Cannabis is the most widely used psychoactive substance in the United States (SAMHSA, 2020). Since the legalization of cannabis across states, the number of adults reporting frequent cannabis use has increased (Cerdá et al., 2019; Compton et al., 2019; Hall and Lynskey, 2020; Spindle et al., 2019). Such changes to the legal landscape of cannabis across states has heightened concerns regarding the impact of increased cannabis accessibility on cannabis use disorders and other adverse health outcomes (Cerdá et al., 2020, Hall and Lynskey, 2020, Simpson et al., 2021, Spindle et al., 2019).

Cannabinoid hyperemesis syndrome (CHS) has been one concern related to increased cannabis consumption patterns. CHS—or severe cyclic vomiting, nausea, and abdominal pain occurring within the context of daily cannabis use (Allen et al., 2004, Wallace et al., 2011)—has increasingly been reported by emergency departments (ED) across the country in the last decade (Dirmyer, 2018, Habboushe et al., 2018, Kim et al., 2015, Wallace et al., 2011). Because of a dearth of outpatient treatment options, the ED is often where people with cyclic vomiting and chronic cannabis use present during an acute symptomatic episode. Despite the increased reports of CHS diagnoses in acute care settings, the root causes and risk factors of CHS remain poorly understood (Sorensen et al., 2017, Wallace et al., 2011). Notably, CHS has similar clinical presentations to cyclic vomiting syndromes (Lee et al., 2012; Pareek, Fleisher, Abell, 2007), yet differs in the reported resolution of symptoms following cannabis use cessation (Galli et al., 2011, Sorensen et al., 2017, Wallace et al., 2011). Because CHS can only be definitively diagnosed following cannabis use cessation and symptom resolution (Galli et al., 2011, Sorensen et al., 2017, Wallace et al., 2011), symptoms and cannabis use patterns (e.g., chronic cannabis use, length of time using cannabis prior to symptom onset) are often used to diagnosis suspected CHS. Understanding people’s lived experiences is critical in order to better support patients presenting in ED settings and improve assessment of health outcomes among people who use cannabis chronically.

While research has documented the therapeutic uses of cannabis for several health conditions (e.g., pain management) (e.g., Haroutounian et al., 2016; (National Academies of Sciences et al., 2017), additional work has underscored the potentially adverse socio-economic and health impacts of chronic cannabis use (Cerdá et al., 2016, Hancox et al., 2010, Hasin, 2018, Hasin et al., 2016, Meier et al., 2016, Metrik et al., 2022, Volkow et al., 2014). Given these variations, research is needed to understand the health and social impacts of recreational and therapeutic cannabis use among people with high-intensity cannabis use.

Although medical cannabis has only been legal in our study setting since 2006, and the legalization of non-medical cannabis use for adults (21 years of age and older) in Rhode Island went into effect December 1, 2022, cannabis has remained highly accessible in our study setting due to street-based markets and the legalization of recreational cannabis in neighboring states. Given the increase in reports of CHS, the aim of this study was to understand how people with chronic cannabis use characterized their experiences with cyclic vomiting and their interactions within the ED setting, including discussions related to CHS.