A new medical study advises chronic marijuana users suffering from uncontrollable scream-vomiting, or “scromiting,” to quit the drug completely.
Doctors call the condition cannabinoid hyperemesis syndrome. Published Wednesday in JAMA Insights, the study warns that “sustained abstinence” is the only sure cure for the gastrointestinal affliction’s cycle of severe nausea, violent retching and abdominal pain.
The study cites increased concentrations of psychoactive THC in cannabis products as a possible factor driving up cases and notes the lack of any treatment that does more than briefly alleviate symptoms.
The study’s authors, from the Mayo Clinic and Ohio State University, recommend addiction counseling, gradual reduction in cannabis use and “transitioning to lower-potency products” to help quit the drug.
“The most effective long-term management for CHS is complete abstinence from cannabis use,” Doctors Thangam Venkatesan, William L. Hasler and Michael Camilleri wrote in the study. “However, abrupt cessation in patients with CHS can induce cannabis withdrawal symptoms such as anxiety, insomnia, nausea, abdominal pain, and sweating and a high risk of relapse.”
It remains unclear how common scream-vomiting is among cannabis users.
The study notes that one analysis of 188.6 million emergency department visits found that those related to the syndrome jumped from 4.4 per 100,000 patients in 2016 to 22.3 in 2022. It said 35.7% of those visits occurred among people aged 18 to 25, and 31.5% among those aged 26 to 35.
Dr. Jared L. Ross, an emergency physician and University of Missouri professor who was not involved in the study, estimated that 6% of marijuana users experience scromiting annually.
He said cases range from mild symptoms soothed by hot showers and capsaicin cream to overnight hospitalization, all unresponsive to standard anti-nausea drugs. Life-threatening complications in severe cases include dehydration, kidney injury, severe electrolyte disturbances, acid-base imbalances and punctured lungs from violent heaving.
“Cases have increased with widespread availability of high-potency, high-THC products, especially vape, edible and beverage-based products that do not require smoking,” Dr. Ross said. “Proliferation of these products has been largely driven by the medical and recreational legalization of cannabis across most of the United States.”
Last year, the World Health Organization created a diagnostic code for cannabinoid hyperemesis syndrome in the International Classification of Diseases to help track the spike in ER visits for related symptoms.
The Centers for Disease Control and Prevention reported on Aug. 6 that CHS-involved emergency department visits jumped nearly fourfold in the first month after the code took effect — from 3.35 per 10,000 in September 2025 to 11.26 per 10,000 in October 2025.
The CDC report concluded that scream-vomiting “is likely underrecognized in both adolescent and adult populations.”
“It can be difficult for people to recognize cannabis as the cause of their symptoms because cannabis can initially reduce nausea,” Dr. Nora Volkow, director of the National Institute for Drug Abuse, said in an email. “The same substance they may associate with relief can ultimately be driving their symptoms. It can also be challenging to diagnose CHS because it mimics many other serious illnesses that must be ruled out.”
Mixed reactions
The JAMA Insights study estimated that men account for roughly 7 of every 10 scromiting patients — and said those who started using cannabis regularly as teenagers are most at risk.
It reported that CHS involves an initial stage of 20 to 90 minutes of panic-inducing nausea and sweating, followed by up to 10 days of dehydrated vomiting and a long recovery as sufferers fight to keep down liquids and solid food.
The syndrome commonly recurs when users resume marijuana consumption, creating a worsening loop.
“Neurological symptoms may occur, including focal seizures, unilateral weakness or numbness, facial droop, and speech or visual deficits,” the researchers wrote.
Some advocates of legalized marijuana pushed back on the findings. They said that cannabis remains more beneficial and less harmful than alcohol.
“If you dramatically increase the dose of almost anything humans enjoy, eventually somebody ends up in an emergency room,” said Demitri Downing, founder of the Marijuana Industry Trade Association. “However, cannabis is almost irrelevant compared to alcohol, which should be the focus of these studies.”
Brandon Dorsky, a California intellectual property attorney who represents marijuana businesses, said doctors could be confusing an estimated 2.75 million scream-vomiting cases annually for cyclical vomiting syndrome, which has similar symptoms and can affect up to 3.4 million people nationwide.
“The available evidence does not support a conclusion that it is the availability of high-concentration cannabinoid products that triggers CHS, and the subject requires additional research,” Mr. Dworsky said.
The average marijuana plant has jumped from 1% to 3% THC content in the 1970s to 18% to 23% today, according to Smart Approaches to Marijuana, which tracks the harms.
“For years the marijuana industry told us this product was harmless and that no one ever died from it,” Kevin Sabet, the group’s president, said Wednesday. “Now the country’s leading medical journal is teaching doctors how to treat an illness so violent that people vomit until they scream, sometimes hard enough to tear their own throat.”
A Gallup poll published Monday found that 17% of adults surveyed in July reported using marijuana, matching a record high in 2023. That included 15% who said they consumed edibles, such as gummies.
’Dire need’
A study in the Journal of the American Medical Association last year found “insufficient evidence” for the health benefits of marijuana, including claims that it relieves insomnia or pain.
Dr. Kevin Hill, a Harvard Medical School professor and addiction psychiatrist who authored that study, attributed rising scromiting cases to the “unintended consequences” of such claims driving up marijuana use.
“I have smart, productive patients who have had multiple visits to the emergency room because of these episodes,” Dr. Hill said in an email. “There is a dire need for balanced, evidence-based education on cannabis and other cannabinoids like CBD so adults can know the risks and potential benefits when they decide to use.”
Doctors first documented cannabinoid hyperemesis syndrome in a 2004 case series involving South Australian marijuana users, who ended up hospitalized after consuming stronger variants of cannabis.
Not all marijuana users who scream-vomit meet the clinical definition of drug addiction. But heavy use of high-potency products appears throughout the literature on those who visit an emergency room for scromiting.
“The most striking thing is how many patients can’t believe their marijuana use is making them sick,” said Keith Humphreys, a Stanford University psychologist and addiction researcher. “Some even get angry at the suggestion because they have so thoroughly bought into the myth that the drug cannot harm anyone.”
Aaron Hall, a Minneapolis business attorney who advises employers on workplace drug policies, called for better labeling of cannabis products.
“Nothing on the package says what heavy daily use does over years,” Mr. Hall said. “A buyer can read the label front to back and learn nothing about this condition.”
Contact the author
Please read our comment policy before commenting.