Man Describes Intense Reaction After Cannabis Use Linked to ER Visits

For decades, cannabis carried a near-universal stigma in American society. Long portrayed as a dangerous “gateway” drug or moral threat, cannabis was largely demonized in media, political discourse, and public policy throughout the 20th century. Warnings often focused on addiction, cognitive impairment, and the risk of introducing users to harder substances.

This perception began to shift in the early 2000s as scientific research, patient advocacy, and changes in law prompted a reevaluation of cannabis’ societal role. Clinical studies highlighted potential therapeutic applications, including pain management, antiemetic properties, and seizure control, prompting states to adopt medical cannabis laws.

By the 2010s, legalization for recreational use began gaining traction in the United States, and by early 2026, at least 24 states and territories had legalized adult-use cannabis.

Public perception evolved alongside legislation. Fewer people now view cannabis as inherently dangerous, even among those who have never used it. Nonetheless, cannabis is not without potential harms — some of which are under-recognized or paradoxical.

One of the most surprising of these is Cannabinoid Hyperemesis Syndrome (CHS), colloquially known as “scromiting” — a term derived from the simultaneous screaming and vomiting that patients often experience during acute episodes.

What Is Cannabinoid Hyperemesis Syndrome?

Cannabinoid Hyperemesis Syndrome (CHS) is a condition linked to long-term, frequent cannabis use that leads to sudden, severe, and cyclical episodes of nausea, vomiting, and intense abdominal pain.

Paradoxical effect: Cannabis is commonly associated with relaxation, euphoria, and appetite stimulation. CHS, however, represents the opposite effect — the body reacts adversely to chronic exposure to cannabinoids, particularly tetrahydrocannabinol (THC).
“Scromiting”: The nickname vividly captures the extreme nature of CHS episodes, combining intense vomiting with distress, sometimes accompanied by loud vocalization due to pain and nausea.

CHS is not widely understood outside specialized medical circles, yet it is increasingly recognized as a growing public health concern, especially in regions with legal recreational cannabis.

How CHS Develops: Mechanisms and Theories

Although the precise cause of CHS is not fully understood, research indicates several consistent patterns:

Chronic, heavy cannabis use: CHS almost exclusively occurs in individuals who use cannabis daily or nearly every day over months to years, often exceeding a decade.
THC potency: Modern cannabis products, particularly concentrates, edibles, and vapes with elevated THC levels, are believed to increase the risk of developing CHS, though causality is still being studied.
Endocannabinoid system dysregulation: The prevailing hypothesis implicates the endocannabinoid system (ECS) — a complex network of receptors throughout the brain, gastrointestinal tract, and nervous system responsible for regulating appetite, nausea, pain, and mood. Chronic overstimulation by THC may paradoxically impair natural regulatory mechanisms, resulting in hyperemesis.

It is important to note that not all heavy cannabis users develop CHS. Genetic predisposition, individual metabolic differences, and variations in ECS receptor sensitivity likely play roles in determining susceptibility. Ongoing studies aim to clarify these risk factors.

Clinical Symptoms: Recognizing CHS

CHS symptoms generally progress through three phases, each with distinct characteristics:

1. Prodromal Phase

Often subtle, lasting months to years
Symptoms include:
- Mild nausea, especially in the morning
- Abdominal discomfort
- Occasional anxiety about vomiting
Many patients increase cannabis use during this phase to self-treat nausea, unknowingly exacerbating the condition

2. Hyperemetic (Active) Phase

The defining stage of CHS
Symptoms are severe and distressing, including:
- Intense, persistent nausea
- Frequent vomiting (multiple times per hour in some cases)
- Severe abdominal pain, often cramping or colicky in nature
- Episodes may trigger screaming due to pain and nausea (“scromiting”)
Patients frequently report temporary relief from hot showers or baths, a hallmark symptom unique to CHS
Duration: 24–72 hours or longer, often prompting emergency medical visits

3. Recovery Phase

Occurs after complete cessation of cannabis use
Symptoms gradually subside over days, weeks, or months
Resumption of cannabis use typically triggers a rapid return of symptoms, creating a cycle of repeated episodes

Epidemiology: How Common Is CHS?

Estimating the prevalence of CHS is challenging due to overlapping symptoms with other conditions (e.g., cyclical vomiting syndrome, gastroenteritis, migraine-associated vomiting) and historical underreporting.

Key trends:

Emergency department (ED) visits: Studies of U.S. ED data from 2016–2022 indicate a sharp increase in CHS diagnoses, particularly coinciding with the rise of high-potency cannabis products and expanded legalization.
Adolescent and young adult impact: Patients aged 13–35 constitute the majority of cases, with rates rising nearly 50% annually in some studies.
Hospitalization rates: Surveys suggest that ~85% of diagnosed patients visit the ER at least once for CHS symptoms, and nearly 50% are hospitalized for severe dehydration or complications.

These figures underscore CHS as far from rare and highlight the need for increased awareness among patients, clinicians, and public health professionals.

