Cannabinoid Hyperemesis Syndrome

Public Health Implications and a Novel Model Treatment Guideline

Jeff Lapoint, DO; Seth Meyer, MD; Charles K. Yu, MD; Kristi L. Koenig, MD; Roneet Lev, MD; Sayone Thihalolipavan, MD, MPH; Katherine Staats, MD; Christopher A. Kahn, MD, MPH


Western J Emerg Med. 2018;19(2):380-386. 

In This Article

Process to Develop CHS Treatment Guideline

Recognizing the public health concerns surrounding the opioid epidemic and the increasing frequency of ED presentations of CHS, the San Diego Emergency Medicine Oversight Commission in collaboration with the County of San Diego Health and Human Services Agency and San Diego Kaiser Permanente Division of Medical Toxicology established an expert consensus panel to create a guideline to unite the regional ED community in the treatment of CHS. The goal of the guideline is to raise awareness of how to recognize and treat CHS, which will allow providers to avoid opioids, radiation, and invasive procedures for CHS patients. Expert panel members engaged in an iterative process to provide evidence-based input into the draft guideline until complete consensus was achieved. The results of this initiative are presented here (Figure).


Cannabinoid hyperemesis syndrome expert consensus treatment guideline.
°C, degrees Celsius; CHS, cannabinoid hyperemesis syndrome; ED, emergency department; GI, gastrointestinal; IM, intramuscular; IV, intravenous; ODT, orally disintegrating tablet; OTC, over the counter; PO, orally; TID, three times a day; TRPV1, transient receptor potential (vanilloid) cation channel 1; UDS, urine drug screen.