An instructor of medicine is concerned cannabis hyperemesis syndrome (CHS) is being diagnosed too often without a proper diagnostic work-up.
Cannabis (or Cannabinoid) hyperemesis syndrome is also known as “scromiting“. It’s a relatively rare condition in which the patient experiences severe abdominal pain and continually vomits — and may scream while doing so. CHS is usually associated with heavy and chronic marijuana use and symptoms often disappear when cannabis use stops.
Conventional anti-emetics typically do not work and management options during an episode are limited: IV fluid hydration and electrolyte management, some patients find relief with benzodiazepines or capsaicin use, and long hot baths or showers
While rare, it’s becoming more prevalent in the USA; purely because more people are using cannabis either medicinally, recreationally (or both) due to various legalisation initiatives and general perceptions of cannabis changing.
This article suggests the overall prevalence of CHS is 0.1%, with it being more common in young adults aged 18 to 39 years old. However, in patients with cannabis use disorder (CUD), the prevalence of CHS is up to 32%.
But what if some of these cases are being misdiagnosed? That’s the concern of Jordan Tishler, an instructor of medicine at Harvard Medical School and president of the Association of Cannabinoid Specialists.
In an article on Stat, Tishler says there’s a risk that clinicians may be attributing any vomiting in a cannabis user to CHS — and the risk is elevated in fast-paced environments such as emergency rooms.
“This sort of knee-jerk thinking is emblematic of the cognitive bias known as ‘anchoring’ — wherein a clinician fixates on an initial piece of information (in this case, cannabis use) and fails to consider alternative or concurrent diagnoses,” he says.
He cites the case of a young person with a history of cannabis use experiencing CHS-type symptoms — and his condition was attributed to that. But further investigation revealed a diagnosis of superior mesenteric artery (SMA) syndrome. Also a rare condition, this is life-threatening and proper treatment was delayed.
To help address the situation, Tishler says:
“Institutions should offer clear guidelines on how to accurately diagnose CHS, with an emphasis on ruling out other causes of vomiting first. We must also train physicians to recognize and counteract their own implicit biases, especially in relation to substance use.”
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