Risk Factors

Although anyone with chronic cannabis use can develop CHS, the following are common risk factors:

Daily or near-daily cannabis consumption
Long-term use (years to decades)
Early initiation of cannabis use (teenagers and young adults)
Male sex appears slightly more represented in some studies, though cases occur across genders

It is important to emphasize that not all chronic users develop CHS, and research continues into why some are more susceptible than others.

Diagnostic Challenges

CHS is often misdiagnosed, which can delay proper treatment:

Symptoms mimic common gastrointestinal disorders, including cyclic vomiting syndrome, gastritis, gastroenteritis, and pancreatitis
Misdiagnosis may result in unnecessary imaging (CT scans, ultrasounds) or invasive procedures
Lack of awareness among clinicians historically contributed to repeated ED visits without effective intervention

In October 2025, a clinical diagnostic code (ICD-10-CM) was officially introduced for CHS, enabling more accurate documentation, epidemiological tracking, and research.

Diagnostic criteria commonly include:

Recurrent vomiting and severe nausea episodes
Chronic cannabis use (daily or near-daily for at least a year)
Symptom relief following sustained cannabis cessation
Behavioral patterns such as compulsive hot bathing to alleviate nausea

Emergency and Symptomatic Management

During acute episodes, standard antiemetics like ondansetron or promethazine often provide minimal relief. Symptom management typically includes:

IV fluids to prevent dehydration
Electrolyte replacement (potassium, magnesium)
Pain management, occasionally including opioids for severe abdominal pain
Hot showers or baths — unique to CHS and often providing temporary relief
Off-label interventions such as haloperidol or topical capsaicin have been used with variable success in ER settings

Why CHS Matters: Public Health Implications

With cannabis legalization expanding and THC concentrations increasing, CHS is emerging as a recognized public health issue:

Rising ER visits indicate that CHS is under-recognized and under-treated
Patients may suffer recurrent episodes, hospitalization, and unnecessary diagnostic testing
Awareness among clinicians is improving, yet misdiagnosis remains common

Education and prevention are critical. Understanding risk factors, recognizing early symptoms, and addressing chronic use patterns can prevent repeated, severe CHS episodes.

While emergency interventions can provide temporary relief, the only known permanent solution for CHS is complete cessation of cannabis use. This includes all forms: smoked, vaped, edible, or other cannabinoid-containing products.

Once cannabis is stopped, symptoms gradually fade over days to weeks, though in some chronic cases, full resolution may take months.
Resuming cannabis use, even in small amounts, can rapidly trigger recurrence, underscoring the importance of strict avoidance for long-term recovery.

Healthcare providers often work with patients to develop support plans to manage withdrawal symptoms, cravings, or coexisting cannabis use disorder. Behavioral therapy, counseling, and peer support groups can improve adherence to cessation and prevent relapse.

Complications of CHS

Repeated episodes of CHS are more than distressing; they can cause serious medical complications:

Dehydration: Continuous vomiting can rapidly lead to fluid loss. Severe dehydration can impair kidney function and cardiovascular stability.
Electrolyte Imbalances: Sodium, potassium, and chloride levels may drop significantly, potentially causing arrhythmias or muscle weakness.
Acute Kidney Injury: Chronic dehydration and electrolyte disturbances increase the risk of acute kidney injury.
Esophageal Tears (Mallory-Weiss syndrome): Forceful vomiting can lead to tears in the esophagus, which may require medical or surgical intervention.
Dental Erosion: Recurrent vomiting exposes teeth to stomach acid, increasing the risk of cavities, enamel loss, and gum disease.
Hospitalizations: Severe CHS can lead to repeated ER visits and inpatient stays, straining healthcare resources and affecting quality of life.

While fatalities directly attributed to CHS are rare, untreated dehydration or metabolic complications can be life-threatening, emphasizing the need for prompt recognition and intervention.

Clinical Research and Emerging Understanding

Recent research has expanded the understanding of CHS, particularly in the context of evolving cannabis use patterns:

THC Potency: Modern cannabis products often exceed 20% THC concentration, with some concentrates surpassing 80%. High-potency THC has been linked to increased CHS severity and earlier onset in chronic users.
Cannabis Use Patterns: Frequent, long-term use correlates with CHS risk. Individuals using daily or multiple times per day, particularly via high-potency concentrates or edibles, are at higher risk.
Genetic Susceptibility: Preliminary studies suggest that genetic variations in cannabinoid receptor expression or metabolism may influence who develops CHS. Ongoing research aims to clarify these mechanisms.

Notably, CHS illustrates a paradox in cannabinoid pharmacology: while cannabinoids have recognized antiemetic properties, chronic overstimulation of the ECS can trigger hyperemesis, reflecting a dose-dependent, context-specific effect.

