#75 Strong Clinical Relevance
High-quality evidence with meaningful patient or clinical significance.
Cannabinoid hyperemesis syndrome (CHS), colloquially termed “scromiting” due to the combination of screaming and vomiting, represents an increasingly recognized adverse effect among chronic, heavy cannabis users that clinicians should routinely screen for in their differential diagnosis of recurrent nausea and vomiting. The condition typically manifests in long-term daily users and is characterized by cyclic episodes of severe vomiting, abdominal pain, and compulsive hot bathing (which temporarily relieves symptoms), with patients often reporting paradoxical cannabis use to manage symptoms despite cannabis being the causative agent. The underlying pathophysiology remains incompletely understood but may involve dysregulation of the endocannabinoid system and effects on gastrointestinal motility, making CHS distinct from other cannabinoid-related adverse effects. Recognition of CHS is clinically critical because definitive treatment requires complete cannabis cessation, and misdiagnosis can lead to unnecessary investigations, inappropriate medications, or delayed resolution of debilitating symptoms. Physicians should obtain detailed cannabis use history in patients with otherwise unexplained hyperemesis, particularly those resistant to standard antiemetic therapy, and counsel heavy users about this emerging but serious risk. Clinicians caring for chronic cannabis users should educate patients about CHS risk and discuss harm reduction strategies, including dose reduction and cessation, to prevent the development of this potentially severe and treatment-resistant condition.
“Cannabinoid hyperemesis syndrome is real and underdiagnosed in primary care, and what we’re seeing with these ‘scromiting’ cases is a clear dose-response relationship where patients with daily high-potency cannabis use develop a paradoxical hyperemesis that only resolves with complete cessation, not dose reduction or switching products.”
🤢 Cannabinoid hyperemesis syndrome (CHS), colloquially termed “scromiting,” represents an emerging clinical challenge as cannabis potency and consumption frequency increase among regular users. This paradoxical condition—in which heavy cannabis use triggers severe, intractable nausea and vomiting—remains underrecognized in primary care and emergency settings, leading to diagnostic delays and unnecessary investigations for other causes of hyperemesis. The pathophysiology likely involves dysregulation of cannabinoid receptors in the gastrointestinal tract and central nervous system, though the exact mechanisms remain incompletely understood and may depend on individual genetic susceptibility, product formulation, and consumption patterns. Clinicians should maintain a high index of suspicion for CHS in patients reporting chronic cannabis use presenting with cyclical or persistent vomiting unresponsive to standard antiemetics, and should routinely screen for cannabis use frequency and potency
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