Cannabinoid hyperemesis syndrome prevalence and risk factors in the U.S․

Cannabinoid hyperemesis syndrome (CHS) is characterized by intense nausea, abdominal pain, and cyclical vomiting following heavy, chronic cannabis use. With increases in cannabis legalization in the United States (U.S.), CHS is an emerging concern for cannabis users, medical professionals, and policymakers. This study is the first to examine a large, nation-wide sample of cannabis users to estimate CHS prevalence and identify risk factors and at-risk populations.

Survey data were collected in the U.S. by the International Cannabis Policy Study in 2023. The prevalence of past-year CHS was calculated among participants reporting cannabis use. Logistic multilevel modeling was used to test a-priori hypotheses for factors associated with CHS.

10,255 participants (45.82% female, M_age = 39.46 years) were included in this study. Approximately 6% reported past-year CHS. Participants who were younger, male, Hispanic, or two or more races were more likely to experience CHS. Older age of first cannabis use, more frequent use of cannabis edibles and concentrates, riskier cannabis use patterns, and past-year alcohol use were associated with higher risk. Those who grew their own cannabis, used cannabis to manage symptoms of headaches/migraines or nausea/vomiting, or experienced bipolar disorder or psychosis/dissociative identity disorder were also more likely to report CHS. Those who used cannabis for lack of appetite or experienced depression were less likely to report CHS. There was no significant effect of state-legal cannabis.

Ongoing surveillance, standardized definitions, and identification of underlying risk factors are essential to enhance public health awareness and accurate diagnosis.