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{
    "pk": 11319,
    "title": "Cannabinoid Hyperemesis Syndrome: Public Health Implications and a Novel Model Treatment Guideline",
    "subtitle": null,
    "abstract": "Introduction: \nCannabinoid hyperemesis syndrome (CHS) is an entity associated with cannabinoid overuse. CHS typically presents with cyclical vomiting, diffuse abdominal pain, and relief with hot showers. Patients often present to the emergency department (ED) repeatedly and undergo extensive evaluations including laboratory examination, advanced imaging, and in some cases unnecessary procedures. They are exposed to an array of pharmacologic interventions including opioids that not only lack evidence, but may also be harmful.This paper presents a novel treatment guideline that highlights the identification and diagnosis of CHS and summarizes treatment strategies aimed at resolution of symptoms, avoidance of unnecessary opioids, and ensuring patient safety.\nMethods: \nThe 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 created an expert consensus panel to establish a guideline to unite the ED community in the treatment of CHS. \n \nResults: \nPer the consensus guideline, treatment should focus on symptom relief and education on the need for cannabis cessation. Capsaicin is a readily available topical preparation that is reasonable to use as first-line treatment. Antipsychotics including haloperidol and olanzapine have been reported to provide complete symptom relief in limited case studies. Conventional antiemetics including antihistamines, serotonin antagonists, dopamine antagonists and benzodiazepines may have limited effectiveness. Emergency physicians should avoid opioids if the diagnosis of CHS is certain and educate patients that cannabis cessation is the only intervention that will provide complete symptom relief.\nConclusion:\n An expert consensus treatment guideline is provided to assist with diagnosis and appropriate treatment of CHS. Clinicians and public health officials should identity and treat CHS patients with strategies that decrease exposure to opioids, minimize use of healthcare resources, and maximize patient safety.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "cannabis"
        },
        {
            "word": "Practice Guideline"
        },
        {
            "word": "vomiting"
        },
        {
            "word": "Capsaicin"
        }
    ],
    "section": "Behavioral Health",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/59z5q826",
    "frozenauthors": [
        {
            "first_name": "Jeff",
            "middle_name": "",
            "last_name": "Lapoint",
            "name_suffix": "",
            "institution": "Department of Emergency Medicine\nKaiser Permanente, San Diego Medical Center",
            "department": "None"
        },
        {
            "first_name": "Seth",
            "middle_name": "",
            "last_name": "Meyer",
            "name_suffix": "",
            "institution": "Department of Emergency Medicine\nKaiser Permanente, San Diego Medical Center",
            "department": "None"
        },
        {
            "first_name": "Charles",
            "middle_name": "K.",
            "last_name": "Yu",
            "name_suffix": "",
            "institution": "Department of Emergency Medicine\nKaiser Permanente, San Diego Medical Center",
            "department": "None"
        },
        {
            "first_name": "Kristi",
            "middle_name": "L.",
            "last_name": "Koenig",
            "name_suffix": "",
            "institution": "University of California at Irvine\nEMS Medical Director\nCounty of San Diego Health & Human Services Agency, Emergency Medical Services",
            "department": "None"
        },
        {
            "first_name": "Roneet",
            "middle_name": "",
            "last_name": "Lev",
            "name_suffix": "",
            "institution": "Scripps Mercy Hospital San Diego Emergency Department",
            "department": "None"
        },
        {
            "first_name": "Sayone",
            "middle_name": "",
            "last_name": "Thihalolipavan",
            "name_suffix": "",
            "institution": "Deputy Public Health Officer\nCounty of San Diego Health & Human Services Agency, Public Health",
            "department": "None"
        },
        {
            "first_name": "Katherine",
            "middle_name": "",
            "last_name": "Staats",
            "name_suffix": "",
            "institution": "Department of Emergency Medicine\nUniversity of California, San Diego",
            "department": "None"
        },
        {
            "first_name": "Christopher",
            "middle_name": "A.",
            "last_name": "Kahn",
            "name_suffix": "",
            "institution": "Department of Emergency Medicine\nUniversity of California, San Diego",
            "department": "None"
        }
    ],
    "date_submitted": "2017-09-11T21:43:48Z",
    "date_accepted": "2017-09-11T21:43:48Z",
    "date_published": "2017-11-08T19:13:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11319/galley/6144/download/"
        }
    ]
}