More potent cannabis might be behind the surge in cases of this mysterious condition, which might lead to psychosis, according to experts.

By Karen Pallarito
July 12, 2021
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Emergency medicine physicians are noticing a rise in cases of a once-rare syndrome tied to cannabis use. Medically it's known as cannabinoid hyperemesis syndrome, or CHS, which causes recurrent nausea, vomiting, and abdominal pain.

But some health care professionals know it as "scromiting," defined as "a mashup of 'screaming' and 'vomiting,'" according to a new NBC News investigation.

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Credit: Getty / Photo Illustration by Jo Imperio

"It seems like we're seeing more and more cases," Leigh Vinocur, MD, a medical cannabis expert and spokesperson for the American College of Emergency Physicians and the Society of Cannabis Clinicians, tells Health. She attributes the trend to increased access to legal cannabis, either recreational or medical, as well as the availability of stronger cannabis products. "There's definitely a trend of high levels of THC in legal cannabis today," Dr. Vinocur says.

Here's what you need to know about scromiting and cannabinoid hyperemesis syndrome: what causes this reaction, how common CHS is, and why it's been linked to psychotic episodes.

What is CHS—aka scromiting?

Cannabinoid hyperemesis syndrome is a cyclic pattern of severe vomiting associated with a history of cannabis use. Other symptoms, according to a 2016 review in the Journal of Medical Toxicology, include nausea, abdominal pain, and compulsive showering or hot baths as a means of seeking symptom relief. Once cannabis use is stopped, symptoms resolve, per the review. CHS also tends to occur more often in men and in younger adults.

While the syndrome was described in medical literature as early as 2004, researchers still don't know a lot about why some cannabis users develop symptoms and others do not. In many ways, it seems counterintuitive. After all, cannabis is often recommended to relieve chemotherapy-induced nausea and vomiting.

"There's a belief that maybe the receptors in the gut get overstimulated, and that's what is causing it," says Dr. Vinocur.

Joseph Habboushe, MD, an emergency medicine physician now with Weill Cornell Medicine in New York City, previously told Health that people with CHS often end up in the emergency room or a gastroenterologist's office, where they tend to be misdiagnosed.

How common is scromiting?

Current statistics are hard to come by. Dr. Habboushe is the lead author of a study conducted in 2015 that surveyed emergency department patients, ages 18 to 49, who reported smoking marijuana at least 20 days a month. Of those surveyed, "roughly a third seemed to have some symptoms to fit CHS."

A 2018 review in the American Journal of Therapeutics points out that the rise in CHS cases poses challenges for the health care system. Doctors used to diagnose patients with this condition "only after years of visits to different hospitals and extensive workups entailing imaging studies, consultation by various specialists, and inpatient hospitalizations," say the study authors, who are from Chicago's Cook County Health and Hospitals System. But these days, they argue, it ought to be considered in "any patient presenting with intractable nausea and vomiting."

Patients end up having extensive workups to rule out other causes of their symptoms, Dr. Vinocur explains. "You don't want to attribute it to cannabis and then have someone's appendix burst."

Getting a good patient history is really important, Dr. Vinocur adds, because the desire to hop into a hot bath or shower is a "good clue" that cannabis use is the cause. "I even ask that of patients who come in vomiting," she says.

Can people with CHS experience psychiatric symptoms?

Four doctors in Colorado, per the NBC News report, cited an increase in the number of patients who exhibit psychiatric issues, including psychosis, after consuming potent marijuana. The article quotes G. Sam Wang, MD, of Children's Hospital Colorado in Denver, who says evidence is growing that cannabis, especially in higher concentrations, can affect mental health.

Dr. Vinocur says overdoing cannabis can cause anxiety, psychotic episodes, and paranoia. "You don't always see that," she adds. But people experiencing acute intoxication with cannabis "can become very paranoid and agitated and anxious."

While chronic smoking or vaping are risk factors for CHS, acute intoxication usually occurs when people ingest cannabis, say by popping gummies containing THC. "It takes longer for it to act, and it stays in the system longer too," says Dr. Vinocur.

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