Links between Cannabinoid Hyperemesis Syndrome and drug use, mental health problems, antisocial behavior, and personality in a national survey of adults in the United States

Aims: Cannabinoid hyperemesis syndrome (CHS) is a disorder observed among those with heavy cannabis use characterized by episodes of severe nausea, vomiting, and abdominal pain. This study estimated differences between those reporting CHS symptoms and others who use cannabis daily and less frequently on measures of drug use, mental health problems, other health problems, antisocial behavior, and personality. Design: The National Firearms, Alcohol, Cannabis, and Suicide (NFACS) survey, a nationally representative survey of US adults. Setting: United StatesParticipants: 7034 adults with survey adjustments to match the US adult population. Comparisons focused on: those with daily cannabis use and CHS symptoms (n = 191) vs those with daily cannabis use without CHS symptoms (n = 882), those with past year cannabis use but not daily use (less-than-daily) (n = 1288), and those without past year cannabis use (n = 4673).Measurements: Survey items assessed substance use, common psychiatric symptoms, personality traits, and symptoms of CHS. Group differences were estimated using logistic and linear regression models. Findings: Those with CHS symptoms reported the highest rates and greatest variety of drug use compared to others who used cannabis. Those with CHS symptoms reported higher rates of other drug use than those who used cannabis daily without CHS symptoms across a variety of drug classes, including opioids (OR = 2.93, 95% CI 1.49, 5.78), hallucinogens (OR = 2.24, 95% CI 1.35, 3.68), and sedatives (OR = 1.69, 95% CI 1.06, 2.70), as well as higher rates of drug overdoses (OR = 3.32, 95% CI 1.71, 6.44), and greater use of all drug classes than those with less-than-daily cannabis use. Those with CHS symptoms also reported more symptoms of depression and anxiety, greater sleep problems, chronic pain, antisocial behavior, intimate partner violence perpetration and victimization, and personality traits associated with disinhibition than those who used daily (mean d = 0.58, all p’s < .001) and less frequently (mean d = 0.69, all p’s < .001) and those with no cannabis use in the past 12 months (mean d = 0.99, all p’s < .001).Conclusions: Those with CHS symptoms exhibit a variety of psychological and behavioral problems including higher rates of other drug use, psychiatric symptoms, antisocial behavior, and dysfunctional personality traits. Most research on CHS has focused on characterizing the physical symptoms of CHS and treatments to address nausea and vomiting. Our results highlight the importance of understanding and addressing the broader psychosocial challenges faced by people experiencing CHS symptoms.