Rising Cases of Cannabis-Related ‘Scromiting’ Highlight Risk

Research from the University of Illinois Chicago reveals a significant increase in emergency department visits related to cannabinoid hyperemesis syndrome (CHS), a condition causing severe vomiting, particularly among younger adults. The study, published in JAMA Network Open, highlights the need for greater awareness among healthcare professionals regarding this debilitating condition.

Between 2016 and 2022, data collected from emergency visits across the United States indicated that cases of CHS have risen sharply, especially following the onset of the COVID-19 pandemic. Lead author James Swartz, a professor at UIC’s Jane Addams College of Social Work, emphasized the importance of recognizing CHS as it becomes a more common issue in emergency medicine.

Understanding Cannabinoid Hyperemesis Syndrome

CHS is characterized by cyclical episodes of intense nausea, abdominal cramps, and vomiting. The term “scromiting” has emerged to describe the extreme discomfort experienced during these episodes, where individuals often scream in pain while vomiting. CHS typically affects those who have used cannabis chronically for several years. While the precise cause remains unclear, overstimulation of cannabinoid receptors in the gastrointestinal tract may play a role.

Initially, diagnosing CHS was challenging due to the lack of a specific classification for record-keeping and insurance purposes. Researchers focused on cases of cyclical vomiting syndrome that also involved cannabis use as a proxy for CHS. During their study, they documented approximately 100,000 suspected cases of CHS. Prior to the pandemic, the incidence of CHS remained stable, but starting in 2020, there was a notable surge in emergency visits for this condition.

Despite a decline in cases in 2022, the numbers remained above pre-pandemic levels. Notably, while cannabis-related health issues increased during this time, cases of cyclical vomiting syndrome unrelated to cannabis did not, reinforcing concerns about the rising prevalence of CHS.

Factors Behind the Increase

The study’s authors suggest that the COVID-19 pandemic may have exacerbated the rise in CHS cases due to increased stress, isolation, and cannabis use. They noted that the incidence peaked in 2021 but has since plateaued above pre-pandemic levels, indicating ongoing structural or clinical factors at play.

The growing legalization of cannabis in various states and potentially higher concentrations of THC in contemporary cannabis strains are also considered contributing factors. Swartz cautioned that while the findings are significant, they should not incite panic. Instead, they illustrate that cannabis carries risks, particularly with high doses and prolonged use.

Healthcare providers can effectively manage CHS, with hot baths or showers often providing temporary relief during acute episodes. However, the only definitive solution is to cease cannabis use entirely, which may lead to symptom resolution over time.

In a notable development, CHS was officially recognized in the latest edition of the International Classification of Diseases (ICD), simplifying the diagnostic process for healthcare professionals. Increased awareness is essential to avoid misdiagnoses and unnecessary medical testing, the researchers argue.

Further investigation is necessary to fully understand the underlying causes of CHS and why only a subset of long-term cannabis users develops this condition. As cannabis use continues to rise, especially in legalized settings, ongoing research will be crucial in addressing the associated health risks.