Cannabis Hyperemesis Syndrome: An Increasing Challenge in Emergency Care

大麻剧吐综合症：紧急护理中日益严峻的挑战

• 批准号: 10346090
• 负责人: Rachel Wightman
• 金额: $ 25.55万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10346090
• 关键词: Accident and Emergency department; Address; Affect; Agonist; Ambulatory Care; Antiemetics; Back; Bathing; Behavior Therapy; Biological; Blood; CNR1 gene; Cannabidiol; Cannabinoids; Cannabinol; Cannabis; Capsaicin; Chronic; Colorado; Consensus; Dependence; Development; Diagnosis; Diagnostic Imaging; Disease Progression; Dopamine; Educational Status; Emergency Care; Emergency department visit; Employment Status; Endoscopy; Ethnic Origin; Etiology; Exposure to; Formulation; Foundations; Frequencies; Future; Gender; Geographic state; Health Care Costs; Health Expenditures; Healthcare; Hospitalization; Image; Individual; Interview; Knowledge; Legal; Maintenance; Medical; Medical Marijuana; Methods; Motivation; Nausea and Vomiting; New Mexico; Oils; Outpatients; Patient Recruitments; Patients; Pattern; Periodicity; Physiological; Plant Roots; Policies; Preparation; Prevalence; Prevention; Public Health; Race; Regulation; Reporting; Research; Resolution; Resources; Rewards; Role; Smoke; Standardization; Structure; Substance Withdrawal Syndrome; Symptoms; Syndrome; Testing; Tetrahydrocannabinol; Time; TimeLine; Toxicology; Treatment Cost; Visit; Vomiting; Water; Waxes; Whole Blood; Work; affective disturbance; base; behavioral health intervention; cannabigerol; cannabis cessation; cannabis withdrawal; cohort; cost; demographics; diaries; disability; emotional distress; experience; high risk; increased appetite; indexing; marijuana use; marijuana use disorder; marijuana user; patient oriented; profiles in patients; response; symptomatology; vapor

Project Summary Cannabis hyperemesis syndrome (CHS) is a frequently under-recognized syndrome of cyclic nausea and vomiting occurring in the context of daily chronic cannabis use. The characterization of CHS and rise in CHS cases treated in emergency departments correlates with increasing availability of medical and recreational cannabis. In Colorado medical cannabis liberalization led to a twofold increase in emergency department visits for cyclic vomiting; in New Mexico - when cannabis was legalized - incident CHS cases increased by 400%. Patients with CHS frequently have multiple Emergency Department (ED) visits, hospital admissions, and undergo non-diagnostic advanced imaging, such as CT and endoscopy, which are high cost practices that can be harmful to patients and result in unnecessary healthcare expenditure. Patients often have no choice but to visit the ED as there are extremely limited outpatient treatment resources available for CHS. Despite the increasing prevalence of CHS, there is no medical consensus on the root cause and there is a lack of understanding as to why this syndrome only recently emerged or why CHS occurs in some people who use cannabis daily, but not others. Since the 1970s the average potency (THC concentration) of cannabis preparations has steadily increased while concentrations of other cannabinoids, such as CBD, declined. Additionally, consumers can choose from a growing list of high THC concentration products, such as oils and waxes, with a THC content that can be >75%. High potency cannabis products are associated with increased levels of physiologic dependence, affective disturbances, and development of cannabis use disorder (CUD). CHS occurs in daily cannabis users at high risk of CUD, leading to the hypothesis that CHS may be associated with chronic exposure to higher potency cannabis. Given the large, demographic of young people with chronic cannabis use in the US and rising prevalence of CHS, there is an urgent need to better understand CHS causation and disease progression. A quantitative and qualitative mixed method study in a cohort of 40 patients recruited from the ED with active CHS symptoms will be performed. Over the 180-day period surrounding an index ED visit we will characterize cannabis product and use patterns in relation to symptoms and disease progression and explore motivations and barriers to change cannabis use and treatment engagement. This will be complimented with a toxicological assessment of whole blood cannabinoids and metabolites to evaluate differences in the toxicological cannabinoid profile in patients with CHS on separate occasions when experiencing versus not experiencing a cyclic vomiting episode. This foundational work will guide future cannabis policy and support the development of a patient-centered ED-based behavioral intervention focused on prevention and treatment options.

项目概要 大麻剧吐综合征（CHS）是一种经常被忽视的周期性恶心综合征 以及在日常长期使用大麻的情况下发生的呕吐。 CHS 的特征和发病率的上升 在急诊室治疗的中枢性低通气综合症病例与医疗和医疗资源的增加有关 休闲大麻。在科罗拉多州，医用大麻自由化导致紧急情况增加了一倍 因周期性呕吐而到科室就诊；在新墨西哥州 - 当大麻合法化时 - 事件 CHS 案件 增加了 400%。中枢性低通气综合症 (CHS) 患者经常多次到急诊科 (ED)、医院就诊 入院，并接受非诊断性高级影像检查，例如 CT 和内窥镜检查，这些费用很高 可能对患者有害并导致不必要的医疗支出的做法。患者常常有 由于中枢性低通气综合症 (CHS) 的门诊治疗资源极其有限，别无选择，只能去急诊室。 尽管中枢性低通气综合症的患病率不断增加，但对于其根本原因尚无医学共识，并且存在以下问题： 对为什么这种综合征最近才出现或为什么某些人会发生中枢性低通气综合症缺乏了解 每天使用大麻的人，但其他人则不使用大麻。自 20 世纪 70 年代以来，大麻的平均效力（THC 浓度） 制剂的浓度稳步增加，而其他大麻素（例如 CBD）的浓度则下降。 此外，消费者可以从越来越多的高 THC 浓度产品中进行选择，例如油和 蜡，THC 含量可 >75%。高效大麻产品与增加 生理依赖性、情感障碍和大麻使用障碍 (CUD) 的发展水平。 中枢性低通气综合症 (CHS) 发生在日常吸食大麻的人中，其 CUD 风险较高，因此推测中枢性低通气综合症 (CHS) 可能与 CUD 相关 长期接触效力较高的大麻。 鉴于美国长期吸食大麻的年轻人数量庞大且不断增加 随着中枢性低通气综合症（CHS）的流行，迫切需要更好地了解中枢性低通气综合症（CHS）的病因和疾病进展。一个 定量和定性混合方法研究，对 40 名从 ED 招募的患者进行队列研究 将进行中枢性低通气综合症症状检查。在围绕索引 ED 访问的 180 天期间，我们将描述 与症状和疾病进展相关的大麻产品和使用模式并探索动机 以及改变大麻使用和治疗参与的障碍。这将得到毒理学的补充 对全血大麻素和代谢物进行评估，以评估毒理学差异 中枢性低通气综合症 (CHS) 患者在经历和未经历不同情况下的大麻素特征 周期性呕吐发作。这项基础工作将指导未来的大麻政策并支持发展 以患者为中心的基于急诊科的行为干预，重点关注预防和治疗方案。