Some Bay State emergency room doctors are seeing a growing number of daily marijuana users with an obscure syndrome characterized by screaming, violent retching and abdominal pain, symptoms that can be alleviated with medication but that usually return unless the patients stop using pot.

“When medical marijuana was decriminalized, we started seeing cannabinoid hyperemesis syndrome,” said Dr. Matthew Mostofi, associate chief of emergency medicine at Tufts Medical Center in Boston, referring to the technical name for a syndrome that results in what ER docs call “scromiting,” simultaneous screaming and vomiting.

“We’ve seen it at least weekly the last couple of years. And it does concern me,” Mostofi said. “It’s one of the downsides to the legalization of marijuana.”

Massachusetts voted to decriminalize medical marijuana in 2012 and recreational cannabis last November. But people with cannabinoid hyperemesis syndrome are not occasional pot users, Mostofi said.

“We’re talking about people who use it two, three, four times a day — every day — over a period of months or years,” he said.

Dr. Mark Neavyn, an assistant professor of emergency medicine at UMass Memorial Medical Center in Worcester, said his department has seen only five to 10 cases in the last year or two. But if recreational use of marijuana becomes more common, that could change, Neavyn said.

“If you expose a population to something, there will be more people at risk of developing a substance use disorder,” he said. “And if we saw a lot more cases, it would burden emergency departments.”

The syndrome tends to result in multiple hospital visits, partly because it often goes undiagnosed by doctors who don’t know it exists.

“This is a syndrome we’re just now beginning to understand,” said Dr. Aimee Moulin, an ER doc who sees about one person every other shift at UC Davis Medical Center in Sacramento, Calif.

Anti-nausea medications such as Zofran typically don’t work, Moulin said, so doctors often use an anti-psychotic such as Haldol because it reduces nausea while also addressing the underlying causes of the syndrome.

“If you really want this illness to go away, though, what you need to do is stop using marijuana,” Moulin said. “And that can be such a loaded conversation because patients sometimes don’t want to talk about their marijuana use. … People aren’t fully aware of the potential side effects and consequences.”

Both medical and recreational marijuana are legal in California. And Moulin expects the number of patients she sees with the syndrome to increase once commercial sales begin there next month.

Jim Borghesani of the pro-legalization Marijuana Policy Project, called cases of the illness “quite rare” and questioned if any increased reports of it could be due to better reporting in the era of legalized pot.

“We thought it’s something to be concerned about, and we think that safe, tested marijuana would help,” Borghesani said. “And further funding for education that will be generated from taxes will be helpful in situations like this.”

Little data exists on the syndrome. One study tried to determine if cases of cyclic vomiting, including through cannabinoid hyperemesis syndrome, increased after Colorado legalized medical marijuana in 2009. But the study wasn’t conclusive, noting that while cases of cyclic vomiting nearly doubled and patients were more likely to acknowledge using marijuana, it wasn’t clear whether that was secondary to increased use, more accurate reporting on weed or both.

What ails smokers…

Cannabinoid Hyperemesis Syndrome (CHS), or what is being called “scromiting,” is caused by heavy pot smoking where the user suddenly screams while vomiting. Here’s what is known:

SIGNS OF ILLNESS

Nausea and violent vomiting

Abdominal pain

Dehydration

Relief sought via frequent hot bathing

HISTORY

CHS was first described in 2004

Patients are typically young adults with a long history of pot use

Users who became ill smoked pot three to five times per day

LENGTH OF ILLNESS

Typically 24–48 hours, but the risk for relapse is high

CURE?

There is no cure other than to quit smoking pot

SOURCE: National Center for Biotechnology Information