S3149 Cannabis Legalization and a Spotlight on GI Complications
Bibliographic record
Abstract
Introduction: Cannabis use has surged following legalization in the United States and Canada. Despite its benign public reputation, chronic cannabis use is increasingly linked to severe gastrointestinal (GI) disorders, especially cannabinoid hyperemesis syndrome (CHS), which can present with cyclic nausea, vomiting, abdominal pain. The symptoms are notably relieved by hot bathing. Here we will examine the dangers of cannabis use, focusing on the rising prevalence of GI adverse effects, including CHS, since legalization, and explores pathophysiology and public health challenges. Methods: A review was conducted using clinical databases, including PubMed and Google Scholar, analyzing studies from 2004 to 2024. Search terms included “cannabinoid hyperemesis syndrome,” “cannabis GI effects,” and “legalization.” Studies focusing on CHS prevalence, pathophysiology, and healthcare utilization post-legalization were prioritized, specifically those on CHS-related hospitalizations and emergency department (ED) visits in legalized regions. Only studies with clear CHS diagnostic criteria were included. Results: Multiple studies have indicated that CHS cases have risen sharply post-legalization. A 2024 study reported linked increased CHS-related hospitalizations in Massachusetts to greater cannabis access and tetrahydrocannabinol (THC) potency. In Canada, CHS-related ED visits surged 13-fold from 2014 to 2021 after recreational legalization. In the U.S., an estimated 2.75 million individuals may have CHS annually, with 32.9% of frequent users in one ED meeting diagnostic criteria. Chronic cannabis use is also tied to other GI-related pathologies, including gastritis, pancreatitis, and motility disorders. High-potency THC (18%-35% vs 2%-4% historically) dysregulates the endocannabinoid system, slowing gastric motility and inducing hyperemesis. Other problems related to cannabis use include fetal growth restriction in pregnancy. Conclusion: CHS arises from chronic THC overstimulation of CB1/CB2 receptors. The rise in GI adverse effects, especially CHS, post-legalization highlights the need for increased public awareness. Currently, there are no approved treatments beyond cessation and supportive care. Dependency affects 9% of users, which further complicates cessation. Synthetic cannabinoids may increase CHS risk due to higher THC potency. Public health measures, including THC potency limits, clinician, and public education, are essential. Large-scale studies are needed to quantify prevalence and develop therapies as legalization expands.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.035 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".