Heavy Cannabis Use Tied To Severe Vomiting, Fivefold Increase In Er Visits

The risk of “scromiting” increases with chronic cannabis use, especially daily use. Maskot/Getty Images

• A vomiting disorder linked to chronic cannabis use, known colloquially as “scromiting,” is rising sharply across the United States.
• A new national analysis reveals that cannabinoid hyperemesis syndrome (CHS) cases increased fivefold from 2016 to 2022, particularly among young adults.
• The trend raises urgent questions for patients and caregivers about recognizing early symptoms and reducing risk as cannabis use becomes more common.

A serious vomiting disorder associated with chronic cannabis use is on the rise across the United States.

In a large, retrospective analysis of emergency department visits, researchers found that cases of cannabinoid hyperemesis syndrome (CHS) rose dramatically between 2016 and 2022, peaking during the COVID-19 pandemic. The findings were recently published in JAMA Network Open. 

CHS is a form of cannabis-induced cyclical vomiting characterized by nausea, abdominal pain, and bouts of recurrent vomiting that can last hours or even days.

The disorder has earned the graphic nickname “scromiting,” a portmanteau of “screaming” and “vomiting.” The disorder is also frequently linked to excessive hot bathing and showering, which reportedly eases the symptoms.

The risk of CHS diagnosis increases with chronic cannabis use, especially daily use. 

Although CHS is uncommon, it appears to be becoming more frequent as cannabis legalization expands in the US. Greater access to cannabis products, an ever-expanding variety of products, and higher-potency all likely play a role. However, experts note that the exact cause of CHS remains unclear.

CHS was first documented in Australia in 2004, but has largely remained something of a fringe diagnosis over the past twenty years. Due to this status, its true prevalence is still largely unknown, with the syndrome likely being misdiagnosed or undiagnosed.

James A. Swartz, PhD, a professor and interim associate dean for research at the Jane Addams College of Social Work at the University of Illinois Chicago, and the study’s primary investigator, has been studying the effects of cannabis legalization in Illinois for several years and became interested in CHS after seeing reports of mysterious, uncontrollable vomiting linked to cannabis use.

“We wanted to determine how common this is and whether it was changing over time,” he told Healthline. “AND We found that it sharply increased during the COVID epidemic and has declined some since then, but it has remained well elevated above COVID levels.”

Sharp increase in cannabis induced vomiting cases

The study used a nationally representative sample of emergency department data, analyzing more than 188 million visits and capturing roughly 85% of all U.S. emergency department visits.

Since CHS did not have its own ICD code, a system for classifying diseases and symptoms, at that time (it was only granted its own code in 2025), Swartz had to utilize a proxy diagnosis by combining a simultaneous cannabis use disorder (CUD) with cyclical vomiting.

“We tried to be as careful as possible to divide out people who likely had CHS from other people who probably didn’t because there was no cannabis use reflected in any of the diagnoses in their record, but they had cyclic vomiting,” Swartz said.

Using this proxy definition, the study identified rising rates of CHS in emergency departments, with cases climbing from 4.4 per 100,000 visits in 2016 to 22.3 per 100,000 visits in 2022. Rates of CHS peaked during the COVID-19 pandemic in 2020 at 33.1 per 100,000 visits, before declining.

Swartz told Healthline that the CHS spike during the pandemic is in line with other trends, including increased alcohol use disorder (AUD) and drug overdoses during that time.

CHS has predominantly affected young adults between the ages of 18 and 25, with those individuals 3.5 fold more likely to receive a CHS diagnosis than older adults. 

“We’ve seen in Illinois that this group has been most affected by legalization in terms of increased use and greater frequency of use. So, it makes sense to me that they would also be the group that would show up as being the most affected in terms of CHS,” Swartz said. 

Notably, CHS cases increased while cases of cyclical vomiting declined, suggesting that the CHS reflects cannabis-specific symptoms rather than a general rise in vomiting disorders.

One major caveat of the study however is that it does not answer the questions of whether there are in fact more cases of CHS or if healthcare providers have simply gotten better at identifying it.

“Either there’s an actual increase in the number of people experiencing this disorder, or there’s just a growing recognition of it,” Swartz said. “I think it’s probably a little bit of both, but we won’t really know that until there are more detailed studies.”

How to identify, treat cannabis induced vomiting

Before developing CHS, users typically experience what’s known as the prodromal phase, which can last months or even years.

During this phase, the user may experience increased nausea, abdominal discomfort, and fear of vomiting, though vomiting itself is absent.

“If you are starting to experience more nausea, if it’s becoming more frequent or noticeable, that’s a flashing warning sign that maybe they need to cut back a bit on the cannabis use,” Swartz said.

CHS is fully developed in the next phase, known as the hyperemetic phase. At this point, the individual experiences the full range of CHS symptoms, including:

• recurring bouts of nausea and vomiting
• compulsive bathing with hot water (to ease symptoms)
• weight loss
• abdominal pain

While there are ways to treat symptoms of CHS in the short term, the only true cure is to stop using marijuana completely.

In an accompanying editorial, Michael Gottlieb, MD, vice chair of research and professor of emergency medicine at Rush University Medical Center, calls quitting marijuana “the cornerstone” of prevention.

“We wanted to inform readers, including those who see patients with CHS and those who are experiencing or are at risk for CHS, that reducing or completely stopping use of cannabis is the best option to prevent it before it occurs,” Gottlieb told Healthline.

It is unclear if anything less than full cessation of cannabis will prevent a recurrence of CHS.

“If a person has developed CHS and they go back to even moderate use, will it recur? I don’t know the answer to that. I don’t know if that’s ever been studied,” Swartz said. “Certainly, if you don’t want to experience CHS again, the safest way is to not use cannabis again.”

For individuals who regularly use cannabis but want to cut down their risk, Sherry Yafai, MD, an emergency medicine physician and medical director and founder of The ReLeaf Institute, recommended avoiding high-potency products as a place to start.

“Avoid wax, dab, and shatter. Be aware of how much THC is in the product you are using,” Yafai told Healthline.

“Most people don’t need more than [around] 25% in a smoked product. Decrease the potency of THC and/or decrease your total daily intake of THC,” she said.

Taking a break, especially if nausea or other notable symptoms have begun to appear, is also advisable.

“If you’re starting to experience those warning signs, do an easy self-test and cut back to see if the nausea remits some,” Swartz said.