Ian Mitchell, MD
@drivmitch.bsky.social
Emerg doc with interests in addiction, cannabis, ketamine and naloxone
They say that 32% of those who use cannabis >20 days per month develop CHS. 6% of Canadians use cannabis daily, so 2% rate of CHS.
"If this is extractable to the general population, approximately 2.75 million ... Americans may suffer annually from a phenomenon similar to CHS."
"If this is extractable to the general population, approximately 2.75 million ... Americans may suffer annually from a phenomenon similar to CHS."
December 16, 2025 at 3:02 AM
They say that 32% of those who use cannabis >20 days per month develop CHS. 6% of Canadians use cannabis daily, so 2% rate of CHS.
"If this is extractable to the general population, approximately 2.75 million ... Americans may suffer annually from a phenomenon similar to CHS."
"If this is extractable to the general population, approximately 2.75 million ... Americans may suffer annually from a phenomenon similar to CHS."
No, you didn’t. Their reference estimates that 32.9% of daily users get CHS. 6% of Canadians use cannabis daily. So works out to 1/50 of the population suffer from this rare disease
December 16, 2025 at 1:18 AM
No, you didn’t. Their reference estimates that 32.9% of daily users get CHS. 6% of Canadians use cannabis daily. So works out to 1/50 of the population suffer from this rare disease
Just endless stupidity
December 15, 2025 at 11:18 PM
Just endless stupidity
Using the authors estimates, 1 in 50 Canadians should suffer from cannabinoid hyperemesis syndrome
That would drown our emergency departments in vomiting #medsky
That would drown our emergency departments in vomiting #medsky
December 15, 2025 at 9:14 PM
Using the authors estimates, 1 in 50 Canadians should suffer from cannabinoid hyperemesis syndrome
That would drown our emergency departments in vomiting #medsky
That would drown our emergency departments in vomiting #medsky
I see lots too. According to the authors of this article, it should affect 2% of all Canadians (6% are daily users of whom 32.9% will get CHS)
But this article states prevalence of CHS at 0.1% www.the-hospitalist.org/hospitalist/...
#medsky
But this article states prevalence of CHS at 0.1% www.the-hospitalist.org/hospitalist/...
#medsky
A High Yield Review of Cannabinoid Hyperemesis Syndrome - The Hospitalist
Presenters: Rebecca M. Cantu, MD, MPH, Brittany M. Slagle, DO, and Sara Sanders, MD The overall prevalence of cannabinoid hyperemesis syndrome (CHS) is 0.1% and is more common in young adults aged 18 ...
www.the-hospitalist.org
December 15, 2025 at 8:28 PM
I see lots too. According to the authors of this article, it should affect 2% of all Canadians (6% are daily users of whom 32.9% will get CHS)
But this article states prevalence of CHS at 0.1% www.the-hospitalist.org/hospitalist/...
#medsky
But this article states prevalence of CHS at 0.1% www.the-hospitalist.org/hospitalist/...
#medsky
An easy way to get rid of concerns of contaminants is to provide a regulated market. Contamination is not a concern for Canadians. Regulated cannabis is safe and quantified. Taxation contributes to the public purse rather than criminals
December 14, 2025 at 7:52 PM
An easy way to get rid of concerns of contaminants is to provide a regulated market. Contamination is not a concern for Canadians. Regulated cannabis is safe and quantified. Taxation contributes to the public purse rather than criminals
Speaking of evidence, there are no confirmed cases of overdose from #fentanyl contaminated cannabis. The supplied case report has inadequate toxicology to make the claim, no matter what Trump claims
Stigma comes from medical misinformation
Stigma comes from medical misinformation
December 14, 2025 at 7:49 PM
Speaking of evidence, there are no confirmed cases of overdose from #fentanyl contaminated cannabis. The supplied case report has inadequate toxicology to make the claim, no matter what Trump claims
Stigma comes from medical misinformation
Stigma comes from medical misinformation
Did you notice the medical misinformation?
There are no confirmed cases of overdose from fentanyl contaminated cannabis and their reference is in no way confirmatory
There are no confirmed cases of overdose from fentanyl contaminated cannabis and their reference is in no way confirmatory
December 12, 2025 at 8:34 PM
Did you notice the medical misinformation?
There are no confirmed cases of overdose from fentanyl contaminated cannabis and their reference is in no way confirmatory
There are no confirmed cases of overdose from fentanyl contaminated cannabis and their reference is in no way confirmatory
6. The paucity of research for benefits of cannabis is due to stigma and bias. The last thing that is needed is to add medical misinformation to the list. #medsky
mesudlearningcommunity.org/wp-content/u...
mesudlearningcommunity.org/wp-content/u...
December 11, 2025 at 7:43 PM
6. The paucity of research for benefits of cannabis is due to stigma and bias. The last thing that is needed is to add medical misinformation to the list. #medsky
mesudlearningcommunity.org/wp-content/u...
mesudlearningcommunity.org/wp-content/u...
