OBJECTIVES: Cannabinoid Hyperemesis Syndrome (CHS) is a medical condition associated with daily long-term use of marijuana characterized by nausea, abdominal cramps, and cyclical vomiting which typically presents in the emergency department (ED) setting. There is currently no diagnostic or lab test for CHS. Diagnosis by exclusion is used to rule out other potential causes of vomiting and nausea. The purpose of this study was to understand the economic and procedural burden of CHS in the U.S. ED setting.

METHODS: Data from the 2019 Nationwide Emergency Department Sample (NEDS) database was analyzed with the CHS cohort defined using a combination of primary diagnoses from the F12 series (cannabis related disorders) and secondary diagnosis R11 (nausea and vomiting). Demographic characteristics of the cohort were described. Total U.S. dollar (USD) charges for ED services per visit including mean, median, maximum, minimum and standard deviation were calculated. Total outpatient and inpatient procedures by Current Procedural Terminology (CPT) code were reported.

RESULTS: The CHS cohort represented 4082 ED visits of which 10.4% (424) required admission. Patients were predominantly under the age of 35 (73.5%), majority male (54.8%), and disproportionately minority (white 45.3%, black 31.6%; Hispanic 16.7%). The mean total USD charge per ED visit for the cohort was $6306 with a minimum of $155 and a maximum of $75490 (median $4317, std dev $6431). A total of 40123 outpatient procedures and 144 inpatient procedures were recorded.

CONCLUSIONS: This study documented the procedures utilized in the diagnosis by exclusion approach to CHS including lab work, X-rays, CT scans, and invasive scoping. Diagnosis by exclusion is wasteful from both a fiduciary and hospital resource perspective. This research provides a baseline for cost-effective analysis to inform the value that could be realized with the development of a CHS diagnostic.