Cannabinoid Hyperemesis Syndrome: The ‘Grass Sick’ Filling ERs as Cannabis Use Rises

The Uncontrollable Vomiting Crisis: Understanding Cannabinoid Hyperemesis Syndrome (CHS)

In the wake of widespread cannabis legalization and increased product potency, emergency rooms across the United States are seeing a surge in a baffling and painful condition known as Cannabinoid Hyperemesis Syndrome (CHS). Often referred to by patients and medical staff as “Grass Sick” or, informally, “scromiting” (scream-vomiting), CHS is a severe, cyclical illness characterized by relentless nausea, agonizing abdominal pain, and uncontrollable vomiting.

Patients like Shaylin Schlosser, who experienced sudden, violent episodes of vomiting and shooting abdominal pain, often describe the sensation as the worst pain they have ever felt, leading many to fear they are dying or suffering from a severe internal emergency.

CHS presents a significant diagnostic challenge because its symptoms mimic other serious gastrointestinal issues, and standard anti-nausea medications are typically ineffective. This has led to repeated, costly, and often fruitless ER visits for chronic cannabis users who are unaware their habit is the root cause of their suffering.

Defining the Paradox: Symptoms and Diagnosis of CHS

CHS is a condition that develops in individuals who are chronic, heavy users of cannabis—meaning daily or near-daily use over an extended period. The syndrome is paradoxical because cannabis is widely known and medically prescribed for its anti-nausea properties. However, in chronic users, the constant saturation of the body’s cannabinoid receptors eventually leads to a disastrous malfunction of the digestive system.

Key Symptoms of Cannabinoid Hyperemesis Syndrome

The syndrome typically progresses through three phases, though the hyperemetic phase is what drives patients to the ER:

• Prodromal Phase: Early morning nausea, abdominal discomfort, and fear of vomiting. Users often increase cannabis consumption during this phase, believing it will alleviate the nausea, which only exacerbates the underlying condition.
• Hyperemetic Phase: Episodes of intense, cyclical vomiting and severe, cramping abdominal pain. This phase can last for hours or even days, leading to dangerous dehydration.
• Recovery Phase: Begins only after the patient completely stops using cannabis.

The Diagnostic Clue: Hot Showers

A crucial, defining characteristic of CHS is the patient’s compulsive use of hot showers or baths for temporary relief. Heat applied to the abdomen is often the only thing that provides respite from the severe nausea and pain. While the exact reason for this relief is still debated, it is a key indicator for emergency physicians attempting to differentiate CHS from other causes of vomiting.

“The pain was worse than anything I could imagine. I spent hours in the shower because the hot water was the only thing that stopped the seizing in my abdomen,” recounts one patient experience, highlighting the severity of the symptoms.

Standard anti-emetic drugs, such as Zofran (ondansetron), which are highly effective against most forms of nausea, typically fail to provide relief for CHS patients, further complicating initial diagnosis.

Why Are Cases Increasing?

While CHS was first documented in 2004, its prevalence has skyrocketed in the last decade, coinciding directly with two major trends:

1. Increased Legalization and Availability: As more states and regions legalize recreational and medical cannabis, the number of chronic, heavy users has grown substantially.
2. Rising Potency: Modern cannabis products, particularly concentrates, edibles, and high-THC flower, contain significantly higher concentrations of tetrahydrocannabinol (THC)—the primary psychoactive cannabinoid—than products available decades ago. This chronic exposure to high levels of cannabinoids is believed to overload and dysregulate the body’s endocannabinoid system (ECS), which controls digestion, mood, and pain.

In the ECS, chronic high-dose exposure shifts the balance, leading to the paradoxical effect of severe, debilitating nausea rather than relief.

Treatment and the Only Known Cure

Treating CHS in the emergency setting focuses primarily on supportive care to manage the immediate crisis:

• Hydration: Intravenous (IV) fluids to correct severe dehydration caused by persistent vomiting.
• Pain Management: Medications like benzodiazepines (e.g., lorazepam) or topical capsaicin cream applied to the abdomen have shown some efficacy in managing the symptoms, unlike traditional anti-nausea drugs.

However, medical experts are unanimous: the only definitive cure for Cannabinoid Hyperemesis Syndrome is complete and permanent cessation of all cannabis use.

If the patient resumes use, the symptoms will inevitably return, often within days or weeks, leading to another cycle of pain and ER visits. Because many patients struggle to accept that the substance they use to relax or treat other conditions is causing their illness, the condition frequently recurs, highlighting the need for better patient education and substance use counseling.

Key Takeaways for Public Health and Users

CHS is a growing public health concern, placing a significant burden on emergency services and causing severe distress to patients. Understanding this condition is vital for both healthcare providers and chronic users.

• Definition: CHS is a severe, cyclical vomiting illness linked exclusively to chronic, heavy cannabis use.
• Diagnosis: Look for the triad of symptoms: severe abdominal pain, cyclical vomiting, and temporary relief from hot bathing.
• Ineffective Treatment: Standard anti-emetics (like Zofran) are usually ineffective for CHS.
• Cure: The only known cure is the complete and permanent cessation of all cannabinoid products.
• Risk Factors: High-potency products and daily or near-daily consumption significantly increase the risk of developing CHS.

Conclusion

The rise of Cannabinoid Hyperemesis Syndrome serves as an important reminder that while cannabis may be widely available and generally considered safe, chronic, high-dose use carries specific, severe health risks. For individuals experiencing unexplained, cyclical vomiting and abdominal pain, especially those who find relief in hot showers, consulting a physician and being transparent about cannabis consumption is the critical first step toward diagnosis and recovery. Without complete abstinence, the painful cycle of CHS will continue, leading to repeated, costly, and potentially dangerous emergency episodes.