CDC's ICD Code Creation Better Reveals Extent Of ED Visits For Scromiting

Since the legalization of recreational marijuana, hospital emergency rooms are seeing ever growing numbers of patients scromiting. “Scromiting,” a contraction of the words 'screaming and vomiting', is the usual presentation of cannabis hyperemesis syndrome (CHS) in hospital emergency departments (ED).  Episodes last for hours and the patients take weeks to fully recover after release from the hospital.

None of these ED admissions are paid for by the taxes collected on recreational marijuana, of course.  Your health insurance premiums and taxes pay for scromiting admissions.

The CDC’s National Syndromic Surveillance Program data were analyzed to examine trends in CHS-involved ED visits before and after implementation of a new, CHS-specific International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code on October 1, 2025.  This code allowed ED personnel to more accurately report cases of scromiting.

A huge increase in scromiting cases was found due to more accurate reporting.  Even so, the new numbers still likely underrepresent the full number of actual cases.

The Summary, Abstract, and Introduction to the CDC report, as well as its Implications for Public Health Practice at the end:

https://www.cdc.gov/mmwr/volumes/75/wr/mm7530a2.htm#contribAff

https://www.cdc.gov/mmwr/volumes/75/wr/pdfs/mm7530a2-H.pdf

Trends in Emergency Department Visits Involving Cannabis Hyperemesis Syndrome Identified Using a New Diagnosis Code — United States, January 2023–May 2026
August 6, 2026 / 75(30);391–396

By: Alana M. Vivolo-Kantor, PhD; Stephen Liu, PhD; Lauren J. Tanz, ScD; Christine L. Mattson, PhD; Josh Schier, MD
All from: Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC

Summary

What is already known about this topic?

The prevalence of cannabis hyperemesis syndrome (CHS), a condition characterized by cyclical nausea and vomiting associated with frequent cannabis use, increased sharply in the United States during 2016–2022.

What is added by this report?

The proportion of all-cause emergency department visits that involved CHS were higher after implementation of a new International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code, suggesting improved recognition and previous underestimation of the public health impact of CHS. Higher proportions were observed among younger persons and females.

What are the implications for public health practice?

The new CHS-specific diagnosis code has improved CHS surveillance and estimation of public health impact. However, increased clinical recognition and education about risks of frequent cannabis use are still needed, particularly in younger populations.

Abstract

Cannabis hyperemesis syndrome (CHS) is a condition characterized by cyclical nausea and vomiting and is associated with frequent cannabis use. Data from CDC’s National Syndromic Surveillance Program were analyzed to examine trends in CHS-involved emergency department (ED) visits before and after implementation of a new, CHS-specific International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code on October 1, 2025. Monthly CHS-involved ED visits per 10,000 all-cause visits were assessed overall and by demographic characteristics. During January 2023–May 2026, a total of 199,565 ED visits involved CHS. During January 2023–September 2025, the proportion of ED visits that involved CHS remained mostly steady. In the first month after implementation of the new diagnostic code, the proportion of CHS-involved ED visits increased from 3.35 per 10,000 ED visits in September 2025 (preimplementation) to 11.26 per 10,000 ED visits in October 2025 (postimplementation). During the first 8 months after implementation of the new code (October 2025–May 2026), average monthly proportions of CHS-involved ED visits were 3.7 times as high as the monthly average during January 2023–September 2025. Higher proportions of CHS-involved ED visits were observed among persons aged 15–24 years and females, with more pronounced impacts among some demographic groups after code implementation. The abrupt, sustained increase might partly reflect improved recognition and coding of CHS rather than a true rise in incidence. These findings highlight a likely underestimated impact of CHS, suggesting the need to strengthen education about the risks associated with frequent cannabis use, expand ongoing surveillance efforts, and improve clinical recognition of CHS through continuing medical education and implementation of routine cannabis use assessment in ED settings.

Introduction

Cannabis hyperemesis syndrome (CHS) is a syndrome attributed to prolonged, frequent cannabis use, characterized by sudden episodes of severe nausea, vomiting, and abdominal pain (1). Reports of suspected CHS increased sharply during 2016–2022, with the largest increase occurring during the COVID-19 pandemic (2); the increase also coincided with widespread state-level cannabis legalization in the United States, although cannabis use remains illegal under federal law (3). Persons with CHS often seek medical care because symptoms can be severe and debilitating, with outcomes ranging from symptom resolution after cessation of cannabis use to, in rare cases, death (1).

Trends in cannabis use might be contributing to the increasing prevalence and recognition of CHS. The prevalence of past-month and daily or near daily cannabis use has been increasing, particularly among young adults and females (4). In addition, concentrations of tetrahydrocannabinol (THC), the primary psychoactive compound in cannabis, have increased in cannabis products over time (5). Higher THC concentration (>10%) is associated with continued and more frequent cannabis use among adolescents and young adults (6). Although THC concentration has not been directly linked to CHS, higher-potency products are associated with more frequent use, the primary risk factor for CHS (1,6).

CHS is likely underrecognized in both adolescent and adult populations. Clinicians might not routinely assess or document patients’ cannabis use; CHS can be misdiagnosed as other gastrointestinal conditions, such as cyclical vomiting syndrome (7). To improve clinical identification, a specific International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) discharge diagnosis code for CHS was introduced on October 1, 2025. This report examines trends in CHS-involved emergency department (ED) visits before and after implementation of this code.

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Implications for Public Health Practice

These findings highlight the need for increased awareness of CHS among clinicians and the public, but further educational efforts might be needed to prevent the cause of CHS: cannabis use. They also emphasize the importance of implementing evidence-based strategies to prevent cannabis use initiation and mitigate the consequences of cannabis use.

The observed higher proportions of CHS-involved ED visits after the new code was implemented in October 2025 potentially more accurately reflects true impact than previously observed proportions, underscoring the need for preparedness in emergency care settings, including appropriate clinical recognition and management of CHS. Clinicians can consider CHS in the differential diagnosis for patients with nausea, vomiting, and abdominal pain and can routinely assess cannabis use, including frequency, duration, product type, and route of use. Screening for substance use disorders and comorbid psychiatric conditions might also be warranted among patients reporting regular cannabis use (10).

Educational materials and communications campaigns should convey that younger age groups had high proportions of ED visits with CHS identification and that CHS might occur after shorter durations of cannabis use than was previously recognized (7,8). Expanded and tailored messaging might also be needed to raise awareness of CHS and other potential adverse health effects of cannabis use, particularly among younger populations. Communities can identify a wide range of effective substance use prevention and intervention strategies using CDC’s ENGAGE: Evidence-Based Strategies to Prevent Youth Substance Use resource for action.

Continued surveillance is important to better understand CHS epidemiology, including the potential role of high-potency THC and hemp-derived products and information on cannabis product characteristics (e.g., potency, type, or route of use) and to observe trends after code implementation to better assess prevalence. Monitoring trends across demographic groups and geographic areas can help identify populations at greatest risk and guide tailored prevention and intervention strategies.