A Surgeon’s Warning About Severe Vomiting Syndrome
In recent years, emergency rooms across the United States and other countries have seen an unusual and alarming trend: a surge in patients suffering from severe nausea, relentless vomiting, and abdominal pain — symptoms that often defy typical diagnosis and treatment. Many of these patients share one common factor: heavy, long‑term cannabis use. What was once dismissed as a rare or anecdotal condition has now become a serious public health concern, prompting warnings from emergency physicians and surgeons alike. This mysterious and often painful disorder, formally identified as Cannabinoid Hyperemesis Syndrome (CHS) — and colloquially dubbed “scromiting” — is sending a growing number of cannabis users to the emergency department.
In this comprehensive article, we’ll explore what CHS is, why it’s occurring more frequently now, how it presents in users, the challenges of diagnosis and treatment, surgeon and clinician warnings, risk factors, public health implications, and why awareness — both among patients and health professionals — is crucial.
What Is Cannabinoid Hyperemesis Syndrome (CHS)?
Cannabinoid Hyperemesis Syndrome is a condition linked to chronic, often heavy use of cannabis (marijuana), characterized by:
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Persistent nausea
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Severe, repetitive vomiting
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Intense abdominal pain
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Compulsive hot bathing or showering for temporary symptom relief
The term “scromiting” — combining screaming and vomiting — has emerged among patients and clinicians to describe the horrifying experience of vomiting so forcefully and painfully that it can be accompanied by vocal distress.
Though it may seem counterintuitive — after all, cannabis is widely known for its anti‑nausea properties and is prescribed to cancer patients undergoing chemotherapy and others with chronic nausea — CHS is a paradoxical effect that arises in a subset of frequent long‑term users. Researchers believe it has to do with changes in the body’s endocannabinoid system and how chronic exposure to THC (the main psychoactive compound in cannabis) alters nausea control mechanisms.
Why Is CHS on the Rise?
1. Increased Cannabis Use and Potency
In the past decade, recreational and medical cannabis legalization has expanded dramatically across the United States and other countries. Greater access, broader social acceptance, and the rise of high‑THC products — such as concentrates, vapes, edibles, and dabs — have led to more frequent and heavier use among consumers. This shift may be partly responsible for the rise in CHS cases, as heavy, chronic exposure seems to be a key risk factor.
2. Long‑Term and Daily Use
Studies have shown that CHS is most commonly reported among individuals who use cannabis daily, often multiple times per day, and who have been doing so for years or even decades. In a survey of more than a thousand self‑identified cannabis hyperemesis sufferers, daily use was nearly universal before the onset of symptoms, with many respondents reporting use more than five times a day and for more than five years.
3. Recognition and Tracking by Health Authorities
Until recently, cannabis‑related vomiting was poorly tracked — often misdiagnosed as food poisoning, stomach flu, or other more common gastrointestinal conditions. That has changed. In late 2025, the World Health Organization (WHO) formally added Cannabinoid Hyperemesis Syndrome to its International Classification of Diseases (ICD) with a specific diagnostic code, now also adopted by the U.S. Centers for Disease Control and Prevention (CDC). This classification allows doctors to more accurately diagnose, track, and study CHS rather than clustering it under generic vomiting or GI disorder categories.
4. Cultural and Clinical Awareness
In emergency departments, clinicians increasingly recognize the symptom pattern of CHS, particularly when relieved temporarily by hot showers or baths — a curious but well‑documented behavioral relief strategy that many patients adopt during episodes. This growing awareness has helped identify more cases, but also highlighted how little is still known about why only some cannabis users develop this condition.
Symptoms and Clinical Presentation
CHS typically progresses through three phases:
1. Prodromal Phase
This early stage may involve mild nausea, stomach discomfort, and a general sense of malaise. Patients may still consume cannabis without realizing these early symptoms foreshadow a more serious issue. Symptoms can last for months or even years before progressing.
2. Hyperemetic Phase
This is the hallmark stage of CHS:
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Severe, repetitive vomiting that can continue for hours or days
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Persistent nausea and retching
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Abdominal pain
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Weight loss
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Dehydration
During this phase, sufferers often take long, hot showers or baths to temporarily relieve symptoms — a behavior seen so consistently it is considered a clinical clue to CHS.
3. Recovery Phase
Symptoms begin to improve only after cessation of cannabis use, sometimes requiring days to months to resolve completely. If cannabis use resumes, symptoms can return quickly.