5. Was there testing of source material to confirm contamination?
No. The patient denied using opiates, yet there were opiates in the blood
That is a conundrum, can’t say I have ever seen that in the emergency department #medsky
No. The patient denied using opiates, yet there were opiates in the blood
That is a conundrum, can’t say I have ever seen that in the emergency department #medsky
a man in a white shirt is covering his face with his hands .
ALT: a man in a white shirt is covering his face with his hands .
media.tenor.com
December 11, 2025 at 7:43 PM
5. Was there testing of source material to confirm contamination?
No. The patient denied using opiates, yet there were opiates in the blood
That is a conundrum, can’t say I have ever seen that in the emergency department #medsky
No. The patient denied using opiates, yet there were opiates in the blood
That is a conundrum, can’t say I have ever seen that in the emergency department #medsky
4. Looks like we are off to a bad start with the journal it appears in. Cureus recently LOST its impact factor apparently due to quality issues
#medsky
#medsky
December 11, 2025 at 7:43 PM
4. Looks like we are off to a bad start with the journal it appears in. Cureus recently LOST its impact factor apparently due to quality issues
#medsky
#medsky
3. So how robust is their evidence to support the first ever confirmed case of overdose from smoking cannabis contaminated with fentanyl?
“Extraordinary claims require extraordinary evidence “ #medsky
assets.cureus.com/uploads/case...
“Extraordinary claims require extraordinary evidence “ #medsky
assets.cureus.com/uploads/case...
assets.cureus.com
December 11, 2025 at 7:43 PM
3. So how robust is their evidence to support the first ever confirmed case of overdose from smoking cannabis contaminated with fentanyl?
“Extraordinary claims require extraordinary evidence “ #medsky
assets.cureus.com/uploads/case...
“Extraordinary claims require extraordinary evidence “ #medsky
assets.cureus.com/uploads/case...
They are also spreading misinformation that can be cleared up by a visit to the website of the “this is your brain on drugs people“. drugfree.org/article/mari...
December 10, 2025 at 8:58 PM
They are also spreading misinformation that can be cleared up by a visit to the website of the “this is your brain on drugs people“. drugfree.org/article/mari...
I'm saying there is a finger on the scale. If you outlaw/restrict/deny funding for research of benefits, while massively funding research for harms, there is a bias, plus not enough evidence to say anything. For example, for insomnia, I can only find one RCT ever done, with 9 subjects. Why no more?
December 10, 2025 at 8:26 PM
I'm saying there is a finger on the scale. If you outlaw/restrict/deny funding for research of benefits, while massively funding research for harms, there is a bias, plus not enough evidence to say anything. For example, for insomnia, I can only find one RCT ever done, with 9 subjects. Why no more?
I would agree that there is "little evidence". How many RCTs for benefits of cannabis have been carried out in the US?
www.vice.com/en/article/v...
The lead example of a drug-drug interaction they list is for warfarin, which is supported by "very low quality data" (Garwood, et al)
www.vice.com/en/article/v...
The lead example of a drug-drug interaction they list is for warfarin, which is supported by "very low quality data" (Garwood, et al)
Inside the Fight to Study Marijuana for Vets with PTSD
The VA won't help recruit veterans for an FDA-approved trial.
www.vice.com
December 10, 2025 at 6:21 PM
I would agree that there is "little evidence". How many RCTs for benefits of cannabis have been carried out in the US?
www.vice.com/en/article/v...
The lead example of a drug-drug interaction they list is for warfarin, which is supported by "very low quality data" (Garwood, et al)
www.vice.com/en/article/v...
The lead example of a drug-drug interaction they list is for warfarin, which is supported by "very low quality data" (Garwood, et al)
I remember this mostly being based on pharma shenanigans. onlinelibrary.wiley.com/doi/abs/10.1...
Droperidol—Behind the Black Box Warning
Click on the article title to read more.
onlinelibrary.wiley.com
December 9, 2025 at 6:48 PM
I remember this mostly being based on pharma shenanigans. onlinelibrary.wiley.com/doi/abs/10.1...
I’m a huge ketamine fan, but it lasts too long for cardioversion. I’ll use it if there is any hypotension but otherwise 50-100 of fentanyl with propofol on top
December 9, 2025 at 4:57 PM
I’m a huge ketamine fan, but it lasts too long for cardioversion. I’ll use it if there is any hypotension but otherwise 50-100 of fentanyl with propofol on top
I would only ever attempt the Sid Viscous version youtu.be/rDyb_alTkMQ?...
Sid Vicious - My Way (Original and Complete Version)
YouTube video by Luis Asenjo
youtu.be
December 6, 2025 at 6:47 AM
I would only ever attempt the Sid Viscous version youtu.be/rDyb_alTkMQ?...