Like many cannabis smokers, Jared Panks used marijuana as medicine. As a paramedic, he’d seen the disastrous effects of other drugs and alcohol so, after years of fighting fires for the U.S Forest Service, he began to smoke marijuana to dull the pain from scoliosis and his torn-up knees.

He became more interested in the plant’s potential benefits after seeing family members suffer from cancer and opioid abuse. Panks and his wife founded HomeGrown ORegonicX, a small medical cannabis farm that serves the deaf community in Oregon, and started smoking pot frequently every day to test different strains.

He was shocked in 2013 when he was struck by vicious bouts of vomiting. He would start vomiting in the morning and continue the rest of the day non-stop, sometimes for days at a time. He couldn’t eat or keep down fluids. Only a hot shower would offer some relief. The condition would fade, then reemerge after two or three months, often at times of stress..

Panks lost 50 pounds as his body seemed to be trying to purge something. His abdomen and back ached from constant dry heaves. His throat was burned by the stomach acids, and a dentist told him his teeth were ruined.

When a doctor gave him his diagnosis, he initially refused to believe it: cannabinoid hyperemesis syndrome, or CHS. While Panks doesn’t scream from it, other people affected sometimes cry out in pain, leading to its other name: scromiting, for the combination of screaming and vomiting.

“Sometimes it goes 14 days, where my whole body starts to seize up,” Panks said. “I have to go to the ER and get fluids. It can be very, very brutal. You’re sliding down the stairs because you don’t have the strength to stand up.”

The condition is rare and the mechanism of its cause unexplained, prompting some cannabis advocates to refuse to believe it. But Panks is far from alone. A new study of hospital emergency departments nationwide by the University of Illinois Chicago found the number of diagnosed cases of CHS jumped sevenfold from 2016 to 2022.

The increase came at the same time as increased cannabis legalization and potency, and peaked at 33 cases per 100,000 ER visits during the COVID pandemic, when substance abuse increased sharply. The increase came primarily among young adults, 18 to 35, most of them men.

Most people with CHS are long-term users who smoke every day, often high potency weed or concentrates, research shows. Seventy-five percent of people diagnosed with CHS consumed cannabis every day, a systematic review found.

Normally, cannabis is well-known for its ability improve appetite. The U.S. Food and Drug Administration has approved synthetic THC for the treatment of nausea from conditions such as chemotherapy, though many patients prefer flowers from the plant itself.

But like any drug, what can have mild effects in moderation may have toxic effects from over-consumption. It is known that cannabis acts on the endo-cannabinoid system, which helps regulate the digestive system.

The lead author of the UIC study, professor James Swartz, said he believes the increase in state legalization and higher potency were the main factors at work behind the increase. He hopes the study will encourage clinicians to consider CHS when treating patients.

“There is still some skepticism,” Swartz said. “Proponents of cannabis say this is being alarmist, it hardly occurs. No, this is real, and it’s common enough that it’s of concern.”

People should consider the condition when considering how much to use and what’s safe, and take “a long hard look” at very high potency products, he said.

Swartz has some unlikely allies in the cannabis world.

Tim Blake, founder of The Emerald Cup, the Oscars of the cannabis world, said he ran into a wall with hyperemesis years ago and had to cut way back on his consumption.

Blake is 68 and has been smoking since he was 14, with a few periods of abstinence. He has grown cannabis and used it to deal with three rounds of metastatic cancer, so he is an enthusiastic advocate.

But a little more than 10 years ago, he got very sick with cyclic vomiting. It only went away after he quit smoking for several months to eliminate the buildup of THC, the main component of pot that gets users high, and which accumulates in the body’s fatty tissues.

Now, like drinkers who abstain from alcohol for “Dry January,” he starts every year by abstaining from cannabis for a month or two to clean out his system. When he stopped smoking, he would sweat profusely for five days to clean out his system. He stopped using concentrates, but still vapes once a day or so, and meditates daily.

He decries the high THC dabs and concentrates that have transformed the use of marijuana for some, and advocates a more moderate approach to consumption, comparing weed to alcohol.

“We shouldn’t be drinking 151 rum shots every day,” he said. “We should do more beer and wine. It is a real issue we want to address so people can safely and effectively use cannabis.”

Panks, who with his wife started Deafining Cannabis to develop sign language related to the plant, said that instead of focusing on high THC, users should look more into the effects of cannabis terpenes, the compounds that help give cannabis and other plants their distinctive effects.

“We need to stop looking at THC percentages and more at the terpenes, so you can understand how your body reacts,” he said. “I hope to be part of a study that can further define the mechanism of CHS and a documentary on the process so that we all can have a better understanding of the science behind it.”

CHS research remains in its infancy, but may be enhanced by recent federal efforts to reclassify cannabis as a less dangerous drug. The World Health Organization only recently recognized CHS as a medical condition. Everyone affected by CHS wants more research to explain its causes, cures, the potential roles of neem oil and other pesticides, and why it affects some people and not others.

For now, abstinence remains the only known cure for CHS.

Prominent cannabis advocate Alice Moon said she wants more research so maybe she can use cannabis again someday.

“I promote a substance I cannot consume,” she said. “I’m adamant about spreading awareness, because I don’t want anybody to be as sick as I was.”