Cannabis Hyperemesis Syndrome in the Differential Diagnosis of Bathtub Deaths

Cannabis hyperemesis syndrome (CHS) is a condition caused by chronic use of cannabis in which individuals develop severe cyclic vomiting, nausea, and abdominal pain. This report presents two case fatalities of a 38-year-old male and a 44-year-old male, both found in bathtub and shower settings with past medical histories significant for long-standing CHS. The aim of this report is to discuss two deaths occurring in individuals with CHS who were found in bathtub or shower settings. Through examination of the investigative, autopsy, toxicologic, and vitreous chemistry findings, these cases illustrate the interpretive challenges encountered when assessing the role of CHS in death and highlight the importance of considering CHS among the potential causes or contributing conditions in similar medicolegal investigations. Establishing CHS and its related complications as a potential cause or contributor to death requires increased familiarity with these diagnostically challenging cases and highlights the importance of a thorough scene investigation, autopsy, toxicology review, and complete medical history by forensic pathologists.