The day after Christmas, 37-year-old Taylor Armendariz woke up in her South Jersey apartment feeling an intense stomach pain and nausea that she had never experienced before.
A self-proclaimed “avid” cannabis user, she had enjoyed some before a holiday feast of beef Wellington, mashed potatoes, and an apple pie topped with ice cream. In her relaxed mindset, she thought, “Let’s smoke a bit before we dive in.” But after the meal, she rued her choices, believing she had eaten too much.
Despite vomiting until she had emptied her stomach, the nausea persisted to the point where she considered making herself throw up more.
Her boyfriend drove her to urgent care, where the doctor suggested a hospital visit, suspecting appendicitis. At Virtua Voorhees Hospital’s emergency department, she underwent several tests—EKG, CT scan, and blood work—all of which turned out negative.
Back at home, she continued to feel sick and decided to take a shower before heading back to the emergency room. To her surprise, as soon as the hot water hit her, she felt a bit of relief, but the discomfort returned as soon as she dried off.
On her second visit to the ER, she mentioned the shower’s soothing effect. The doctor immediately suspected her symptoms were linked to something called cannabinoid hyperemesis syndrome (CHS), a condition that can arise unexpectedly in long-term marijuana users.
A key indicator is feeling better after a hot bath or shower. Another sign is “scromiting,” a term that describes the combination of screaming and vomiting.
Emergency doctors in the Philadelphia area are noticing a significant increase in CHS cases, coinciding with evolving state laws that have made cannabis more accessible and potent.
Two Jefferson Health hospitals, Thomas Jefferson University Hospital and Jefferson Methodist Hospital, reported over 300 cases in patients mostly aged between their late teens and 40s in the fiscal year ending July 2025, which marks a threefold rise compared to two years ago.
At Temple University Hospital in North Philadelphia, staff can often identify the syndrome just by the distinctive sounds patients make while vomiting.
St. Christopher’s Hospital for Children is reporting about three cases each week in patients aged 16 to 22, a sharp increase from just a few years ago, according to Richard Hamilton, the chief of emergency medicine there.
Hamilton, who is also a toxicologist, was glad when federal health officials recognized CHS as a legitimate medical condition last fall, assigning it a diagnosis code for tracking purposes.
However, many patients struggle to accept this diagnosis.
“Patients will insist, ‘It can’t be that; I’ve been smoking for years,’” Hamilton shared. Some argue that cannabis helps with nausea and vomiting, especially in chemotherapy patients.
“That may hold for low-level use, but not for someone who spends five hours smoking in a haze,” he noted.
What’s driving the uptick?
The prevalence of CHS has prompted local ER doctors to query patients about their cannabis usage, duration, and whether hot showers provide relief.
Sometimes, it’s the smell that gives it away.
“They walk in smelling like skunk,” noted R. Alan Shubert, the lead physician at Virtua Mount Holly Hospital, although he prefers addressing health issues stemming from regulated cannabis over illegal drugs.
The increasing THC levels, the psychoactive element in cannabis, play a significant role in the rise of CHS cases, according to Kory London, an emergency medicine doctor at Jefferson Health.
“This isn’t the ‘70s anymore with 2% to 3% cannabis; we’re dealing with highly concentrated products that resemble methamphetamine distillates,” he pointed out.
Lauren Murphy, another emergency medicine practitioner at Temple, compared today’s potent cannabis to the cautionary narrative of Jurassic Park: “We didn’t consider if we should, only if we could. We never anticipated the complications of increased concentration.”
Moreover, the unprecedented access to cannabis also fosters this uptick. Currently, 24 states—including New Jersey and Delaware—allow recreational cannabis use for adults. In Pennsylvania, medical marijuana is available through state-approved dispensaries.
After New Jersey legalized recreational cannabis in 2022, dispensaries began popping up everywhere. A single-serving edible is capped at 10 milligrams of THC, but packages can contain up to 100 milligrams with ten gummies. Patrons can purchase up to ten packages, totaling 1,000 milligrams, per visit.
