As a wise person named Maple Cocaine once said, “Each day on twitter there is one main character. The goal is to never be it.” Well, this past weekend that person was Eve Simmons, Deputy Health Editor of the Mail On Sunday, which is the Daily Mail, but, well, on Sunday. So, trash, essentially. But it was on Saturday that Simmons produced this blessed Twitter thread in which she reports from “sunny (smelly) LA” on the “public health disaster” that cannabis legalization has wrought here in California. This was obviously hilarious from her initial tweet, because those of us who actually live in California know that cannabis legalization has generally been, well, nice. For instance, personally speaking I can open my laptop, place an order for a sack of chocolate peanut butter cups that contain 10 milligrams of sativa, indica, or hybrid cannabis (my choice!) and they will be at my door in about 45 minutes.
Prices have dropped a bit, our courts are a bit less clogged with minor drug offenses, and opioid prescriptions are way down. At the same time, it’s not all happy stuff: opioid overdoses are way up (probably due mostly to COVID), the black market is still hopping (probably thanks in part to it still being illegal federally, meaning many banks and credit cards won’t allow the sales, and federal agents still occasionally disrupt dispensaries and farmers and steal their money and products). Also, there are still persistent problems with racial inequity, meaning white entrepreneurs like Seth Rogan get to set up business and rake in the cash while black men who were imprisoned for selling cannabis a decade ago are barely scraping by.
So, bit of a mixed bag, but nowhere near a “public health disaster.” Simmons continued her thread, though, saying that she spoke to doctors who see cannabis poisonings every day. Cannabis poisoning is when you get so high you think you can see time as a series of moments, like a photo album you can flip through, and you’re not sure if you’re seeing them in the right order anymore. That’s a real example from my life. It sucks but it’s nearly impossible to overdose on cannabis. You drink water and you try to sleep and you wait, and eventually you’re fine.
I HAVE read one case study of an extremely rare incident where a patient was brought to the hospital in a catatonic state. The doctors ran every test they could think of, first assuming some kind of stroke, then getting a bit stumped: he was perfectly healthy according to every scan, and was breathing just fine, brain and heart in great condition, but just OUT. Finally his family said, “Oh, right, not sure if this is relevant but he ate 22 weed cookies. And each cookie had six doses of ten milligrams of THC each.” For those in my audience who do not partake, I can eat one 10 mg peanut butter cup and have a pleasant evening and a deep sleep. I have some friends who can handle up to 40 mg. My dude took 1,320 mg. Anyway, after a few hours he woke up, drank some water, and he was fine.
But sure, this IS an issue: clogging up our poison control lines and our hospital ERs because someone couldn’t handle their shit, or someone unknowingly ate a “magic” brownie, isn’t great even if the risk to the patient is minimal. But again, not exactly a public health crisis.
But Simmons soldiered on in her thread, and it was in her third tweet that she did it – she became Twitter’s main character.
“Oh and there’s also a doubling of something odd called ‘scromiting’. That’s screaming and vomiting which lasts for weeks on end, with no treatment. A result of long term use of high potency cannabis.”
Yes. Scromiting. Screaming and vomiting at the same time. That’s the kind of Tweet that serves as something like the bat signal for amateur and professional comedians alike, with my friend Bill Corbett replying “Thank you for telling the truth. I smoked too much pot and have been scromiting and jumpsharting for months.” I honestly read through every reply and laughed my ass off, and then I started over again to read all the quote tweets. Just, perfection.
Sadly, my laughter was tinged with sadness, because I knew that at the end of the day–and I’m so sorry to say this, for many reasons–Simmons is right. Scromiting is a real thing. Scromiting is a real thing, caused by ingesting too much cannabis for too long in some people, and it IS on the rise thanks to legalization, either because more people are enjoying weed products or because more people are willing to admit it. So, let’s talk about scromiting.
I absolutely understand the kneejerk skepticism: most people in places where cannabis is still illegal or highly regulated probably don’t know many daily users, so they wouldn’t have heard of a relatively rare (more on that word in a minute) disorder related to it. Also, let’s just admit it, “scromitting” is a very funny word and does not sound like a real medical condition.
So, allow me to introduce you to the term, “Cannabinoid Hyperemesis Syndrome,” or CHS, colloquially known as “scromiting.” CHS was first described in the medical literature in 2004, in a report of nine patients in South Australia who were all heavy cannabis users presenting with severe vomiting and abdominal pain. The researchers found that these patients didn’t have any issues prior to their cannabis use, but that after months or years of use they found that they were experiencing early morning nausea and stomach pains, occasionally along with a weird fear of vomiting.
