A condition affecting some chronic marijuana users that causes painful nausea and vomiting has been recognized by the World Health Organization – a move that will make it easier to track and treat the syndrome, health experts said.
The clinical name for the condition is cannabis hyperemesis syndrome, or CHS, but online it has been dubbed "scromiting," because the bouts of nausea and abdominal pain can be so intense and frequent it causes people to scream.
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"It was some of the worst pain, like, physical pain I've ever experienced in my life," one TikTok user says she posted about her symptoms. "… It was really bad, like I was crying and screaming, and I was like, I'm just begging, 'God, Please make it stop.'"
Scromiting is also on the rise, research suggests. One study found that emergency department visits for CHS among adults 18 to 35 surged during the COVID-19 pandemic, from 2020 to 2021, and have stayed high. Another study showed that emergency department visits for CHS increased more than 10-fold between 2016 and 2023 for adolescents 13-21.
But researchers have had a hard time pinpointing how common CHS really is, in part because not everyone who experiences it goes to an emergency department or doctor. Also, the condition is sometimes confused with other gastrointestinal issues, the Cleveland Clinic says.
The fact that the WHO has created a diagnostic code for CHS in its International Classification of Diseases manual that clinicians in the United States can use will help providers and researchers more accurately diagnose and collect data on the syndrome.
"A new code for cannabis hyperemesis syndrome will supply important hard evidence on cannabis-adverse events, which physicians tell us is a growing problem," said Beatriz Carlini, a research associate professor at the University of Washington School of Medicine.
Symptoms of CHS
CHS usually develops after years of frequent cannabis use, but not everyone who uses cannabis on a regular basis gets CHS. One study found that nearly 33% of people who said they frequently used marijuana reported having symptoms, according to the Cleveland Clinic.
The onset varies from person to person, according to Dr. Chris Buresh, an emergency medicine specialist with UW Medicine.
"Some people say they've used cannabis without a problem for decades. Or they smoke pot because they think it treats their nausea," Buresh said. "It seems like there's a threshold when people can become vulnerable to this condition, and that threshold is different for everyone. Even using in small amounts can make these people start throwing up."
Intense cycles of abdominal pain and vomiting typically start within 24 hours of the last cannabis use and can last for days. A recent study of more than 1,000 people who have had CHS found that 85% had had at least one emergency department visit and 44% reported at least one hospitalization.
According to the Cleveland Clinic:
• The prodromal phase, which can last months or years, most commonly affects adults who have consistently used marijuana since they were teenagers. It is marked by abdominal pain or morning nausea and sometimes a fear of vomiting.
• The hyperemetic phase, marked by recurrent vomiting and nausea, may last 24 to 48 hours. People in this phase may start compulsively bathing and avoiding certain foods or purposefully restricting how much they eat.
• The recovery phase comes when people stop using cannabis altogether. But even then, it may take days or months for the symptoms to go away.
Causes of CHS
What causes the syndrome is unclear and needs more research, health experts say.
"We don't know if it's related to the greater general availability of cannabis or the higher THC potency of some products or something else," Buresh said.
Cannabis contains many chemicals, including THC, or delta-9-tetrahydrocannabinol, which causes the mood-altering effects of the drug. THC levels in cannabis products have risen sharply in recent decades.
The percent of THC in cannabis samples the U.S. Drug Enforcement Agency seized rose from about 4% in 1995 to more than 16% in 2022, an analysis from the National Institute on Drug Abuse found.
Most cannabis products now available have potencies above 20%, a recent report showed.
"The marijuana and cannabis products that your grandparents may have used are very different from what's out there now," said Dr. Deepak Cyril D'Souza, a psychiatry professor at Yale School of Medicine.
How CHS is treated
Hot baths and showers can alleviate the symptoms of CHS, but the only way to get rid of CHS is to stop using all cannabis products, the Cleveland Clinic says.
People who are dehydrated from vomiting may require intravenous fluids and hospitalization.
People with CHS may also lose weight, become malnourished and have tooth decay, among other complications, the Cleveland Clinic says.