Cannabis Use Patterns and Blood Profiles in Adolescent Cannabinoid Hyperemesis Syndrome

Objective: Adolescent use of cannabis in the United States is on the rise. Multiple toxicities and negative outcomes are possible with chronic or heavy cannabis use, including cannabinoid hyperemesis syndrome (CHS). This study analyzes a population of adolescent emergency department patients with cyclic vomiting onset after cannabis use, with a hypothesis that use patterns or biomarkers may offer insights into diagnostics, pathophysiology, or management of this disease. Methods: This pilot prospective observational cohort study recruited pediatric emergency department patients aged 14 to 21 years with symptomatic cyclic vomiting onset after chronic cannabis use, and reassessed them at an asymptomatic follow-up visit. Cannabis use patterns were assessed with validated questionnaires, and blood profiles of cannabinoid metabolites and essential minerals and B vitamins were quantified and compared. Results: We screened 869 adolescent ED patients and enrolled ten participants. All participants (n=10) had cannabis use disorder (n=9) or hazardous cannabis use (n=1) by the Cannabis Use Disorders Identification Test-Revised, and participants reported withdrawal symptoms when attempting to discontinue cannabis. There were significant differences in 11-hydroxy-delta-9-tetrahydrocannabinol between index [median 0.6 ng/mL (IQR: 0, 2.6)] and asymptomatic follow-up visits [median 4.2 ng/mL (IQR: 1.2, 10.1)]. Median vitamin and mineral concentrations were within reference ranges. Conclusions: Symptomatic adolescent patients with suspected CHS had evidence of cannabis use disorder and had significantly lower blood concentrations of 11-hydroxy-delta-9-tetrahydrocannabinol when symptomatic. Further research is needed to better explore the pathophysiology and diagnostics in adolescent CHS, and exploration and treatment of cannabis use disorder should be considered in these patients.