By Dr. Roneet Lev
“Scromiting” is the popular name for cannabis hyperemesis syndrome, or CHS. A recent article in the Washington Post’s popular medical mysteries series highlighted the case of a woman’s uncontrolled vomiting.
The article chronicled the effects of cannabinoid hyperemesis and the challenge patients and doctors face when attempting to make an accurate diagnosis. Yet the syndrome should not be a mystery. In fact, it is a daily diagnosis here in San Diego. Ask any emergency room physician or nurse.
The typical patient with this syndrome has been smoking marijuana on a regular basis for many years. There is a spectrum of the disorder from episodes of unprovoked vomiting to having to call 911 because of severe abdominal pain. In extreme cases, people have died from CHS.
How could marijuana be causing vomiting when it is advertised as helping appetite? The answer is related to the high concentration of THC, the main intoxicating ingredient in cannabis, in today’s pot products. Add to that the frequency of marijuana use, and changes in the receptors in the brain and intestines that trigger vomiting.
Research shows that pure THC at low dose can help with nausea and vomiting for people with AIDs and cancer chemotherapy. But comparing pure THC such as in the FDA-approved dronabinol to smoking marijuana, a plant with over 400 chemicals and THC content of 25%, is like comparing apples and elderberries.
In 2017, at the height of the opioid epidemic San Diego physicians got together to create a consensus treatment guideline to treat CHS. The issue at hand was that people with CHS were exposed to a cancer risk by high levels of radiation from repeated abdominal CT scans and treated with high-dose pain medications, creating a potential opioid addiction
Most physicians are very familiar with the syndrome but may feel compelled to rule out more serious diagnosis. Patients have a responsibility to be honest with their doctor and with themselves about the frequency of their marijuana use.
The good news is that CHS and scromiting are curable by simply ceasing to use marijuana. There is treatment, recovery and hope for people who have marijuana withdrawal and addiction.
Dr. Roneet Lev is an emergency and addiction physician at Scripps Mercy Hospital in San Diego.
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