Complications and Why It Sends Users to the ER
The severe vomiting associated with CHS can lead to dangerous complications, making emergency care necessary:
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Severe dehydration, leading to dizziness, rapid heart rate, and potentially kidney issues
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Electrolyte imbalances (e.g., low potassium or sodium), which can cause muscle cramps, weakness, or arrhythmias
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Esophageal tears due to forceful vomiting
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Acute kidney injury, seizures, or even rare cases of shock or death in extreme situations
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Weight loss and malnutrition due to prolonged vomiting and avoidance of food
Emergency departments often provide supportive care like IV fluids, anti‑nausea medications, electrolyte correction, and sometimes antipsychotic medications like haloperidol when vomiting is severe and unresponsive. However, standard anti‑nausea drugs frequently fail in CHS, underscoring the complexity of the syndrome.
Diagnosis: A Clinical Challenge
Diagnosing CHS is complex because its symptoms overlap with many other gastrointestinal conditions. Physicians typically rely on a combination of criteria, including:
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A history of heavy cannabis use (daily or near‑daily) for at least one year
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Multiple episodes of severe vomiting and abdominal pain
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Symptom relief with hot bathing
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Symptom resolution with cannabis cessation
Guidelines also suggest ruling out other causes of vomiting before confirming CHS, such as bowel obstructions, infections, or metabolic conditions. In some clinical discussions, experts warn there is a risk of diagnostic bias, where clinicians may too hastily attribute vomiting to CHS simply because a patient uses cannabis, potentially overlooking more serious underlying conditions.
A Surgeon and Clinician’s Warning
Surgeons and emergency physicians who are on the frontlines of treating patients with severe vomiting have increasingly issued public warnings about CHS. The main thrust of these cautions is clear:
1. Cannabis Is Not Without Risk
Even though cannabis is often marketed and perceived as a natural and harmless recreational or therapeutic substance, it can produce serious adverse effects, especially with heavy chronic use. CHS is a stark example of a condition that is directly linked to long‑term exposure and that can produce life‑altering symptoms.
2. Awareness and Early Recognition Are Vital
People who use cannabis regularly should be aware of CHS symptoms, especially if unexplained nausea or vomiting persists. Early identification can prevent repeated visits to the ER and reduce the severity of illness by prompting timely cessation of cannabis use. Emergency clinicians also stress the need for physicians outside of emergency settings to recognize the condition so patients can be advised earlier.
3. Not Everyone Will Get It — But Risk Is Real
Medical professionals emphasize that CHS doesn’t occur in all cannabis users. It’s most commonly seen in heavy, chronic users who consume high‑potency products. However, the risk increases with frequency and duration of use, and there’s no easy way to predict who will develop the syndrome.
4. The Only Effective Treatment Is Stopping Cannabis
While supportive care in a hospital can manage dehydration and acute symptoms, the only known way to prevent recurrence of CHS episodes is to completely cease cannabis use. For many patients dependent on cannabis for recreational or medical reasons, this advice can be difficult but critical.
Public Health Implications
With CHS now officially recognized and tracked, health systems have better tools to evaluate its prevalence and impact. Data from JAMA Network and other studies indicate that emergency department visits related to CHS have increased substantially over the past decade, particularly in places with widespread cannabis access.
This rise has broad implications:
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Increased burden on emergency services due to recurrent and severe symptoms
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Economic costs from hospital stays, diagnostic tests, and treatments
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Need for clinician education across specialties about early recognition and proper diagnosis
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Public education campaigns to inform cannabis users of potential risks
Voices From the ER and Patients
Accounts from emergency medicine professionals and patients alike highlight the deep impact of CHS on individuals. Many patients describe experiences of desperation, repeatedly presenting to ERs, undergoing extensive tests, and only later discovering a link between chronic cannabis use and their symptoms. Some have described multiple episodes of vomiting, intense pain, and relief only through prolonged hot bathing — a pattern that finally led clinicians to suspect CHS.
In more extreme personal cases, individuals have reported repeated hospitalizations and life disruptions, underscoring how profoundly this condition can affect quality of life and health outcomes.
Conclusion: Cannabis, CHS, and the Importance of Awareness
Cannabinoid Hyperemesis Syndrome stands as a modern medical paradox: a condition triggered by a substance often used precisely for relief from nausea. Its rise in emergency departments, formal recognition by global health authorities, and growing research base have shifted CHS from obscurity to a significant concern for emergency medicine and public health.
Surgeons, ER doctors, and researchers warn that while cannabis may offer therapeutic benefits for many, it also carries real risks when used heavily and chronically. Awareness, careful monitoring, and honest conversations between patients and clinicians are essential to identify CHS early and prevent repeated suffering.
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