As much fun and helpful as cannabis can be, every drug has its potential tradeoffs. Case in point, a study out this week finds that more Americans are coming down with a stomach-churning side effect of long-term use.
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 constant, painful bouts of vomiting—have noticeably risen in the last several years, especially among younger adults. The researchers say that more doctors need to be aware of this debilitating, but ultimately treatable, health problem.
“Cannabinoid hyperemesis syndrome is real, and it’s becoming a more routine part of emergency medicine in the U.S.,” lead author James Swartz, a professor at UIC’s Jane Addams College of Social Work, told Gizmodo.
The scromiting syndrome
People with CHS will experience cyclical periods of intense cramps, nausea, and vomiting. An acute episode can last one to two days, and the experience is often so intolerable that people will scream out in pain as they’re vomiting—a phenomenon that’s been given the charming nickname “scromiting.”
CHS typically happens in people who have been using cannabis chronically for at least several years. Scientists aren’t sure why it develops, but it might be caused by the overstimulation of native cannabinoid receptors in the gastrointestinal tract. It’s thought to be a rare complication, but recent research has suggested that cases of CHS have been increasing in the U.S. and other places where cannabis legalization has expanded.
In this latest study, the researchers analyzed data from a nationwide sample of ER visits in the U.S. between 2016 and 2022. Until recently, doctors couldn’t diagnose CHS as a distinct medical condition for record-keeping and insurance purposes. So the researchers instead looked for diagnoses related to cyclical vomiting syndrome (severe, sudden vomiting that can’t 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, roughly 100,000 cases of suspected CHS were documented. Prior to the covid-19 pandemic, they found, annual rates of CHS were steady. Starting in 2020, however, suspected cases of CHS seen in the ER surged. And though cases did decline in 2022, they were still above the pre-pandemic baseline. Importantly, cases of cannabis-related health problems in general also rose during that same period, while cases of cyclical vomiting syndrome without any cannabis link did not, further suggesting a real rise in CHS.
The team’s findings were published Monday in JAMA Network Open.
The chart shows that the likelihood of CHS among people diagnosed with cannabis-related health problems at the ER rose over time. © Swartz et al./JAMA Network Open
Though this study can’t directly answer why CHS is becoming more common, the timing of this surge indicates that covid-19 probably played a role. At the same time, ongoing factors like the growing legalization of cannabis in the U.S. and perhaps the increased amounts of THC in today’s cannabis strains are also likely important, the researchers say.
“The COVID-19 pandemic likely catalyzed the rise in CHS through stress, isolation, and increased cannabis use,” the authors wrote. “After peaking in 2021, CHS incidence declined but plateaued above prepandemic levels, suggesting sustained structural or clinical drivers.”
How to stay safe from CHS
CHS is a horrific experience, but it’s one that we know how to effectively manage and treat.
For some reason, hot baths and showers can temporarily relieve an acute episode. The only way to truly keep it from happening, though, is to stop using cannabis altogether. It might take weeks, but the symptoms will eventually stop.
And while the rate of CHS may be climbing, it’s still a relatively rare side effect, the authors say.
“Our findings shouldn’t be interpreted as a reason to 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 that’s used worldwide for diagnostic and billing purposes. So it’s now much easier for doctors to diagnose the condition and for researchers to track its prevalence. That said, doctors and hospitals will still need to know that CHS exists in order to make a timely diagnosis, the study authors say.
“Given frequent misdiagnosis and costly, unnecessary testing, greater clinical awareness is needed,” the authors wrote. They also argue that more research is needed to figure out the exact causes of CHS and why only some long-term users develop it.
Days like these, I’m glad that I only occasionally indulge in the sticky icky.
