Cannabinoid Hyperemesis Syndrome and ‘Scromiting’: What You Should Know

Cannabis use continues to rise in the U.S. as more states legalize its use. But cannabis can lead to side effects, including some potentially serious ones. Cannabinoid hyperemesis syndrome (CHS) is a medical condition that’s becoming more common among people who use cannabis. 

CHS is a potentially dangerous condition that causes symptoms like severe dehydration and “scromiting” — a combination of screaming and vomiting. If you use cannabis regularly, here’s what to know about CHS. 

What is cannabinoid hyperemesis syndrome (CHS)?

CHS is a very real and potentially serious medical condition. Sometimes called “weed sickness,” CHS can cause excessive vomiting, abdominal pain, and dehydration. And it can be tough to manage. Some people even need treatment in a hospital when they develop an episode of CHS. 

Not everyone who uses cannabis develops CHS. You’re more likely to develop CHS if you use cannabis regularly or if you’ve been using cannabis regularly for longer than a year. So far, there’s no evidence on whether taking a specific amount of cannabis is more likely to cause CHS. But higher doses are more closely linked with CHS. 

EXPERT PICKS: WHAT TO READ NEXT

• THC dosage guide: Learn more about safe cannabis use.

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• When to get help: Lots of things can lead to nausea and vomiting. Learn the red-flag symptoms.

What is scromiting?

The word “scromiting” is slang for episodes of intense vomiting and screaming in people who have CHS. This combination of symptoms is how the term got its name. CHS is a condition that causes excessive nausea and vomiting in people who frequently use cannabis. The discomfort from severe and frequent vomiting may cause some people to scream. 

What are the symptoms of cannabinoid hyperemesis syndrome?

CHS symptoms tend to occur in distinct stages. Here’s a closer look.

Early (prodromal) phase

During the early phase, people experience:

• Nausea that comes and goes

• Stomach pain that’s usually worse in the morning

• Heartburn or burping

• Occasional episodes of vomiting

These symptoms usually go away on their own, and people are able to go about their usual activities. The phase can last for months to years. 

Excessive vomiting (hyperemesis) phase

During the hyperemesis phase, people develop:

• Severe, constant nausea

• Back-to-back episodes of vomiting that won’t stop

• Stomach pain that can be constant

In many cases, people can’t manage this phase on their own. Often the symptoms are so severe that people can’t eat, drink, or take medication to help relieve their symptoms. This can lead to more serious symptoms, like:

• Dehydration

• Electrolyte imbalances

• Rapid heart rate

• Low blood pressure

Recurrent vomiting can also lead to other complications including tooth decay, injury to your esophagus, or aspiration pneumonia.

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People often need emergency medical care to get through this phase. To help stop the symptoms, it’s best to stop using cannabis. But even then, this phase can last for days. 

How long does CHS last?

Once people stop taking cannabis, the body starts to heal and enters the recovery phase. Symptoms gradually go away after stopping cannabis use. Many people start feeling better within 48 hours. But some take longer to fully recover. 

What causes cannabinoid hyperemesis syndrome?

CHS is probably caused by taking in high levels of THC (tetrahydrocannabinol) over long periods of time. THC is the ingredient responsible for the “high” that people who use cannabis experience. And at low doses, THC can actually help with nausea or help increase appetite.

The body’s endocannabinoid system reacts to THC. Using a lot of cannabis every day can overstimulate the nervous system and endocannabinoid receptors, and make the body unable to control nausea and vomiting. This may cause some people to experience CHS symptoms. 

One potential factor for the rise of CHS cases is how strong cannabis is today. Research shows that cannabis has more THC now than it did in the past. One study found that some cannabis joints now contain around 18 mg of THC. In the 1990s, they contained 1 mg to 3 mg.

Diagnosing CHS

Diagnosing CHS can be tricky since lots of different things can lead to abdominal pain, nausea, and vomiting. A healthcare professional will ask you questions about your symptoms and do a physical exam. 

