Can you name some of your favorite types of patients in the Emergency Department? Weak and dizzy? Syncope? Low back pain? How about gastroparesis or cyclic vomiting syndromes?
Well, good news – if drug-induced vomiting is on your list of rewarding patient encounters, then this wave of states with newly legalized marijuana is just for you.
This is a small review of two urban, academic Emergency Departments in Colorado, retrospectively analyzing their diagnoses for encounters involving nausea & vomiting. The breakpoint in their analysis was the legalization of recreational marijuana in 2009. Through, frankly, a great number of assumptions involving documentation, drug screens, and other chart review calisthenics, the authors distilled out the patients with multiple ED visits for vomiting associated with drug abuse – clinically, the cyclic vomiting syndrome. And, if you accept the limitations of their review: the number of visits for cyclic vomiting to their EDs has doubled since the introduction of legalized marijuana.
Interestingly, there is also a small exploratory analysis included in the paper regarding the antiemetic of choice. They note promethazine use, despite the small sample, was significantly associated with needing admission – with an OR of 5.06 (95% CI 2.01 to 13.63). Whether this represents unmeasured cofounders or a real effect is uncertain. Anecdotally, with some evidence to support the practice, I have good experiences with droperidol and haloperidol in these sorts of patients.
“Cyclic Vomiting Presentations Following Marijuana Liberalization in Colorado”