴于在美国使用慢性大麻的年轻人的人群很大，并且正在上升 CHS的患病率迫切需要更好地了解CHS因果关系和疾病的发展。一个 从ED招募的40名患者中，定量和定性混合方法研究具有活性 CHS症状将进行。在围绕索引ED访问的180天期间，我们将描述 大麻产品和使用与症状和疾病进展有关的模式并探索动机 以及改变大麻使用和治疗参与的障碍。这将与毒理学相称 评估全血大麻素和代谢物，以评估毒理学的差异 CHS患者的大麻素轮廓在经历与不遇到的情况下不同 循环呕吐情节。这项基础工作将指导未来的大麻政策并支持发展 基于患者以患者为中心的行为干预的重点是预防和治疗选择。