P4177 - Cannabis Legalization and a Spotlight on GI Complications

Sahil Sabharwal, MD¹, Deepak Sabharwal, MS², Sarah Assem, MD¹
1University of Arkansas for Medical Sciences, Fayetteville, AR; 2Health Orlando Incorporated, Orlando, FL

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 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 THC potency. In Canada, CHS-related ED visits surged 13-fold from 2014 to 2021 after recreational legalization. In the U.S., there is 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.

Discussion: 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.

Disclosures:
Sahil Sabharwal indicated no relevant financial relationships.
Deepak Sabharwal indicated no relevant financial relationships.
Sarah Assem indicated no relevant financial relationships.

Sahil Sabharwal, MD¹, Deepak Sabharwal, MS², Sarah Assem, MD¹. P4177 - Cannabis Legalization and a Spotlight on GI Complications, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.