Changes in Emergency Department Visits for Cannabis Hyperemesis Syndrome Following Recreational Cannabis Legalization and Subsequent Commercialization in Ontario, Canada

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Abstract
Cannabis is one of the most commonly used substances in Canada and the United States: in 2019, 17.5% of individuals in the US and 21.0% of individuals in Canada reported using cannabis in the past year.1,2 There is increasing recognition that regular cannabis use is associated with various health concerns, including psychosis, anxiety, depression, altered brain functioning, and dependence.3-6 Cannabis hyperemesis syndrome (CHS) is a lesser-known complication associated with persistent use of high potency cannabis, involving repeated episodes of nausea, vomiting, and abdominal pain.7,8 To date, several studies have found increases in emergency department (ED) visits owing to vomiting or CHS after the legalization of medical or recreational cannabis.9-12 However, the characteristics of individuals with CHS have only previously been described in small studies or case series, limiting our understanding of who is at risk of this condition. In addition, there is limited information on how recreational cannabis legalization and different regulatory policies (eg, access to retail stores and product types) are associated with the frequency and severity of CHS or the clinical characteristics of individuals with CHS.

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