Cannabis hyperemesis syndrome: 5 scientific answers to "scromiting" questions

There’s much ado about “scromiting.”

The deeply unpleasant sounding term is what some ER healthcare workers are calling “cannabis hyperemesis syndrome,” in which people who use marijuana experience uncontrollable vomiting and abdominal pain, often accompanied by screaming.

Vomiting + screaming = scromiting.

Cannabis hyperemesis syndrome (CHS), some hospital workers claim, is on the rise — something they believe is the result of “high potency weed,” according to a report published in July by NBC News.

While the condition is certainly real, it may sound a bit counterintuitive considering cannabis is notoriously used to treat nausea. Overall, our understanding of it is limited by marijuana’s legal status, experts tell Inverse.

“I don’t think anyone would tell you this condition isn’t real,” Sheila Vakharia, Deputy Director of the Department of Research and Academic Engagement for the Drug Policy Alliance tells Inverse. “What I am saying is the fact that we have made drugs illegal has made it impossibly hard to study these in isolation to truly understand what they do in the human body.”

The leading theory is that long-term, daily cannabis use dysregulates the endocannabinoid receptors in the stomach, leading to abdominal pain and vomiting. But while the condition very much exists, experts say the flurry of panicked headlines overstate what we actually know about CHS and how prevalent it is.

If you’re a cannabis fan, don’t despair: There are effective treatments for the syndrome. Here Inverse answers 5 essential questions about cannabis hyperemesis syndrome — a situation that ultimately demands more research and a more nuanced understanding.

What causes cannabis hyperemesis syndrome (scromiting)?

While we don’t definitively know the precise mechanism by which CHS occurs, we have a general idea of what’s happening.

The human body responds to the endocannabinoids in cannabis because of the endocannabinoid receptors we have throughout the body. Endocannabinoid receptors are especially concentrated in the brain and digestive system. It’s why cannabis is an effective treatment for nausea and low appetite (and also why you sometimes get the munchies after consuming cannabis).

Reilly Kayser, a psychiatrist and assistant professor at Columbia University, has researched the endocannabinoid system.

“A leading theory [about CHS] is that cannabis use may disrupt the endocannabinoid system’s (ECS) in some individuals — possibly those who use heavily for long periods of time or have genetic risk factors — leading to CHS symptoms like nausea, vomiting, and abdominal pain,” Kayser tells Inverse.

“Give the science behind cannabinoids, we understand how [CHS] works in theory,” Vakharia adds.

What we don’t know is why some cannabis users develop the syndrome and others don’t. Even among longtime, daily users, not everyone will develop the syndrome, indeed likely only a fraction will. Better research would help us understand why that is.

Are cases of cannabis hyperemesis syndrome (scromiting) increasing?

Marijuana is the most widely used illegal drug in the country. It’s the third most commonly used drug in the United States, after alcohol and tobacco. Given that, Vakharia says, “hyperemesis syndrome seems to be quite rare, but we really can't put our finger on it.”

“The research in this area is really bad.”

It could be more common than emergency departments are reporting because people in non-legalized states might be hesitant to seek help, Vakharia says. It may also be true that, in the 15 states where the recreational use of cannabis is legal, people might just be more comfortable seeking help.

It’s possible that what looks like a rise in cases could actually just be a rise in people seeking help and/or a rise in people admitting to their cannabis use.

“It’s very hard to estimate the prevalence of this syndrome,” says Vakharia. “The research in this area is really bad.”

Medical literature on this subject tends to fall into two categories:

• Case studies, in which a physician or clinician sees something new or unusual in a patient and writes a report. In these cases, Vakharia says: “They do a deep dive into the clinical profile and the symptomology and sometimes possible treatments.” These aren’t particularly good for evaluating trends in any given condition.
• Studies using data collected from hospitals across a state or insurance claims in a state.

In the latter, she explains, researchers look for ICD (insurance) codes associated with nausea and vomiting. Then, they cross-reference those codes for marijuana use or marijuana use disorder. (Currently, there is no ICD code for CHS.)

“It’s really hard to get accurate numbers unless you do a randomized controlled trial or a study where you follow people over time,” she says.

The self-reported nature of the patients’ cannabis use is also problematic from a research perspective.

“A lot of times qualitative information like where they procured the marijuana, the strain, the frequency of their use isn’t even in the record,” she explains.

Furthermore, there’s no real way to check the accuracy of those self-reported statements.

Is cannabis hyperemesis syndrome (scromiting) permanent?

No, both doctors and people who have experienced it say that CHS isn’t permanent are there are treatments for it.

How long does it take for cannabinoid hyperemesis syndrome (scromiting) to go away?

“Most reports suggest that CHS symptoms resolve within 1 to 2 weeks after stopping cannabis,” Kayser says.

Fortunately, the vomiting phase of CHS usually goes away faster, typically within 48 hours after stopping cannabis use.

There are also treatments. One treatment that’s been highly effective in treating CHS is topical capsaicin (yes, the stuff that gives hot peppers their heat). A 2015 study found that out of 13 patients admitted to the hospital with CHS, using a capsaicin cream got rid of the symptoms in all 13 patients.

Taking a hot shower or bath has also been shown to relieve symptoms.

Whatever you do, it’s also important to make sure that you replenish the many fluids you have undoubtedly lost with all that vomiting.

Can you still smoke with cannabinoid hyperemesis syndrome (scromiting)?

Right now, Kayser says, it seems like the only way to permanently avoid symptoms once you’ve developed the syndrome is to stop consuming cannabis.

That’s often more complicated than it sounds.

“Nearly always, people who continue using cannabis despite experiencing these effects have experienced it as beneficial in other parts of their lives,” he says.

“Depending on their perception of its benefit, some in this group will not be interested in abstinence from cannabis, even if it means their CHS symptoms could persist,” Kayer adds. “However, they may be willing to consider reducing their use, which might decrease the frequency of CHS episodes and improve their overall quality of life.”

Ultimately, Vakharia has real concerns about the people using CHS as an excuse to demonize all cannabis use.

“Saying people shouldn’t use cannabis because someone came into the ER with CHS is like a doctor telling someone don't eat a Snickers bar, because I just chopped off a diabetic foot,” she says.

Cannabis hyperemesis syndrome is real, likely occurs in longtime, daily users, there are treatments that can help, and stopping cannabis use altogether may be required. But we simply don’t have enough quality research to say anything more than that.