Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases

Cannabinoid hyperemesis syndrome (CHS) is one of the more clinically challenging effects of cannabis consumption. It is characterized by cyclic attacks of nausea and vomiting in chronic cannabinoid users and learned behavior of compulsive hot bathing. The deaths of a 27‐year‐old female, a 27‐year‐old male, and a 31‐year‐old male with a history of CHS are reported. The decedents had a history of cyclical nausea and vomiting, chronic cannabinoid use and negative laboratory, radiological and endoscopic findings. All presented to the emergency department with nausea and vomiting in the days preceding death and were treated symptomatically. Toxicological analysis revealed tetrahydrocannabinol in postmortem blood. The cause of death of two of the three cases was attributed to CHS. CHS was appreciated in the third case but was not the cause of death. These three cases demonstrate the importance of recognizing CHS as a potential cause or contributing factor to death in cannabinoid user.     

UNEMPLOYMENT INSURANCE IN SURVEY AND ADMINISTRATIVE DATA

Unemployment Insurance (UI) benefits were a central part of the social safety net during the COVID-19 recession. UI benefits, however, are severely understated in surveys. Using administrative tax data, we find that over half of UI benefits were missed in major survey data, with a greater understatement among low-income workers. As a result, 2020 official poverty rates were overstated by about 2 percentage points, and corrected poverty reached a six-decade low. We provide data to correct underreporting in surveys and show that, compared to UI benefits, the UI exclusion tax expenditure was less targeted at low incomes.