“Scromiting” is an informal term describing a severe medical symptom that combines intense screaming with uncontrollable vomiting. This phenomenon signals a serious underlying medical issue, typically caused by chronic substance use. The term highlights the extreme distress and pain experienced during an episode, often leading to emergency medical visits. The severity of the vomiting and abdominal pain causes the patient to cry out, giving rise to the colloquial name.
Defining Scromiting
The clinical presentation involves recurring, overwhelming bouts of severe nausea and vomiting (emesis). These episodes are so debilitating that the patient experiences immense abdominal discomfort and distress, translating into audible anguish and screaming. The cyclical nature of the vomiting is a hallmark, where the individual may vomit up to five times in a single hour. This intense physical reaction places the patient at risk for severe complications like dehydration, electrolyte imbalance, and injury to the esophagus.
Patients often display a distinctive behavior, seeking temporary relief through frequent, prolonged, and sometimes scalding hot showers or baths. This compulsive hot bathing is a strong diagnostic clue, as the heat temporarily eases the nausea and abdominal pain. The period of active vomiting and screaming is known as the hyperemetic phase of the underlying syndrome, and it typically lasts between 24 and 48 hours. The experience is physically exhausting and emotionally taxing, causing a profound fear of vomiting and sometimes a reluctance to eat.
The Underlying Cause: Cannabinoid Hyperemesis Syndrome (CHS)
Scromiting is a symptom of Cannabinoid Hyperemesis Syndrome (CHS), a paradoxical reaction that develops in long-term, heavy cannabis users. While cannabis is known for its anti-nausea properties, chronic exposure to high doses of cannabinoids, particularly tetrahydrocannabinol (THC), can trigger this severe vomiting condition. The syndrome is caused by the overstimulation of cannabinoid receptors (CB1) in the central nervous system and the gastrointestinal tract.
The effect of cannabinoids on the digestive system is complex, leading to altered gut motility and delayed gastric emptying, which contributes to the cyclic vomiting. Furthermore, the hypothalamus, a brain region that regulates both body temperature and the vomiting center, is also rich in cannabinoid receptors. The theory suggests that chronic cannabis use desensitizes these receptors, leading to a dysregulation that manifests as severe, cyclical vomiting and abdominal pain. This connection to the hypothalamus explains why hot water provides temporary relief, as the heat may override the dysregulated temperature and vomiting signals.
CHS progresses through three distinct stages: the Prodromal, Hyperemetic, and Recovery phases. The Prodromal phase can last for months or years, characterized by early morning nausea and mild abdominal discomfort, with many patients mistakenly increasing their cannabis use, believing it will alleviate the symptoms. The Hyperemetic phase is the period of scromiting, involving severe, uncontrollable vomiting and pain that often requires emergency medical care. The Recovery phase begins only when the individual completely stops using cannabis.
Immediate Crisis Management and Treatment
Managing an acute scromiting episode requires urgent medical intervention. The primary concern is dehydration and electrolyte imbalance, treated with intravenous (IV) fluids and the correction of mineral deficiencies. Standard antiemetic medications, such as ondansetron, often fail to relieve the symptoms of CHS.
Healthcare providers instead use medications that target different pathways, such as benzodiazepines like lorazepam, which help to calm the patient, or antipsychotics like haloperidol. Haloperidol has shown effectiveness in some patients, possibly due to its action on dopamine receptors. Another specific treatment is the topical application of capsaicin cream to the abdomen. Capsaicin activates a specific heat-sensitive receptor, TRPV1, providing a therapeutic effect similar to hot showers by diverting pain signals.
Long-Term Resolution and Prevention
The only definitive cure for Cannabinoid Hyperemesis Syndrome and the prevention of future scromiting episodes is the complete and permanent cessation of all cannabis use. Symptoms will return if the individual resumes using cannabis, even in small amounts. Once cannabis use is stopped, symptoms generally resolve within days, though full recovery may take several weeks or up to three months.
The long-term prognosis is excellent for individuals who maintain abstinence. Counseling and support are important components of the recovery process, especially for those with a cannabis use disorder. The complete resolution of nausea, vomiting, and abdominal pain upon cessation of cannabis confirms the diagnosis of CHS.