Canada

As cannabis use among youth rises in Canada — and THC potency reaches record highs — emergency departments are seeing a surge in cases of a once-rare condition: cannabis hyperemesis syndrome (CHS).

Characterized by relentless vomiting, abdominal pain and temporary relief through compulsive hot showers or baths, CHS is increasingly affecting adolescents and young adults. Yet few people — including many clinicians — know it exists.

Canada ranks among the highest globally for youth cannabis use, with 43 per cent of 16-19-year-olds reporting use in the past year. Usage peaks among those 20–24 years, with nearly half (48 per cent) reporting past-year use.

This rise in regular, heavy use coincides with a 400 per cent increase in THC potency since the 1980s. Strains with THC levels above 25 per cent are now common. As cannabis becomes more potent and accessible, clinicians are seeing more cases of CHS, a condition virtually unheard of before 2004.

CHS unfolds in three phases:

1. Prodromal phase: Nausea and early morning discomfort begin. Users increase cannabis consumption, thinking it will relieve symptoms.

2. Hyperemetic phase: Intense vomiting, dehydration and abdominal pain follow. Hot showers or baths provide temporary relief — a hallmark of CHS.

3. Recovery phase: Symptoms resolve after stopping cannabis entirely.

Diagnosis is often delayed. One reason is because CHS mimics conditions like gastroenteritis or eating disorders, leading to costly CT scans, MRIs and gastric emptying tests. One telltale sign — compulsive hot bathing — is frequently overlooked, despite its strong diagnostic value.

Youth face unique risks. The brain continues to develop until about age 25, and THC exposure during this critical window can impair cognitive functions like memory, learning and emotional regulation. Heavy cannabis use is associated with heightened risks of anxiety, depression, psychosis and self-harm.

Edit, the link in the article goes to this study:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796355

Results There were 12 866 ED visits for CHS from 8140 individuals during the study. Overall, the mean (SD) age was 27.4 (10.5) years, with 2834 individuals (34.8%) aged 19 to 24 years, 4163 (51.5%) females, and 1353 individuals (16.6%) with a mental health ED visit or hospitalization in the 2 years before their first CHS ED visit. Nearly 10% of visits (1135 visits [8.8%]) led to hospital admissions. Monthly rates of CHS ED visits increased 13-fold during the 7.5-year study period, from 0.26 visits per 100 000 population in January 2014 to 3.43 visits per 100 000 population in June 2021. Legalization was not associated with an immediate or gradual change in rates of ED visits for CHS; however, commercialization during the COVID-19 pandemic period was associated with an immediate increase in rates of CHS ED visits (incidence rate ratio [IRR], 1.49; 95% CI, 1.31-1.70). During commercialization, rates of CHS ED visits increased more in women (IRR, 1.49; 95% CI, 1.16-1.92) and individuals older than the legal age of cannabis purchase (eg, age 19-24 years: IRR, 1.60; 95% CI, 1.19-2.16) than men (IRR, 1.08; 95% CI, 0.85-1.37) and individuals younger than the legal age of purchase (IRR, 0.78; 95% CI, 0.42-1.45).