A serious vomiting disorder linked to chronic cannabis use is increasing sharply across the United States, with emergency department cases rising fivefold between 2016 and 2022.
The Growing Problem
A recent analysis published in JAMA Network Open examined over 188 million emergency department visits and found that cases of cannabinoid hyperemesis syndrome (CHS) climbed from 4.4 per 100,000 visits in 2016 to 22.3 per 100,000 visits in 2022.
The disorder peaked during the COVID-19 pandemic in 2020 at 33.1 per 100,000 visits before declining somewhat, though rates remain well above pre-pandemic levels.
CHS is characterized by severe nausea, abdominal pain, and bouts of recurrent vomiting that can last hours or even days. The condition has earned the nickname "scromiting," combining "screaming" and "vomiting" to describe its intensity.
First documented in Australia in 2004, CHS has remained relatively obscure over the past two decades. The syndrome is likely underdiagnosed or misdiagnosed, making its true prevalence difficult to determine.
The disorder is strongly associated with chronic cannabis use, particularly daily use. As cannabis legalization expands across the US, greater access to products, increased variety, and higher potency levels likely contribute to rising cases. However, the exact cause of CHS remains unclear.
A distinctive feature of CHS is the compulsive hot bathing and showering behavior, which temporarily eases symptoms for many sufferers.
Young adults aged 18 to 25 are most vulnerable, being 3.5 times more likely to receive a CHS diagnosis than older adults.
James A. Swartz, a professor at the University of Illinois Chicago who led the study, notes that this age group has been most affected by cannabis legalization in terms of increased use and frequency, making them more susceptible to developing CHS.
Notably, while CHS cases increased during the study period, cases of cyclical vomiting from other causes declined, suggesting that CHS reflects cannabis-specific symptoms rather than a general rise in vomiting disorders.
CHS develops in two distinct phases:
Prodromal Phase: This early stage can last months or even years. Users experience increased nausea, abdominal discomfort, and fear of vomiting, though actual vomiting is absent. These symptoms serve as warning signs that cannabis use should be reduced.
Hyperemetic Phase: The disorder is fully developed at this stage, with symptoms including:
While short-term symptom management is possible, the only definitive cure for CHS is complete cessation of cannabis use.
Michael Gottlieb, a professor of emergency medicine at Rush University Medical Center, emphasizes that quitting marijuana is "the cornerstone" of prevention.
It remains unclear whether anything less than full cessation prevents recurrence. Even moderate cannabis use after developing CHS may trigger symptoms again, though this hasn't been thoroughly studied.
For individuals who regularly use cannabis but want to reduce their risk, Sherry Yafai, an emergency medicine physician and founder of The ReLeaf Institute, recommends:
Avoid high-potency products: Stay away from wax, dab, and shatter. Most users don't need products with more than 25% THC content.
Monitor THC intake: Be aware of the THC concentration in products and decrease either the potency or total daily consumption.
Take breaks: If warning signs like increased nausea appear, reduce use immediately to see if symptoms improve.
Self-test: Cut back on cannabis consumption when early symptoms emerge to determine if nausea lessens.
One limitation of current research is uncertainty about whether the increase reflects more actual cases or simply better recognition and diagnosis among healthcare providers.
"Either there's an actual increase in the number of people experiencing this disorder, or there's just a growing recognition of it," Swartz explains. "I think it's probably a little bit of both, but we won't really know that until there are more detailed studies."
As cannabis becomes more widely available and socially accepted, awareness of CHS is critical for users and healthcare providers. Recognizing early warning signs and reducing use at the first symptoms can prevent progression to the full disorder. For those who develop CHS, complete cessation of cannabis use remains the only proven way to prevent recurrence.