“You don’t have to seek out a dealer anymore; you just head to a dispensary,” conveyed Rachel Haroz, a toxicologist and emergency medicine doctor at Cooper University Hospital in Camden. “This is uncharted territory for cannabis exposure.”
Research indicates that emergency departments have witnessed a doubling of CHS cases in states where cannabis has been legalized, either medically or recreationally, as mentioned in an article published in the journal Cureus.
That article also noted that nearly 30% of regular cannabis users might experience this syndrome. “It’s quite common in that demographic,” said Haroz.
Some patients make multiple trips to the ER. For example, doctors at Nemours Children’s Hospital in Delaware have seen the same patient six times over a few months.
Dr. Katie Giordano from Nemours mentioned that patients can face dehydration, electrolyte imbalances, and malnutrition, with severe cases posing life-threatening risks.
Shubert shared that several patients he encounters have already been diagnosed with CHS but find themselves in cycles of recurring symptoms.
More patients are now using internet resources to self-diagnose, say doctors.
There are actually two Facebook support groups for CHS that collectively have around 40,000 members globally.
‘It felt animalistic’
Tailored to her experience, Armendariz described her cannabis use as “morning, noon, and night, with snacks in between” for over 15 years.
She started with friends and co-workers after shifts at Applebee’s, eventually using it to alleviate negative emotions—sadness, anxiety, and frustration. She and her boyfriend previously worked at dispensaries in California before relocating to Blackwood in Camden County.
The nausea hit her suddenly around 4 a.m. on December 26 and persisted even after she had thrown up everything. In a desperate attempt to alleviate her discomfort, she even tried to force herself to throw up using her toothbrush handle. “It felt animalistic,” she recalled.
“The pain was unbearable,” Armendariz said. “I’m usually tough and don’t rush to the ER, but this felt wrong.”
At the ER, she implored the doctor for anything to relieve her suffering.
Typical anti-nausea medications don’t usually work for CHS, so doctors often administer antipsychotic injections, like haloperidol, along with IV fluids to restore electrolytes. That approach worked for her.
Patients also receive capsaicin cream, a topical treatment made from chili peppers, activating heat-sensitive nerves to mimic the relief of a hot shower.
Heat can distract the brain from pain—something known as “gating,” explained Hamilton from St. Christopher’s. It’s akin to using a heating pad for back pain; it doesn’t change the actual pain, but it diverts the brain’s attention to the heat.
Documented instances exist of CHS patients only seeking ER care after running out of hot water.
In the days following her diagnosis, Armendariz found solace by soaking in hot baths for up to two hours, sipping broth, and reading a novel for her book club.
The only remedy for CHS is complete abstinence, yet Armendariz feared she couldn’t quit. “I was thinking, ‘Can I actually do this? Is it even possible?’” she admitted.
The heightened THC levels can trigger withdrawal-like symptoms after cessation.
“The products available today are entirely different,” said Lynda Bascelli, an addiction medicine specialist with Virtua Health. “It’s a myth that cannabis is harmless and non-addictive.”
Many individuals will experience symptoms such as anxiety, insomnia, mood fluctuations, loss of appetite, and strong cravings for cannabis alongside CHS symptoms that may linger for months. Doctors explain that THC accumulates in body fat, making it slow for the body to eliminate it. Prolonged cannabis use can lead to nerve and receptor dysfunction in the gastrointestinal tract.
“Nerves and receptors don’t adapt quickly,” London from Jefferson Health remarked. “So when patients say their symptoms take months to ease, I completely trust that.”
The exact cause of CHS remains unknown to doctors; however, they suspect it relates to a neurotransmitter called anandamide and chronic overstimulation of endocannabinoid receptors in the brain and gut.
Researchers are exploring why the syndrome affects certain long-term users and not others, investigating potential genetic factors, the differences between smoking and edibles, specific strains, and the impact of duration of use.
Ultimately, Armendariz recognized that quitting was the only solution to prevent another trip to the ER.
“I felt like I was stuck between a rock and a hard place—if I stop, I think I’m gonna die, but if I continue, I feel like I’m dying,” she reflected.
