For some chronic cannabis users, a case of the munchies is the least of their problems.

Over the past decade, ERs have seen a surge in regular tokers showing up with sudden, stomach-churning attacks that leave them doubled over in pain.

The worst part? Many sufferers experience these episodes three or four times a year, often leaving both patients and providers scratching their heads.

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What is CHS?

The culprit is cannabis hyperemesis syndrome (CHS), a gut-wrenching disorder that triggers relentless nausea, abdominal pain and severe vomiting that can strike four or five times an hour, according to the Cleveland Clinic.

Symptoms usually appear within 24 hours of cannabis use and can last for days. The episodes are so brutal that ER staff have coined a term for them: “scromiting” — a chilling mashup of screaming and vomiting.

Tough to treat

Despite its growing prevalence, many doctors are still unfamiliar with the syndrome, which was only recently defined, making it hard to distinguish from medical issues like food poisoning or the stomach flu.

“A person often will have multiple [emergency department] visits until it is correctly recognized, costing thousands of dollars each time,” Dr. Beatriz Carlini, a research associate professor at the University of Washington (UW) School of Medicine who studies adverse health effects of cannabis use, said in a statement.

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But even after a diagnosis, CHS can be difficult to treat.

There are currently no FDA-approved therapies, and standard anti-nausea medications often don’t work, according to Dr. Chris Buresh, an emergency medicine specialist with UW Medicine and Seattle Children’s Hospital.

That sometimes forces clinicians to try second- and third-line options, including Haldol, a medication more commonly used for psychotic episodes.

Some patients find limited relief by rubbing capsaicin cream on their stomachs, which creates a warming sensation that can temporarily ease discomfort.

Hot baths and showers also often help curb symptoms, with many patients driven to bathe for hours each day to soothe their pain.

“That’s something that can clinch the diagnosis for me, when someone says they’re better with a hot shower,” Buresh said. “Patients describe going through all the hot water in their house.”

Recovery challenges

Even after symptoms subside, long-term recovery can be tricky.

Because the syndrome strikes intermittently, some cannabis users assume a recent episode was unrelated and continue using — only to become severely ill again, according to UW.

For those who accept the diagnosis and try to quit, addiction often makes abstinence a major challenge, prolonging the cycle of illness. Carlini said.

Stopping cannabis use is currently the only way to fully cure the condition.

From teens to long-time users

Scientists don’t know the exact cause of CHS, but the leading theory is that long-term overstimulation of receptors in the endocannabinoid system may disrupt the body’s natural control of nausea and vomiting, per the Cleveland Clinic.

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Why it affects some cannabis users but not others remains a mystery.

“We don’t know if it’s related to the greater general availability of cannabis or the higher THC potency of some products or something else,” Buresh said.

“It seems like there’s a threshold when people can become vulnerable to this condition, and that threshold is different for everyone,” he added. “Even using in small amounts can make these people start throwing up.”

A study published earlier this year by researchers at George Washington University surveyed 1,052 people with CHS in an effort to better understand risk factors.

They found that starting cannabis use earlier in life was linked to a higher likelihood of future ER visits for hyperemesis symptoms. Daily use and prolonged consumption were also common, with 44% reporting regular use for more than five years before the syndrome appeared.

But CHS isn’t just an adult problem. Research shows that emergency department visits among adolescents in the US have jumped more than 10-fold from 2016 to 2023.

Notably, while overall rates were higher in states with legal recreational cannabis, the fastest year-over-year increases in the number of adolescent CHS cases at hospitals occurred in states where casual cannabis use is still illegal.

Gaining attention

On Oct. 1, the World Health Organization formally recognized cannabis hyperemesis syndrome, adding an official diagnosis code to its manual. The CDC has also incorporated the new code into US diagnostic systems.

Experts say the update offers several benefits, including giving researchers a clearer picture of how often CHS occurs. Having the code appear in a patient’s medical record also helps providers spot repeat episodes during future visits.

“A new code for cannabis hyperemesis syndrome will supply important hard evidence on cannabis-adverse events, which physicians tell us is a growing problem,” Carlini said.