Public Health Implications

With the legalization of recreational cannabis and rising THC concentrations, CHS has become an emerging public health concern. Key implications include:

Emergency Department Burden: Increased CHS presentations are straining ER resources, particularly in states with legal cannabis markets.
Education Gaps: Many patients and clinicians remain unaware of CHS, leading to misdiagnosis, unnecessary testing, and prolonged suffering.
Preventive Messaging: Public health campaigns are increasingly emphasizing safe cannabis use, recognition of CHS symptoms, and the importance of medical consultation for chronic nausea and vomiting.
Youth and Adolescent Risk: Early initiation of cannabis use is associated with higher lifetime CHS risk, highlighting the need for targeted prevention programs.

Patient Guidance and Self-Management

For individuals experiencing CHS symptoms, evidence-based recommendations include:

Immediate Steps During an Episode:
- Use hot showers or baths to temporarily relieve nausea (a CHS hallmark symptom)
- Stay hydrated with oral rehydration solutions if possible
- Seek urgent medical care for severe or prolonged vomiting
Long-Term Management:
- Complete cessation of all cannabis products
- Consider counseling or support for cannabis dependence or habitual use
- Monitor for complications (e.g., electrolyte imbalance, dehydration) and follow-up with healthcare providers
Medical Communication:
- Patients should inform healthcare providers of cannabis use history, as CHS is often under-recognized
- Documenting symptom patterns (frequency, triggers, relief strategies) can help clinicians diagnose CHS accurately

Misdiagnosis and Clinical Challenges

CHS is frequently misdiagnosed as:

Cyclical vomiting syndrome (CVS)
Gastroenteritis or food poisoning
Migraine-related nausea
Pancreatitis or gastritis

Misdiagnosis can result in:

Repeated ER visits without relief
Unnecessary imaging, lab tests, or invasive procedures
Increased healthcare costs
Delayed initiation of effective treatment (cessation of cannabis)

The introduction of an official ICD-10-CM diagnostic code for CHS in October 2025 has facilitated more accurate tracking, research, and healthcare billing.

Emerging Research Directions

Current research priorities include:

Understanding Genetic Susceptibility: Identifying biomarkers or genetic predispositions that increase CHS risk.
Mechanistic Studies: Investigating how chronic cannabinoid exposure dysregulates the ECS and gastrointestinal motility.
THC Concentration Impact: Quantifying risk differences between high-THC concentrates, edibles, and traditional cannabis flower.
Public Health Interventions: Developing educational campaigns to raise awareness among chronic users and healthcare providers.
Therapeutic Strategies: Exploring adjunctive pharmacological treatments that may alleviate symptoms during hyperemetic episodes, though cessation remains the only definitive cure.

Societal and Cultural Considerations

CHS also has broader societal implications:

Normalization vs. Risk Awareness: As cannabis becomes more socially accepted and legally available, users may underestimate risks, including CHS.
Youth Education: Early education on potential harms, including CHS, is critical to prevent lifelong health consequences.
Healthcare Training: Clinicians need comprehensive training to identify CHS, differentiate it from other vomiting disorders, and provide evidence-based advice.

Raising awareness can prevent unnecessary suffering and reduce the economic burden on healthcare systems, while also informing safer cannabis consumption practices.

Key Takeaways

CHS is paradoxical: Cannabis, a substance known for anti-nausea effects, can induce severe vomiting in chronic users.
Only cessation cures CHS: Symptomatic treatments provide temporary relief, but long-term recovery requires complete abstinence from all cannabis products.
High-risk populations: Daily or near-daily cannabis users, particularly young adults and those using high-potency products, are most at risk.
Public health significance: With legalization and widespread use, CHS is a growing issue requiring clinician awareness, patient education, and preventive interventions.
Complications are serious: Repeated vomiting can lead to dehydration, electrolyte imbalances, kidney injury, esophageal tears, dental damage, and hospitalizations.

Conclusion

Cannabinoid Hyperemesis Syndrome is a paradoxical and often under-recognized consequence of chronic cannabis use. Its hallmark feature — intense, cyclical vomiting sometimes accompanied by screaming, or “scromiting” — presents both a clinical challenge and a public health concern.

Despite the widespread perception of cannabis as safe or therapeutic, CHS highlights the importance of understanding dose, duration, and individual susceptibility. Recognizing the signs early, educating users, and supporting complete cessation are essential strategies to prevent recurrence and severe complications.

As cannabis legalization continues to expand, both patients and healthcare providers must balance the therapeutic potential of cannabinoids with the real risks of chronic use. Awareness of CHS is not just a medical concern — it is a societal imperative, ensuring that the benefits of cannabis are realized safely while minimizing harm.

For anyone experiencing recurrent vomiting with chronic cannabis use, prompt medical consultation is crucial. Early recognition can prevent repeated suffering, unnecessary interventions, and long-term complications. Understanding, vigilance, and informed action are the most effective tools for addressing CHS in today’s era of legalized cannabis.

Once cannabis is stopped, symptoms gradually fade over days to weeks, though in some chronic cases, full resolution may take months.
Resuming cannabis use, even in small amounts, can rapidly trigger recurrence, underscoring the importance of strict avoidance for long-term recovery.