Cannabinoid Hyperemesis Syndrome: Evidence for Systematic Misattribution of Synthetic Cannabinoid Toxicity to Natural Cannabis

This paper presents evidence that Cannabinoid Hyperemesis Syndrome (CHS) prevalence estimates may be systematically inflated by misattribution of synthetic cannabinoid toxicity to natural cannabis use. When extended toxicology panels are employed, military hospital and New Zealand forensic data reveal that approximately 70% of presumed "cannabis hyperemesis" cases test positive for synthetic cannabinoids, while only ~5% test positive for THC alone. The analysis presents seven converging lines of evidence: (1) Military and New Zealand toxicology data showing 70%+ synthetic cannabinoid detection in presumed CHS cases; (2) Timeline analysis demonstrating CHS case increases (2009-2013) correlate with synthetic cannabinoid market expansion rather than high-THC cannabis availability; (3) Mass overdose events physiologically impossible with natural cannabis; (4) Manufacturing evidence documenting contamination and unpredictable dosing; (5) Testing methodology gaps wherein standard drug screens detect THC but not synthetic cannabinoids; (6) COVID-19 natural experiment showing 7.5-fold CHS spike correlating with Delta-8 market explosion; (7) Geographic inverse correlation showing prohibition states have highest CHS rates. Supporting datasets including military toxicology data, New Zealand ESR forensic results, and CDC surveillance data are available through Harvard Dataverse at https://doi.org/10.7910/DVN/WAHSL5 The convergence of these evidence streams suggests current CHS diagnostic criteria conflate synthetic cannabinoid toxicity with natural cannabis use, with significant implications for clinical practice, public health policy, and cannabis legalization debates.