“Scromiting” is the informal term for the severe, cyclical vomiting and abdominal pain episodes experienced by some long-term, heavy cannabis users. This phenomenon, which combines “screaming” and “vomiting,” defines the serious medical condition known as Cannabinoid Hyperemesis Syndrome (CHS). CHS involves recurrent, overwhelming episodes of nausea and vomiting that can lead to significant dehydration and requires emergency medical intervention.
Cannabinoid Hyperemesis Syndrome and Its Phases
Cannabinoid Hyperemesis Syndrome is a paradoxical disorder that affects individuals with a history of chronic cannabis consumption, often daily or weekly use over several months or years. It represents a complete reversal of cannabis’s well-known anti-nausea properties, presenting instead as severe, cyclical vomiting. The condition progresses through three distinct clinical phases, representing the patient’s journey from mild discomfort to acute crisis and eventual resolution.
Prodromal Phase
The initial stage is the Prodromal Phase, which can last for months or even years. During this time, individuals often experience mild symptoms such as early morning nausea, abdominal discomfort, and a fear of vomiting. Some users may mistakenly increase their cannabis intake during this phase, believing it will alleviate the nausea, which may inadvertently accelerate the syndrome’s progression.
Hyperemetic Phase
The second stage, the Hyperemetic Phase, is the acute crisis where “scromiting” occurs and typically brings patients to the emergency department. This phase is marked by intense, persistent nausea, severe abdominal pain, and uncontrollable vomiting that can occur up to five times per hour. The severity of the pain often causes patients to cry out. Dehydration and electrolyte imbalances are serious risks due to the prolonged vomiting.
Recovery Phase
The final stage is the Recovery Phase, which begins only after the individual completely stops using all cannabinoid products, including THC and CBD. Once cessation occurs, the hyperemetic symptoms usually subside within a few days to a few months. Full symptom resolution and recovery of normal eating patterns can take several weeks or longer, depending on the duration of prior cannabis use and the severity of the acute episode.
The Biological Mechanism Behind the Symptoms
The underlying cause of Cannabinoid Hyperemesis Syndrome involves the complex interaction of cannabinoids with the body’s endocannabinoid system (ECS), which regulates numerous functions including appetite, pain, and nausea. The condition is a paradoxical effect of chronic, high-dose cannabis use, which ultimately disrupts the normal functioning of cannabinoid receptors (CB1 and CB2) located throughout the central nervous system and the gastrointestinal tract. While low doses of THC can act as an antiemetic, chronic saturation of CB1 receptors in the gut and brainstem may lead to a dysfunctional state.
Gastric and Thermoregulatory Disruption
One proposed mechanism is the desensitization or downregulation of CB1 receptors, leading to delayed gastric emptying, a condition known as gastroparesis. This slowing of the digestive system contributes to the cycles of nausea and vomiting. Furthermore, chronic cannabinoid exposure can disrupt the thermoregulatory center in the hypothalamus, which is why patients often seek temporary relief through compulsive hot showers or baths.
Hot Water Relief
The relief from hot water is linked to the Transient Receptor Potential Vanilloid Type 1 (TRPV1) receptors, which are activated by heat and found in the gastrointestinal tract and nervous system. Activation of TRPV1 receptors by the heat of the shower may counteract the nausea signals. This temporary relief is a strong diagnostic indicator of CHS.
Acute Treatment and Long-Term Recovery
Managing an acute episode of scromiting is primarily focused on supportive care to address the life-threatening complications of severe vomiting. Immediate treatment in an emergency setting involves the administration of intravenous (IV) fluids and electrolyte replacement to correct dehydration and mineral imbalances. Standard anti-nausea medications, or antiemetics, such as ondansetron, are often ineffective during a CHS episode, prompting the use of alternative pharmacological agents.
Pharmacological Interventions
Healthcare providers frequently turn to specific medications that target different pathways in the brain to stop the vomiting cycle. Antipsychotic drugs, such as haloperidol or droperidol, have shown particular success because they block dopamine receptors, which helps to decrease the persistent nausea and vomiting. Topical capsaicin cream, which is derived from chili peppers, is also applied to the abdomen, as its activation of the TRPV1 receptors mimics the effect of a hot shower and provides symptomatic relief.
Definitive Treatment
Although these treatments can manage the acute crisis, they do not cure the underlying syndrome. The only definitive and curative treatment for Cannabinoid Hyperemesis Syndrome is the complete and permanent cessation of all cannabinoid products. Abstinence allows the body’s endocannabinoid system to reset, and symptoms will typically resolve within a few weeks to a few months. Reintroducing cannabis, even in small amounts, will almost certainly cause the severe, cyclical vomiting episodes to return.