Sometimes abdominal pain and repeated vomiting can be a sign of a serious medical condition that needs prompt treatment. To rule out other possible causes, they may need to run some studies, such as:

• Blood tests

• Urine tests

• Imaging tests, such as an X-ray, ultrasound, or a CT scan

• Electrocardiogram (ECG)

No one test can confirm a CHS diagnosis. But the following point to CHS:

• Severe nausea and vomiting that takes place over months

• Use of cannabis for more than 1 year (often with at least weekly use)

• Abdominal pain

• Symptom relief after stopping cannabis use

It’s important to rule out other conditions, such as appendicitis, gallbladder pain, kidney stones, pancreatitis, diverticulitis, as well as pregnancy complications.

What are the treatments for CHS?

Besides stopping cannabis use, there aren’t many effective treatments for CHS. But there are several treatments that can help people get through CHS symptoms. These include:

• Heat packs and hot showers: Many people experiencing CHS feel better if they take a hot shower (though it’s not clear why). A hot bath, heat pack, or hot water bottle can also help relieve stomach pain, nausea, and vomiting. Remember not to make water too hot so that you don’t accidentally burn yourself. 

• Capsaicin cream: There’s some evidence that capsaicin cream can help relieve CHS symptoms. Researchers haven’t determined which strength is best, but experts recommend 0.025% to 0.1% capsaicin cream, which is available over the counter. You can apply capsaicin cream in a thin layer to your stomach as needed. 

If these two remedies aren’t enough to relieve your symptoms, it’s important to get medical care. You’ll also need to get care if you can’t keep down enough fluid to stay hydrated. Most people need treatments with prescription medications through an IV (intravenous) infusion, including:

• Antinausea medications: There are several antinausea medications that may help relieve CHS symptoms. These medications, including ondansetron (Zofran) and metoclopramide (Reglan), also come in a pill form or dissolvable tablet. You may be able to take these medications by mouth at home. These medications don’t always work for everyone, and you may need other types of medications to help relieve your symptoms.

• IV fluids: IV fluids replace water and electrolytes that you’ve lost from constant vomiting. This will treat any dehydration you may have developed because of CHS.

While these treatments will make you feel better and stop your vomiting, they won’t cure CHS. If you start taking cannabis again, your symptoms will likely come back. 

Experts recommend that people who experience CHS stop using cannabis entirely. Talk with a healthcare professional about resources to help, such as support groups or an addiction counselor.

How common is cannabinoid hyperemesis syndrome?

Reports show that CHS is becoming more common. It occurs mainly in people who use cannabis long term or heavily. 

One study of patients in the emergency room found that roughly 1 in 3 who reported smoking cannabis 20 or more times per month had CHS. Research also suggests that most people with CHS are between ages 18 and 40. But, regardless of age, anyone who uses cannabis can get CHS. 

Can cannabinoid hyperemesis syndrome be deadly?

CHS can be life-threatening. Uncontrollable vomiting can lead to severe dehydration. When you vomit, your body loses the essential electrolytes that it needs to survive. This lack of electrolytes can cause serious complications, including kidney failure and heart arrhythmias. 

It can be challenging to understand and cope with CHS. This is especially true for people who take cannabis to help with the symptoms of other conditions. If you have CHS, work with your healthcare team to create a treatment plan that doesn’t include THC-based products. 

How can you prevent cannabinoid hyperemesis syndrome?

The best way to prevent CHS and scromiting is to not use cannabis. If you’ve had an episode of CHS in the past and you use cannabis again, you’re at high risk of developing another episode. 

Right now, there’s no research on whether a certain dose of THC is more likely to cause CHS. That means there’s no “safe amount” of THC you can use and know you won’t develop it. But lower doses seem less likely to cause it. Certain people might be more likely to develop CHS based on their genetics, but more research needs to be done to know for sure. 

Can you still smoke weed if you have CHS?

If you have a history of CHS, it’s best to avoid using cannabis. The only science-backed way to stop CHS from coming back is to avoid all cannabis use. If you have CHS and continue to use cannabis, you’ll likely have more episodes of vomiting and nausea. 

It’s worth noting that CBD (cannabidiol) doesn’t seem to cause CHS by itself. CBD and THC are two different chemicals. While both come from the cannabis plant, only THC seems to cause CHS. But keep in mind that over-the-counter CBD products aren’t regulated, and some may contain THC that’s not listed on the label. 

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Written by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a special interest in chronic care management, women’s health, mental health, and preventive care. She has over 10 years of experience in primary care research, innovation, and practice.

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