Because most people know that cannabis RELIEVES nausea, to the point of being frequently used by cancer patients to help them through chemotherapy, the patients INCREASED their use to help with the nausea. Eventually, they started vomiting, often with no warning at all. Even weirder, all nine patients found that taking a hot shower or bath immediately helped them feel better–the hotter the better, which means several of them ended up scalding themselves.
The doctors suggested all nine patients stop using cannabis. Most of the patients happily agreed to try that out, and they immediately got better. Three of them refused to stop, and they stayed sick (until two of them finally gave in and stopped, and got better).
Since that study in 2004, there’s been a lot of literature confirming that CHS is a very real thing. It was originally thought to be very rare, but now that more places are decriminalizing cannabis, we have more people using cannabis regularly AND more people who are willing to admit to their doctors that they use cannabis, meaning that we have a lot more data points. So now, new cases of CHS present to doctors every day.
I’ll pause here to note that the Mail on Sunday journalist, Simmons, was obviously wrong when she Tweeted that there is no treatment. There is a treatment, and it’s quite simple: stop using cannabis, at least for a few weeks or months while your body gets back to normal. Hot baths or showers is also, technically, a “treatment” that treats the symptoms but not the disease and shouldn’t necessarily be considered a long-term solution.
I say “necessarily” because there’s one thing I haven’t seen mentioned in the literature I’ve read on CHS: the idea that there may be a large number of cannabis users who experience that first stage of morning nausea and abdominal pain, but who never progress to the “scromiting” stage. I am not a doctor, so I may be missing something here, but it seems to me that someone who consumes more or less cannabis at various times might go in and out of that first stage. I will admit that this hypothesis comes from personal experience: I occasionally have gone through phases of my life where I take an edible every night for a few weeks, and in those periods I have experienced abdominal pain in the mornings. Is it CHS, or is it cannabis-induced cheese consumption before bed? I don’t know, but when it happens I take a little tolerance break, just to be sure. And after several years of fairly regular cannabis use, I have yet to scromit. It’s just one anecdote, but that’s the kind of data point that researchers need to collect more of to figure out how common this issue is and how to best fix it, especially for people who rely on regular cannabis use to help them sleep, or get through chemo, or help with anxiety or depression, or come off of more dangerous drugs like opioids.
So, you might be wondering why this all happens. Researchers aren’t 100% sure, but they do have some ideas. Cannabis is fun for most people because it contains THC and other related chemicals that interact with “cannabinoid receptors” in your brain, leading to that “high” feeling as well as helping relieve nausea and vomiting. But a lot of people don’t realize that your digestive tract ALSO has cannabinoid receptors, and THC also interacts with those and seems to have the exact opposite effect of CAUSING nausea and vomiting. When you first start taking cannabis, the receptors in your brain take priority. But as you use it regularly, those receptors in your brain may become habituated to it, meaning you have to use more to get the same effects. When the brain’s receptors stop telling your body to chill out, your stomach receptors are more likely to take the lead, which means…it’s scromit time, baby.
I hate to defend someone who is obviously fear-mongering and spreading misinformation, but I do think it’s important that people understand the actual negative impacts of the food and drugs we put in our bodies. Obviously I’m a proponent of cannabis legalization, and I can state definitely that compared to other, legal drugs like alcohol, tobacco, Advil, or Tylenol, cannabis is about as safe a high as you can get. But that doesn’t mean that it isn’t without its drawbacks, and it’s important that as more people get easy access to it, more people should know how to use it safely.
In fact, while as I said earlier it’s nearly impossible to overdose on cannabis, it IS very possible to die from the continued effects of CHS. There have been several case studies described by doctors in the literature, like this report in which one 41-year old heavy cannabis user lived with frequent vomiting and stomach pain for TEN YEARS before dying of dehydration due to the vomiting. In a second case, a 48-year old man was found dead of the same condition, with the saddest detail being that he was discovered in his bathtub, probably trying to relieve his symptoms without medical intervention even to the end.
In the many deaths I read about across various studies, most of the patients got the correct diagnosis of CHS prior to death, but they just did not believe that such a safe and normal part of their life like cannabis could possibly be causing it, or they thought that it just wasn’t that big a deal that they should stop.
So if you use cannabis more than four or five times a week and you find that you’re needing more and more cannabis to get high, or if you are experiencing abdominal pain or nausea, please consider stopping or slowing down your use, or seeing a doctor and asking them about CHS. Oh god, now I sound like a US pharmaceutical ad. “Talk to your doctor about whether or not Magical Peanut Butter Cups are for you. If you experience nausea or scromiting while taking Magical Peanut Butter Cups, please take a warm (but not too warm) bath and discontinue use. Raw dogging reality for a few weeks is far better than dying of scromit.”