Rare, cannabis-related illness needs ICD 10 code, physician argues
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Key takeaways:
- No IDC-10 code exists for cannabinoid hyperemesis syndrome, even though it can cause serious illness.
- Cases in one hospital increased significantly after marijuana was legalized in Michigan.
WASHINGTON — Cases of a rare cannabis-related condition increased significantly in one Michigan hospital after the state legalized marijuana, researchers reported here.
It took a chart review to catch the increase in cannabinoid hyperemesis syndrome (CHS) — a task made more difficult by the lack of an International Classification of Diseases, Tenth Revision (ICD 10) code for the illness, which can occur in long-term users of marijuana and is characterized by acute episodes of vomiting, nausea, weight loss, and abdominal pain. The lack of an ICD 10 code makes CHS “exceptionally difficult to study,” according to Brittany Tayler, MD, FAAP, the Alice Hamilton Public Health Scholar at Michigan State University-Hurley Children’s Hospital, who presented findings from a study of CHS at the AAP National Conference & Exhibition.
Tayler and Jenny LaChance, MS, research director at Hurley Medical Center in Flint, Michigan, compared the number of cases of CHS that occurred among adolescents and young adults in the years before and after Michigan legalized marijuana in 2018.
Tayler said more patients speak openly about marijuana use since legalization.
“I didn't feel like they were getting quite the care that they deserved, and I really wanted to examine how many patients we were actually seeing,” Tayler told Healio. “It's something that's a very huge strain on them, because there's this perception that since it's cannabis use, that it's somehow their fault that they're experiencing this syndrome.”
Tayler and LaChance conducted a chart review of patients starting in 2017 and ending in 2022, searching electronic medical records for the ICD 10 code R11, or “nausea with vomiting, unspecified,” and the uncomplicated code “cannabis-related disorders.” Altogether, they identified 275 patients aged 13 to 26 years old with CHS — just 30 who were treated before legalization compared with 245 treated after.
About half of each group were identified as African American or Black. The researchers did not find any significant differences in marijuana use documentation in the pre- (90%) or post-legalization (81.2%) group, or in reported alcohol use in the pre- (37.9%) or post-legalization (28.9%) group. Tayler noted that 100% of the pre-legalization group identified as smokers of tobacco or e-cigarettes, whereas only 2.4% did in the post-legalization group, which she said might be a sign that the former group was trying to imply their marijuana smoking instead of directly stating it.
“This might reflect the fact that people became more honest about their cannabis use,” “They were alluding to it with their vaping or e-cigarette documentation. But they were actually saying, ‘No, I don't smoke tobacco. I use [cannabis].”
Tayler said that the data should encourage ICD-10 to consider giving CHS a proper diagnostic code.
“A lot of people think that it is harmless to use marijuana, and it is not,” Tayler said. “There are a lot of side effects, particularly from chronic and heavy use, that we don't discuss with our patients, and I think we need to be more transparent with that, given the way that we're really moving toward cannabis being part of our life just like alcohol and tobacco. We need to be informed as pediatricians and medical providers about what some of the harms are and inform our patients about this.”
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Tayler B, et al. Abstract P3A046. Presented at: AAP National Conference & Exhibition; Oct. 20-24, 2023; Washington, D.C.
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