Researchers at the University of Illinois Chicago examined emergency department visits from across the country. They found evidence that ER visits for cannabinoid hyperemesis syndrome (CHS) – a condition characterized by persistent, painful vomiting – have increased significantly over the past several years, especially among young adults. Researchers say more doctors need to be aware of this debilitating, but ultimately treatable health problem.
“Cannabinoid hyperemesis syndrome is real, and it is becoming a more routine part of emergency medicine in the US,” lead author James Swartz, a professor at UIC’s Jane Addams College of Social Work, told Gizmodo.
scromiting syndrome
People with CHS will experience intense cramps, nausea, and vomiting in cyclical periods. An acute episode can last one to two days, and the experience is often so unbearable that people begin screaming in pain while vomiting—a phenomenon that has been given the catchy nickname “scromiting.”
CHS usually occurs in people who have been using cannabis consistently for at least several years. Scientists aren’t sure why it develops, but it may be due to overstimulation of native cannabinoid receptors in the gastrointestinal tract. It is considered a rare complication, but recent research has shown that cases of CHS are increasing in the US and other places where cannabis legalization has expanded.
In this latest study, researchers analyzed data from a nationwide sample of ER visits in the US between 2016 and 2022. Until recently, doctors could not diagnose CHS as a distinct medical condition for record-keeping and insurance purposes. So the researchers instead looked for diagnoses related to cyclic vomiting syndrome (severe, sudden vomiting that cannot be explained by other known causes) and cannabis use; Cases where both diagnoses were present were used as a proxy for CHS.
During the study period, approximately 100,000 cases of suspected CHS were documented. They found that before the COVID-19 pandemic, annual rates of CHS were stable. However, starting in 2020, suspected cases of CHS seen in the ER increased. And although cases declined in 2022, they were still above the pre-pandemic baseline. Importantly, cases of cannabis-related health problems in general also increased during the same period, while cases of cyclic vomiting syndrome without any cannabis link did not increase, indicating a true increase in CHS.
The team’s findings were published Monday in JAMA Network Open.
Although this study cannot directly answer why CHS is becoming more common, the timing of this surge suggests that COVID-19 likely played a role. Also important are ongoing factors such as the increasing legalization of cannabis in the US and perhaps the increased amount of THC in today’s cannabis strains, the researchers say.
“The COVID-19 pandemic has likely catalyzed the increase in CHS through increased stress, isolation, and cannabis use,” the authors wrote. “After peaking in 2021, the incidence of CHS declined but stabilized above pre-pandemic levels, suggesting persistent structural or clinical drivers.”
How to stay safe from CHS?
CHS is a frightening experience, but it is one we know how to manage and treat effectively.
For some reason, hot baths and showers can provide temporary relief from an acute episode. However, the only way to truly stop this from happening is to stop using cannabis altogether. It may take a few weeks, but eventually the symptoms will go away.
And although the rate of CHS is increasing, it is still a relatively rare side effect, the authors say.
“Our findings should not be interpreted as cause for panic, but they do reinforce that cannabis is not risk-free, especially at higher doses and with long-term, heavy use,” Swartz said.
Earlier this year, CHS was officially added to the latest edition of the International Classification of Diseases (ICD), the codebook used for diagnosis and billing purposes worldwide. So it has now become much easier for doctors to diagnose the condition and for researchers to track its prevalence. That said, the study authors say doctors and hospitals still need to know that CHS exists in order to make a timely diagnosis.
“Given frequent misdiagnosis and expensive, unnecessary testing, greater clinical awareness is needed,” the authors wrote. They also argue that more research is needed to find out the exact causes of CHS and why only some long-term users develop it.
On days like these, I’m glad I get involved in sticky things once in a while.
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