P3A046: Demographics of Cannabis Hyperemesis Patients Pre and Post Legalization in an Urban Midwestern Hospital

Background: Since its legalization in Michigan in 2018, recreational cannabis use has increased dramatically. With the increased consumption and use of recreational cannabis, increases in the adverse effects of acute and chronic use have been widely seenc One such condition associated with chronic cannabis use, cannabinoid hyperemesis syndrome (CHS), is characterized by acute episodes of vomiting, nausea, and abdominal pain. There is a paucity in data concerning the risk factors and demographic characteristics of those affected by CHS, particularly before and after legalization. This study examined demographic differences before and after marijuana legalization in one academic hospital.

Methods: This retrospective cohort study examined all young adults and adolescents (YAAs) aged 13-26 accessing care at an urban, Midwestern hospital starting in 2017 with CHS as diagnosed by ICD 10 code of R11. 2 (“Nausea with vomiting, unspecified”), along with the appropriate uncomplicated code from category F12 (“cannabis related disorders”). Electronic medical chart reporting produced a de-identified report of patient data. Timing of visit was categorized as pre marijuana legalization (pre) or post marijuana legalization, (post). Changes in patient demographics and visit characteristics after marijuana legalization were examined using chi-square analysis, Fisher’s exact test if indicated, or independent t-test.

Results: A total of 275 YAAs met inclusion criteria; 30 were before marijuana legalization and 245 were after. There was no difference in age group with 46.7% ages 13-19 in the pre legalization time period and 59.2% in the post, p=0.240. There was a statistically significant difference in reported sex with a higher percentage of females in the post (43.3% female in pre vs 69.4% female in post, p=0.004). There was not a statistically significant difference in reported race with the majority identifying as African American in both time periods (50.0% pre vs 54.3% post, p=0.771) nor was there a statistically significant difference in payor class (Medicaid/Medicare 56.7% pre vs 75.1% post, p=0.061).

There was a statistically significant difference in smoking status with 100% reporting as a current/former smoker in pre vs 2.4% in post, p=0.007. There was not a statistically significant difference in marijuana use documentation (90.0% pre, 81.2% post, p=0.236) nor in reported alcohol use (37.9% pre vs 28.9% post, p=0.315). There was a non-statistically significant but potentially clinically meaningful increase in patients being admitted (3.3% pre to 7.0% post, p=0.704).

Conclusion: This study is one of the first of its kind to describe CHD pre and post legalization in YAAs. Given the increasing prevalence of cannabis use in this age group and the spareness of information surrounding CHD and associated demographics, this study helps to improve upon our understanding.so more timely diagnosis of CHD can occur and targeted screening for problematic usage of cannabis can be designed.