Cannabis Hyperemesis Syndrome: An Increasing Challenge in Emergency Care

项目摘要 大麻多吐综合征(CHS)是一种经常被忽视的周期性恶心综合征 以及在日常长期使用大麻的情况下出现的呕吐。CHS和Rise在中国的特征 在急诊科接受治疗的CHS病例与越来越多的医疗和 娱乐用大麻。在科罗拉多州，医用大麻自由化导致紧急情况增加了两倍 因周期性呕吐到部门就诊；在新墨西哥州--当大麻合法化时--发生CHS病例 增长了400%。CHS患者经常有多次急诊科(ED)就诊、医院 入院，并接受非诊断性的高级成像，如CT和内窥镜检查，这些都是昂贵的 可能对患者有害并导致不必要的医疗支出的做法。患者经常会有 由于社区卫生服务的门诊治疗资源极为有限，我们别无选择，只能前往急症室就诊。 尽管CHS的发病率越来越高，但对于其根本原因并没有达成医学共识 对于为什么这种综合征是最近才出现的，或者为什么在一些人中会发生CHS，缺乏理解 每天吸食大麻，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) 制剂稳步增加，而CBD等其他大麻素的浓度下降。 此外，消费者可以从越来越多的高THC浓度产品中进行选择，如油和 蜡，THC含量可达75%。高效力大麻产品与增加的 生理依赖程度、情感障碍和大麻使用障碍(CUD)的发展。 CHS发生在每天吸食大麻的人中，CUD的风险很高，这导致了CHS可能与 长期接触效力更高的大麻。 鉴于美国长期吸食大麻的年轻人人数众多，而且还在不断上升 随着CHS的流行，迫切需要更好地了解CHS的病因和疾病进展。一个 定量与定性相结合的方法在40例急诊急症患者队列中的研究 将执行CHS症状。在围绕索引ED访问的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，并探索动机 以及改变大麻使用和治疗参与的障碍。这将伴随着一种毒物学 评价全血大麻素及其代谢物在毒理学上的差异 慢性阻塞性肺病患者在经历与没有经历不同情况下的大麻素特征 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 以患者为中心，以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.