Introduction: As cannabis legalization has become widespread, we sought to describe the demographics, inpatient utilization, and cost of services among patients hospitalized for cannabinoid hyperemesis syndrome (CHS) predating and postdating cannabis legalization in Massachusetts.
Methods: We performed a retrospective cohort study of patients admitted to Tufts Medical Center in Boston, Massachusetts (MA) with CHS pre- and post-Dec 15, 2016, the date of cannabis legalization in MA. We examined the demographic and clinical characteristics of admitted patients as well as utilization of hospital services including length of stay, laboratory services, antiemetic drugs, intravenous fluids, endoscopies, imaging, gastroenterology consulting services and intensive care requirements both pre- and post- legalization. We also estimated inpatient cost pre- and post- legalization.
Results: We identified 63 patients admitted between 2012-2020 with CHS across 72 hospitalizations, with more admissions post-legalization (n=57) than pre-legalization (n=15). Patient demographics were similar pre- and post- cannabis legalization, with a mean age of 33, 52% identifying as female, and the majority smoking cannabis as the primary route of administration. Utilization of hospital resources increased post-legalization for CHS, with increased length of stay (3 days vs 1 day, p< .005) and increased anti-emetic use (3 days vs 1 day, p< 0.05) compared to pre-legalization, with multivariate linear regression confirming that post-legalization admissions were independently associated with increased length of stay (B=5.35, p< 0.05). The mean cost of hospitalization per patient post-legalization was significantly higher than for pre-legalization ($18,714 vs $7,460, p< .0005), with intravenous fluid administration and endoscopy costs significantly increased post-legalization (p< 0.05). On multivariate linear regression, hospitalization for CHS during post-legalization significantly predicted increased costs (B=10,131.25, p< 0.05).
Discussion: In the post-legalization era of cannabis in Massachusetts, we found increased hospitalizations due to CHS, with a concomitant increase length of hospital stay and total cost per patient. As cannabis use increases, the recognition, measurement, and cost of the deleterious effects are necessary to incorporate into future practice strategies and public health policy development.
