Mysterious marijuana-related vomiting disorder gets official WHO code as ER cases rise

Global health officials are now formally recognizing a mysterious vomiting disorder linked to long-term marijuana use, a move experts say could help save lives as cases rise across the country.

The World Health Organization (WHO) has formally added cannabis hyperemesis syndrome (CHS) to its diagnostic manual, according to guidance published by the agency in October, giving the mysterious disorder a specific code for the first time. The update, which went into effect Oct. 1 and has now been adopted by the Centers for Disease Control and Prevention, allows doctors across the country to identify, track and study the condition instead of grouping it into broader vomiting or gastrointestinal categories.

CHS is a dangerous and sometimes fatal syndrome that, according to the National Institutes of Health, affects chronic cannabis users, causing severe nausea, repeated vomiting, abdominal pain, dehydration, weight loss and, in rare cases, heart rhythm problems, seizures, kidney failure and death. Patients often describe a horrible symptom known as “scromiting”: screaming and vomiting at the same time due to extreme pain, according to the Cleveland Clinic.

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Until now, doctors have had a hard time diagnosing CHS because its symptoms mimic food poisoning, the stomach flu and more, Axios reported, and some patients have gone months and even years without answers.

“It helps us count and monitor these cases,” said Beatriz Carlini, an associate research professor at the University of Washington School of Medicine, which identifies and tracks CHS in its hospitals and emergency rooms and praised the WHO’s decision in a Nov. 18 news release. “A new code for cannabis hyperemesis syndrome will provide strong and important evidence for adverse events from cannabis, which doctors tell us is a growing problem,” added Carlini, who studies the adverse health effects of cannabis use.

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A new JAMA Network Open study published Nov. 24 found that emergency room visits for CHS increased during the COVID-19 pandemic and have remained high since. Researchers say isolation, stress and increased access to high-potency cannabis products likely contributed to the increase.

According to the study, CHS-related ER visits increased approximately 650% from 2016 to their peak during the pandemic, especially among people ages 18 to 35. The authors also noted a dramatic change in THC potency, with current products often exceeding 20% ​​THC, compared to just 5% in the 1990s.

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John Puls, a Florida-based psychotherapist and nationally certified addictions specialist, said he has seen an “alarming” increase in CHS, particularly among teens and young adults who use high-potency cannabis.

“In my opinion, and the research also supports this, the higher rates of CHS are absolutely related to high potency cannabis; often the products are over 90% THC,” Puls told News Digital. He added that the most common misconception about CHS is that it is not a real condition, so he believes the new diagnosis code is “an important step in the right direction.”

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However, some researchers note that causality has not yet been proven, the epidemiology is not fully understood, and the underlying cause of CHS is still unknown. One theory is that excessive, prolonged cannabis use overstimulates the body’s cannabinoid system, causing the opposite of marijuana’s usual anti-nausea effect. “Although cannabis can be used to treat nausea, those products typically contain much lower doses of THC, typically less than 5%,” Puls said.

Stopping cannabis use appears to be the only sure cure, according to the Cleveland Clinic and the NIH. Typical nausea medications rarely help, so doctors often turn to stronger medications or capsaicin creams, which mimic the warm relief that many patients get from hot showers.

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A telltale sign of CHS is that sufferers often find relief only by taking long, hot showers, a temporary solution that scientists still don’t fully understand.

The syndrome is intermittent, leading some users to believe that a bout of illness was a fluke and they may continue using cannabis without incident before becoming violently ill again. Experts say many people resist the diagnosis, and even those who accept it often find it difficult to quit cannabis because of addiction.

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“Some people say they have used cannabis without problems for decades,” said Dr. Chris Buresh, an emergency medicine specialist at UW Medicine. “But even small amounts can cause these people to start vomiting.”

And once someone has had CHS, Puls noted, they are more likely to experience it again. “My hope would be that with this new diagnosis code CHS will be more accurately diagnosed in an emergency room setting,” he said.

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Public health experts hope the new WHO code will dramatically improve surveillance and help doctors spot trends, especially as legalization spreads and high-potency products proliferate.