Emergency departments have reported a steady increase in patients with severe vomiting linked to chronic cannabis use over the past decade. On October 1, the World Health Organization added a specific diagnostic code for cannabis hyperemesis syndrome to its ICD-10 manual, aiding clinicians in identification and tracking. This update highlights a condition that puzzles patients and doctors alike, with relief often found in unexpected remedies.
Cannabis hyperemesis syndrome, a gastrointestinal disorder tied to long-term cannabis use, causes intense vomiting and abdominal pain starting within 24 hours of consumption and lasting several days. Affected individuals typically experience episodes three or four times a year. Until recently, clinicians struggled to document these cases consistently due to the absence of a dedicated code.
The addition of code R11.16 on October 1 by the World Health Organization and the Centers for Disease Control and Prevention marks a significant step forward. This allows for precise billing and recording in medical histories, facilitating recognition of repeat visits. Beatriz Carlini, a research associate professor at the University of Washington School of Medicine, emphasized the value for public health monitoring: "It helps us count and monitor these cases. In studying addiction and other public health concerns, we have three sources of data: what clinicians tell us, what people in the communities tell us, and what health records tell us. A new code for cannabis hyperemesis syndrome will supply important hard evidence on cannabis-adverse events, which physicians tell us is a growing problem."
Despite the rise in cases, awareness remains low, leading to delayed diagnoses and multiple emergency visits that cost thousands of dollars each. Patients often resist the link to cannabis, given its reputation for alleviating nausea in conditions like chemotherapy, HIV, or migraines. Dr. Chris Buresh, an emergency medicine specialist with UW Medicine and Seattle Children's, noted: "Some people say they've used cannabis without a problem for decades. Or they smoke pot because they think it treats their nausea. It seems like there's a threshold when people can become vulnerable to this condition, and that threshold is different for everyone. Even using in small amounts can make these people start throwing up."
The syndrome's causes are unclear, potentially linked to increased cannabis availability or higher THC potency. Standard anti-nausea drugs frequently fail, prompting alternatives like Haldol. Some patients find relief from capsaicin cream applied to the abdomen or hot showers. Buresh added: "That's something that can clinch the diagnosis for me, when someone says they're better with a hot shower. Patients describe going through all the hot water in their house."
Recovery poses challenges, as intermittent symptoms may encourage continued use, while addiction complicates cessation for those who accept the diagnosis.