S1150 Cannabis Use Increases Healthcare Utilization in Patients With Cyclical Vomiting Syndrome: A Propensity-Matched Analysis

Introduction: Cyclical vomiting syndrome (CVS) carries a significant financial burden on the United States (US) healthcare system due to recurrent emergency department (ED) visits and hospitalizations. Large database studies showed a reduction in healthcare resource utilization among cannabis users as compared to non-cannabis users, with potential methodological limitations related to CVS classification. Therefore, using real-world data, we aimed to assess the impact of cannabis on the outcomes of individuals diagnosed with CVS. Methods: We conducted a retrospective cohort study in the US using the TriNetX research network to identify adults ≥18 years with CVS Patients were stratified by cannabis use into 2 groups: patients with CVS and cannabis use, and non-cannabis users with CVS (controls). Cohorts were matched using 1:1 propensity score matching on demographics, body mass index (BMI), comorbid conditions (e.g., risk factors for CVS), and treatment (e.g., abortive and prophylactic therapy). Outcomes included all-cause emergency department (ED) visits and hospitalizations, rates of esogastroduodenoscopy (EGD), and computed tomography (CT) of the abdomen. Results: A total of 21,501 patients with CVS using cannabis were propensity matched with 21,501 controls. Among unmatched samples, cannabis users with CVS were younger, with higher rates of mood/anxiety/sleep disorders, gastroesophageal reflux disease, gastroparesis, IBS, migraines, and were more likely to use alcohol/nicotine/opioids (all P < 0.001), as compared to controls. Furthermore, patients with CVS with reported cannabis use were more likely to be treated with both abortive (P < 0.001) and prophylactic therapy (e.g., tricyclic antidepressants) (P < 0.001). Among matched samples, cannabis use in patients with CVS was associated with a 45% increase in rates of ED visits (adjusted odds ratio [aOR] = 1.45, 95% CI: 1.39-1.51) and a 35% increase in rates of hospitalizations (aOR = 1.35, 95% CI: 1.19 – 1.52), along with reduced rates of EGDs (aOR = 0.85, 95% CI: 0.8 – 0.91), and CT of the abdomen (aOR = 0.44, 95% CI: 0.32 – 0.62). Conclusion: This cohort study is the first study using real-world evidence showing significantly increased odds for all-cause ED visits and hospitalizations among cannabis users with CVS as compared to non-cannabis users. Therefore, the use of cannabis in this patient population should be approached with caution due to the heightened risk of adverse effects and financial burden on the US healthcare system.