Patients with Cannabis-Related Illness are Presenting More Frequently in Duke Health Emergency Department
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An illness linked to marijuana use is landing more people in Duke Health emergency rooms with painful and sometimes debilitating symptoms. Emergency medicine specialists are raising awareness, because the condition comes as a surprise to many people who use cannabis.
The illness is called cannabinoid hyperemesis syndrome (CHS) and it causes severe and recurrent nausea, vomiting, and abdominal pain in people who use cannabis regularly.
“Here at Duke Regional, we treat people experiencing cannabinoid hyperemesis syndrome every week, if not every day,” said Joshua Ring, M.D., associate medical director of education at Duke Regional Hospital in Durham. “I’m seeing more and more people come into the emergency department with symptoms often without realizing that regular cannabis use may be the cause.”
Although the exact cause of CHS is still being studied, experts believe the syndrome may be linked to how THC, the psychoactive component in cannabis, interacts with the brain and gut.
“The hallmark symptoms include nausea, vomiting, and abdominal pain, particularly in the upper middle portion of the abdominal region,” said Ring. “Some patients may also experience severe dehydration and weight loss due to malnourishment.”
Based on emergency department surveys, it's estimated at least 2.75 million Americans are affected by CHS every year. One study found the number of emergency department visits for CHS in the United States and Canada doubled between 2017 and 2021.
Ring said he began seeing more cases during the COVID-19 pandemic and has observed a steady increase since then as more states have legalized marijuana and as cannabis products have become more potent. This is despite marijuana remaining illegal in North Carolina.
“In the 1990s, THC levels in marijuana averaged about 4%. By 2017, that number jumped to around 17%; and many products today – especially edibles – can exceed 20% THC,” said Ring. “Plus, synthetic products like Delta-8 and Delta-9 are largely unregulated and have been linked to CHS.”
CHS can affect anyone who uses cannabis regularly, but Ring said it is most common in young adult men and older adolescent males who have used cannabis daily over an extended period.
“For most individuals, symptoms generally persist for 24-48 hours. However, in rare cases, they can last up to two weeks,” said Ring. “Recurrent marijuana use, which is common in this patient population, tends to exacerbate and prolong symptoms.”
He said the most effective treatment is also the most straightforward.
“Stop using cannabis – including smoking, edibles, wax, vape pens, and synthetic marijuana,” Ring said.
As awareness of CHS grows, he hopes more patients and emergency medical providers will recognize the signs and take them seriously.
“It’s a real condition,” said Ring. “While cannabis products may provide temporary relief, continued use perpetuates the cycle of nausea and vomiting, prolonging illness and increasing the likelihood of recurrence.”
If you or someone you know is experiencing CHS symptoms, including persistent vomiting and dehydration, seek medical attention immediately. To learn more about emergency care at Duke Health, visit emergencymedicine.duke.edu.