Drug policy experts were left scratching their heads this week when it was claimed that there had been a huge spike in people simultaneously screaming and vomiting in California because of excessive cannabis use, as “scromiting” became the latest battleground in the debate around weed legalisation.
Over the weekend, the Mail on Sunday tabloid, the Sunday edition of the Daily Mail, which has a notorious past record of doing sensationalist anti-drug stories and stigmatising drug users, published a heavily one-sided piece critical of US cannabis legalisation, describing it as a “public health nightmare” that has sparked a rise in addiction, criminality and violence.
The article said in states such California and Colorado there had been a dramatic rise in “scromiting,” which it said was simultaneous screaming and vomiting caused by intensive use of cannabis.
Some US doctors were unconvinced.
Peter Grinspoon, a primary care doctor teaching at Harvard Medical School, told VICE World News when asked whether “scromiting” was a massive problem in the US: “Certainly not. It’s a made up word.”
The initial claim caused a backlash across Twitter, with many people mocking the phrase and saying it was another example of old-fashioned Reefer Madness-style hyperbole around the dangers of cannabis.
So what is scromiting and does it have any basis in reality?
Snopes notes that the word “scromit” first appeared in the Urban Dictionary in 2008, meaning a “screaming vomit or wailing upchuck,” although there was no connection with cannabis.
Four years beforehand in 2004, a medical condition known as cannabis hyperemesis syndrome (CHS), where some heavy cannabis users were seen by doctors to experience more than just a normal whitey, but repeated vomiting, nausea and abdominal pain, was identified in Australia.
Since then, the condition has been mentioned in many studies over the last two decades. Even so, as Harry Sumnall, professor of substance use at Liverpool John Moores University points out, there does not appear to have been any formal scientific reviews into the prevalence of the syndrome, either in the US or internationally.
It’s likely that the first link between this syndrome and the word “scromiting” appeared in a 2017 interview with Dr Roneet Lev, an emergency doctor at Scripps Mercy Hospital in San Diego in November 2017.
“Lev said the condition has become so common, ER staff have coined a new term that helps identify it: ‘scromiting’, for ‘screaming’ and ‘vomiting’,” said the article. Lev, who later became chief medical officer for the White House’s office of national drug control policy during Donald Trump presidency, was extensively quoted in the Mail on Sunday article about how common scromiting is.
Since cannabis hyperemesis was nicknamed scromiting, the number of articles about the syndrome and its new buzzword has increased, including pieces in the Daily Mail in 2017 and 2021 and in the Wall Street Journal in June this year.
But Sumnall said of CHS: “Doctors in several countries report regularly treating cases over the years but numbers are relatively small compared to other cannabis related presentations. Whilst there have been studies of cases stretching back around 20 years, there have only been a few focused studies, including hospital presentations in US states that have introduced legal regulation.”
Some studies suggest 10 percent of people coming into US hospitals with recurrent vomiting may have used cannabis. But Sumnall said some of them may have only been using cannabis to try and treat their symptoms.
Studies have also tried to extrapolate from ER visits to the general population the number of people suffering from CHS, but Sumnall said people visiting hospitals are unrepresentative of the wider population of cannabis users so this would overestimate prevalence.
Lastly, studies have attempted to show that a small rise in vomiting-related emergency department visits between 2013 and 2018 was related to an increase in the number of licensed recreational cannabis outlets, but Sumnall said this was unreliable because legalisation often leads to more people getting help for, and admitting to, cannabis use.
“In order to make a balanced assessment of the potential harms of cannabis, and different forms of legal regulation, and to ensure that proper support is available to patients, it's important that we take a clear headed look at these types of issues. That’s the approach we take with other sources of potential harm,” said Sumnall. “Unfortunately, as is still the case with drug-related topics, despite some signs of more mature policy and health debates, it seems that sensationalist reporting and political point-scoring trumps sensible discussion.”
Ryan Marino, an emergency doctor at Case Western Reserve University School of Medicine in Cleveland, Ohio, said: “I do not think a serious person would talk in such a way [about scromiting]. CHS is reportedly increasing, but there are significant confounders present for that data mostly because there are no actual diagnostic criteria for CHS and then also the significantly increased awareness and attention. Even taking those numbers, CHS remains incredibly, exceedingly rare.
“And the thing that is most important to me that nobody in these stories likes to mention is that there is no evidence of causation between cannabis and hyperemesis, and not even a proposed theoretical mechanism that is accepted.”
While the legalisation of weed across US states, Canada and Uruguay has undeniably had teething problems, there have also been benefits. But for those with a pro or anti drug agenda to peddle, there has been a huge amount of cherry-picking of the facts to suit their narratives.
Steve Rolles, senior policy analyst for the Transform Drug Policy Foundation said he’d never encountered the term “scromiting” in 20 years of cannabis policy work until this weekend.
“Cannabis reforms consistently provide striking examples of misuse of data to promote particular positions,” he told VICE World News.
“While reform advocates are far from guilt-free on this front, there's a particularly pernicious history of Reefer Madness propaganda amongst reform opponents. Data is routinely cherry picked, misrepresented and stripped of context or important caveats, to make cannabis, or cannabis reforms, look as bad and scary as possible.
“'Scromiting' feels like a rather desperate new ploy in this tired old propaganda battle. There's a nugget of truth in it, albeit horribly overblown; cannabis hyperemesis syndrome - severe vomiting amongst long term daily users - is a real if very rare condition. On most outcomes legalisation has been a success and the doom mongers predictions of a stoner-apocalypse have so conspicuously failed to materialise.”
Despite its long-held anti-drug reform stance, the UN’s Office on Drugs and Crime admitted last week in its annual drug report that behind it’s top line message that “cannabis use and frequency of cannabis use have increased in the countries and states that have legalised non-medical use of cannabis”, evidence showing that this was directly due to legalisation was thin on the ground. It admitted that in the United States and Canada, the increase in cannabis use started long before legalisation.
“Legalisation by itself does not account for the larger increase in cannabis use in those states where cannabis was legalised. Cannabis use among adolescents in state-level jurisdictions and in countries that have legalised cannabis in general seems to have remained stable following legalisation.”
It said data suggested that “there was no association between cannabis use or frequency and measures allowing medical use of cannabis”. Meanwhile in Canada, which legalised recreational weed in 2019, the report said “there has been no marked increase in cannabis use among school students.”