The proven and true way to treat cannabinoid hyperemesis syndrome is to completely stop using marijuana.
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A new, counterintuitive slang term for the symptoms of long-term cannabis use is emerging, and experts are divided.
Medical experts say the symptoms should serve as a warning, but cannabis advocates say they’re fear-mongering.
“Scromitting” has been making headlines in recent weeks. According to the Cleveland Clinic, the image-inducing term combines the words “vomit” and “scream,” which are common symptoms of cannabinoid hyperemesis syndrome (CHS). Severe pain from periodic vomiting caused by CHS may cause patients to scream while vomiting.
The term is gaining popularity as more states legalize medical and recreational cannabis. As of December, 24 states had legalized the substance for recreational use.
Dr. David Stream, medical director of Cleveland Clinic’s Alcohol and Drug Recovery Center, said he has treated a variety of CHS patients over the years. He explained that even the most powerful anti-nausea drugs given to chemotherapy patients, such as ondansetron, did not stop the nausea.
Stream told USA TODAY on Dec. 5 that most of the emergency department doctors he spoke to in the Cleveland, Ohio, area have been treating CHS cases every day for the past five years.
But marijuana advocates like Paul Armentano, deputy director of the cannabis reform group NORML, say CHS is actually “extremely rare” and that a lack of research into the syndrome has obscured understanding of what causes it. Armentano claimed that CHS and “fraudulent practices” have been the latest anti-marijuana talking points.
“The scrotum is obviously sensational, the very fact that we’re renaming what was known for 20 years as cannabinoid hyperemesis syndrome, the scrotum,” Armentano said. “This is an unscientific coinage of leu, which combines a very specific terminology and diagnosis, and has been recognized in the literature for decades.”
What is Cannabinoid Hyperemesis Syndrome?
According to the Cleveland Clinic, cannabinoid hyperemesis syndrome is a side effect of long-term marijuana use that causes nausea, vomiting, and abdominal pain. According to the Rome Foundation, a nonprofit organization that defines the medical diagnosis and treatment of bowel-related diseases, to be diagnosed with CHS, a patient must meet the following criteria:
- periodic vomiting
- Presentation after long-term use of marijuana
- Reduced vomiting after discontinuing marijuana use
How long have you been diagnosed with Cannabinoid Hyperemesis Syndrome?
CHS was first described in Australian medical literature in 2004. One small study analyzed 19 patients who experienced periodic vomiting after long-term marijuana use.
What causes cannabinoid hyperemesis syndrome?
The causes of CHS, outside of long-term marijuana use, remain unclear due to limited research. Stream said “prolonged” in CHS’s case means daily marijuana use.
“I haven’t been able to really connect efficacy, and in the papers and literature that I’ve looked at, I don’t really understand the trend of what percentage of THC is needed to cause this,” Stream said.
Armentano agreed, adding that toxicology tests done on marijuana patients before they develop CHS would help understand the more immediate cause.
“That’s my first question: Is there something unique or different about the products that they’re consuming? Especially when you hear people say, ‘I started using cannabis in my late teens or early 20s, and I’ve used it for 30 years, but I didn’t develop this syndrome until I was in my mid-40s,'” Armentano said. “If you think about it that way, I feel like there’s something different about cannabis.”
Armentano said he wonders if unregulated or synthetic cannabis products, such as Delta 8 and Delta 10, can cause CHS. Delta 8 and Delta 10 are legal to purchase and consume under federal law as long as they contain 0.3% or less THC. Delta-9, on the other hand, is a cannabinoid associated with medical and recreational cannabis laws. It is regulated by the state.
“It’s very likely, if not likely, that in at least some of these cases these people are people who have been exposed to synthetic cannabis … and simply don’t know any better,” he said. “They just show up to the ER and say, ‘I used marijuana.’ Without marijuana, we don’t know if it’s synthetically derived cannabis like K2, or synthetic hemp intoxicants, including things like Delta-8, or if it’s actually more traditional cannabis flower.”
How common is Cannabinoid Hyperemesis Syndrome?
There are still few studies on CHS, so it is difficult to determine how common it is. And current research is also quite inconsistent.
A study cited by the Cleveland Clinic found that about 33% of people who self-reported frequent marijuana use visited the emergency room and met criteria for CHS. And in a small 2021 study of 321 patients who used marijuana and had nausea and vomiting, about 17% were suspected of having CHS.
From a more local perspective, Mercy Hospital in Springfield, Missouri, which legalized recreational marijuana in 2023, has reported 32 CHS cases in the hospital’s emergency department since January, media relations and communications manager Ettie Berneking told USA TODAY on Dec. 5.
What treatments are used for Cannabinoid Hyperemesis Syndrome?
The first step to treating CHS is to stop using marijuana completely, Stream said.
When it comes to medication, Dr. Stream said intravenous infusions of substances such as droperidol and haloperidol are often used in the CHS emergency room.
For temporary relief, hot showers or baths may reduce nausea and vomiting, according to the Cleveland Clinic. Capsaicin, commonly called hot pepper cream, can also be applied to the abdomen to relieve pain, Stream said.
Greta Cross is USA TODAY’s national trends reporter. Story ideas? Email her at gcross@usatoday.com.
