A Growing Burden, a Persistent Gap: Cannabinoid Hyperemesis Syndrome Education and Emergency Department Trends in Michigans Legal Cannabis Market
- 1Western Michigan University Homer Stryker MD School of Medicine
Abstract
BackgroundSince Michigans legalization of recreational adult-use cannabis in December 2018, health care providers in the city of Kalamazoo, Michigan, have informally observed an increase in cannabinoid hyperemesis syndrome (CHS) presentations, although the extent of this increase has not been formally characterized locally. CHS is frequently underrecognized and misdiagnosed, often resulting in repeated emergency department (ED) visits and substantial diagnostic costs before a diagnosis is reached. Despite this clinical and financial burden, it is unclear whether consumers are adequately informed of this risk through point-of-sale or public health resources.
MethodsA cross-sectional environmental scan was conducted to identify publicly available educational content about CHS on the websites of licensed cannabis retailers in Kalamazoo and relevant public health agencies. Provisioning centers and public health websites were screened using a structured coding rubric developed specifically for the environmental scan to assess the presence, depth, web page placement, and intended audience of CHS-related content. Additionally, the electronic medical records at a local teaching hospital in Kalamazoo were queried to identify ED visits with a primary diagnosis of CHS from January 1, 2010 to December 31, 2025.
ResultsBefore the legalization of marijuana, the hospital recorded six ED encounters with the primary diagnosis of CHS between January 2010 and November 2018, and 274 ED encounters between December 2018 and December 2025 (mean age: 29 years; 157 females, 123 males). The incidence rate of CHS-related ED encounters was 57.2 times higher during the post-legalization period than during the pre-legalization period (95% CI, 26.0-157.3; exact Poisson rate-ratio test, p < 0.0001). Among the licensed Kalamazoo provisioning centers reviewed, only one mentioned CHS as a warning but did not describe symptoms or offer medical guidance. CHS content was not identified on the websites of the state or local health departments.
ConclusionDespite the growing clinical concern regarding CHS, consumer-facing educational resources remain scarce. Although this study cannot establish a causal relationship between the availability of CHS-related educational content and the observed increase in ED encounters following legalization, it identifies a substantial lack of CHS-specific warnings in the evaluated consumer-facing resources. Given the clinical and potential economic burden associated with delayed CHS recognition, we recommend that Michigans existing point-of-sale pamphlet requirement be amended to include CHS-specific warning language.
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BibTeX
@misc{lorbeer2026growing,
title = {{A Growing Burden, a Persistent Gap: Cannabinoid Hyperemesis Syndrome Education and Emergency Department Trends in Michigans Legal Cannabis Market}},
author = {E. R. Lorbeer and N. Bronson and L. A. Burgard and M. E. Engle and D. S. Randhawa and P. V. Sotiroff and H. R. Walker and H. Zhu and J. D. Mastenbrook},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.09.26365113},
url = {https://www.medrxiv.org/content/10.64898/2026.10.09.26365113v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - A Growing Burden, a Persistent Gap: Cannabinoid Hyperemesis Syndrome Education and Emergency Department Trends in Michigans Legal Cannabis Market
AU - E. R. Lorbeer
AU - N. Bronson
AU - L. A. Burgard
AU - M. E. Engle
AU - D. S. Randhawa
AU - P. V. Sotiroff
AU - H. R. Walker
AU - H. Zhu
AU - J. D. Mastenbrook
PY - 2026
DA - 2026/10/09
PB - medRxiv
DO - 10.64898/2026.10.09.26365113
UR - https://www.medrxiv.org/content/10.64898/2026.10.09.26365113v1
AB - BackgroundSince Michigans legalization of recreational adult-use cannabis in December 2018, health care providers in the city of Kalamazoo, Michigan, have informally observed an increase in cannabinoid hyperemesis syndrome (CHS) presentations, although the extent of this increase has not been formally characterized locally. CHS is frequently underrecognized and misdiagnosed, often resulting in repeated emergency department (ED) visits and substantial diagnostic costs before a diagnosis is reached. Despite this clinical and financial burden, it is unclear whether consumers are adequately informed of this risk through point-of-sale or public health resources. MethodsA cross-sectional environmental scan was conducted to identify publicly available educational content about CHS on the websites of licensed cannabis retailers in Kalamazoo and relevant public health agencies. Provisioning centers and public health websites were screened using a structured coding rubric developed specifically for the environmental scan to assess the presence, depth, web page placement, and intended audience of CHS-related content. Additionally, the electronic medical records at a local teaching hospital in Kalamazoo were queried to identify ED visits with a primary diagnosis of CHS from January 1, 2010 to December 31, 2025. ResultsBefore the legalization of marijuana, the hospital recorded six ED encounters with the primary diagnosis of CHS between January 2010 and November 2018, and 274 ED encounters between December 2018 and December 2025 (mean age: 29 years; 157 females, 123 males). The incidence rate of CHS-related ED encounters was 57.2 times higher during the post-legalization period than during the pre-legalization period (95% CI, 26.0-157.3; exact Poisson rate-ratio test, p < 0.0001). Among the licensed Kalamazoo provisioning centers reviewed, only one mentioned CHS as a warning but did not describe symptoms or offer medical guidance. CHS content was not identified on the websites of the state or local health departments. ConclusionDespite the growing clinical concern regarding CHS, consumer-facing educational resources remain scarce. Although this study cannot establish a causal relationship between the availability of CHS-related educational content and the observed increase in ED encounters following legalization, it identifies a substantial lack of CHS-specific warnings in the evaluated consumer-facing resources. Given the clinical and potential economic burden associated with delayed CHS recognition, we recommend that Michigans existing point-of-sale pamphlet requirement be amended to include CHS-specific warning language.
ER -