CHS: What to know about the rare cannabis condition

Cannabinoid Hyperemesis Syndrome (CHS) is currently making its way through mainstream media, and it’s being sensationalized under the term “scromiting,” or screaming while vomiting, due to the intense abdominal pain that typically accompanies severe nausea and vomiting during a CHS episode.

On one side, headlines and clinician reports indicate an increase in cases around the country. On the other side, some in the cannabis community question how often the condition is truly occurring and how it’s being interpreted. On both sides, there’s a palpable sense of fear and anger. What’s missing from the narrative is a balanced perspective, more research, better definitions, and, most importantly, nuance.

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As a pro-cannabis nurse who also researches CHS, I’m here to cut through some of the misinformation and offer some unbiased facts about CHS, as well as some fascinating data points that you have the privilege of learning about before they’re published in a medical journal this year.

So let’s break it down.

What is CHS?

CHS is characterized by severe cyclical nausea, vomiting, and abdominal pain in the context of long-term and frequent cannabis use. Symptoms are often relieved temporarily with hot bathing, and the current medical consensus points to quitting completely as the only “cure,” though it is also important to note that anecdotally, some consumers report switching products, sources, delivery forms, or strains has alleviated their nausea and vomiting symptoms.

CHS appears to have a genetic link, based on a 2022 study by Ethan Russo, which could explain why some heavy users develop the condition, and others don’t. But this body of knowledge is still small, and we need broader studies with better data collection, both about the individuals who develop CHS, their symptoms, and what products they are choosing to consume 

What isn’t CHS?

As hard as it may be to believe, CHS isn’t propaganda from big pharma, big alcohol, or big tobacco. It’s not reefer madness or fake news. Pesticides are unlikely to be the cause (although we acknowledge pesticides are an issue in some parts of the industry). It’s been documented in the literature for over 20 years, but CHS was only recently given an ICD-10 diagnostic code, which will help us study it in more detail down the line.

What CHS can be

CHS can be life-altering for those who suffer from it. Imagine how devastating it would be to learn that your medicine for the last number of years is now making you sick, and you can no longer consume it. Imagine if something like a specific food or drink or stressful event triggered symptoms, even in the absence of recent cannabis consumption.

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CHS can also be life-threatening. If left untreated, the persistent nausea and vomiting can progress to severe dehydration, electrolyte imbalance, organ failure, and possibly even death. I invite you to be a fly on the wall in a CHS Facebook support group and learn how people are navigating this condition in real time.

Our Research

Last year, a team of pro-cannabis professionals, including nurses, pharmacists, and researchers, led by Codi Peterson, Pharm D., collected information on the cannabis use patterns and symptoms of over 1100 people who suffer from CHS, making it the largest data set ever collected on CHS patients. Also on the team are Riley Kirk, Jill Simonian, Jacqueline Higgins, Katie Nava, and me. This research is currently being peer reviewed and will be published this year.

I’m excited to be sharing some of the raw data points for the first time with you.

Here’s just some of what we found:

1. Most people describe their cannabis use as both medical and recreational, and well over half reported using it to treat anxiety or depression.
2. The time to develop CHS symptoms varied greatly. For some, it took over 10 years, while others developed symptoms in less than a year.
3. The most common methods of consumption were smoking and vaping, but edibles, dabbing, beverages, tinctures, and even suppositories were represented.
4. The vast majority of people were consuming products that were dominant in THC or a cannabinoid that activates the same receptors as THC (like delta-8 or HHC).
5. 96 percent of our study participants reported using cannabis daily, with 85 percent using three or more times a day. 
6. People got their weed from all over, including licensed dispensaries, smoke shops, pharmacies, and yes, even homegrown. Regardless of its source, the symptoms were consistent.
7. The most common symptoms experienced in the prodrome period (in the months leading up to the first vomiting episode) were nausea, stomach pain, and appetite changes, most often experienced in the morning hours.
8. The most common symptoms during the hyperemetic (vomiting) phase were nausea, vomiting, and changes in body temperature. Yes, we even assessed “scromiting,” or screaming while vomiting, and over half of the participants reported it as a symptom.
9. Women experienced longer episodes than men, and for many women, symptoms also correlated with their menstrual cycle.
10. 28 percent of people said their symptoms were triggered by trying to quit. This means that some people experienced severe nausea, vomiting, and abdominal pain in the withdrawal period, while on a T break.

These are just a few raw data points, and there’s much more where this came from, so be sure to stay tuned for more information. We plan to publish the results in two or three parts, with the first one just finishing peer review now.

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We’re proud to say this research is completely independent and was completed with no outside funding. As a team, we volunteered our own time and resources to this research, with the goal of answering what’s been missing in the research, so that we can better identify and diagnose CHS and ultimately, see less of it.

Cannabinoid Hyperemesis Syndrome: a rare but real condition

As an industry, avoiding difficult conversations and shifting responsibility elsewhere ultimately slows our progress towards legalization. When CHS is dismissed or denied, it unintentionally alienates members of our own community (they were once your stoner buddies) and raises questions about credibility. If we can’t acknowledge the real risks of cannabis use, how do we cultivate the necessary awareness when we speak to the benefits?

In all, cannabis is a well-tolerated plant for most, but like any medicine, substance, or food, it’s not appropriate or beneficial for everyone. There are risks for certain individuals, and the sooner we, as an industry, acknowledge those realities, the more trust we will build and the closer we move toward legalization and freeing the plant.