April 21, 2025 • 31 mins
Cannabinoid Hyperemesis Syndrome (CHS), also known as "scromiting," is a debilitating condition characterized by severe nausea, vomiting, and abdominal pain that affects heavy cannabis users. Dr. Casey Grover explains this increasingly common syndrome caused by high-potency cannabis products, which paradoxically improves with hot showers and proves challenging to treat with conventional medications.
• First identified in 2009 and named "scromiting" to reflect the combined screaming and vomiting patients experience
• Cannabis potency has increased dramatically from 1% THC in the 1970s to 25-30% THC in today's products
• Patients experience cyclical episodes of diffuse abdominal pain, nausea, and vomiting lasting 24-48 hours
• Compulsive hot bathing is a hallmark symptom, with patients focusing hot water on their abdomen for relief
• Standard anti-nausea medications like Zofran don't work well; psychiatric medications like Haldol often provide better relief
• Many patients question the diagnosis because cannabis is thought to help nausea rather than cause it
• Treatment requires cannabis cessation, though symptoms may persist for months after quitting
• Multiple theories explain CHS, including nerve hypersensitivity and paradoxical stress responses from high-dose THC
To contact Dr. Grover: ammadeeasy@fastmail.com
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Transcript
Episode Transcript
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Speaker 1 (00:00):
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
Today we are going to becontinuing our discussion about
(00:44):
the hazards of cannabis use.
Last week, we took a look atcannabis overdose.
This week, we're going to belooking at a syndrome that
develops as a consequence ofheavy cannabis use, and that
syndrome is cannabinoidhyperemesis syndrome.
Some people refer to it asscrometing syndrome.
(01:07):
Some people refer to it asscrometing.
I recorded myself giving alecture on this topic to my
colleagues at the drug andalcohol treatment program I work
at, and I wanted to share thislecture with all of you.
So with that, grab your barfbucket and let's get started.
Okay, we're going to discusscannabinoid hyperemesis syndrome
and I was going to give yousome of the history.
So this condition was firstidentified in 2009, and we
(01:31):
really didn't know what it was.
People had reported thissyndrome of recurrent vomiting
and cannabis use and compulsivebathing, and we weren't really
sure what it was, and we weren'treally sure what it was and I
graduated medical school in 2010.
And really in the first fewyears of my training, 2010 to
(01:54):
2013, we didn't know much aboutaddiction and it was really in
the mid-2010s that we started toreally start tackling addiction
as doctors, and particularlydoctors in the emergency
department and in the hospitals,doctors, and particularly
doctors in the emergencydepartment and in the hospitals.
And so the lovely, lovely DrClose, who happens to be my
bride, she started working inMonterey County on trying to
(02:15):
address addiction at thehospitals and in the emergency
department and we met who youcan see on the screen here, dr
Ranit Lev, and Ranit is an ERdoc like us, and she was working
in San Diego while we wereworking in Monterey on trying to
address addiction treatment inthe emergency department.
So we started by working onopioids and we started to
(02:36):
identify more of this syndromecannabinoid hyperemesis syndrome
and she was working ontreatment guidelines and trying
to come up with a way to helpthese patients.
And we were on a meeting and wewere talking about it and I had
just read a magazine articlewritten by a physician just
reflecting on some recent casesthat he had seen and he heard a
(02:57):
staff member say that patientisn't just vomiting, they're
scrommeting, because they werescreaming and vomiting at the
same time.
And so Ranit and Reb and myselfwere just brainstorming on how
to help some of these patientsand Ranit said scrommeting,
that's genius.
That's exactly what thissyndrome is.
(03:18):
And she ran with it and you cansee here on the screen this is
a picture of her on the newsannouncing her efforts in San
Diego County to try to treataddiction.
And Ranit is much morewell-connected than we are.
She served in the White Houseas an advisor on drug policy.
She's written articles, she'sbeen on the news getting the
(03:46):
word out that there's thisreally bad syndrome that happens
when people smoke too muchcannabis, where they get this
horrible syndrome of nausea andvomiting and abdominal pain
called cannabinoid hyperemesissyndrome, and she popularized
this term scrommeting to reflectjust how miserable patients
with cannabinoid hyperemesissyndrome are.
So now, if you google the termscrommeting, it's a thing.
(04:08):
So I googled the termscrommeting when I was preparing
for this lecture and I'm goingto read here Some people call
symptoms of cannabinoidhyperemesis syndrome scrommeting
.
The term combines vomiting andscreaming.
You may have intense pain whichcauses you to scream while you
vomit.
And here you go.
(04:29):
This is another graphic from arecovery website scrommeting
hazards of cannabis use.
Here's another one from anotherrecovery website scrommeting
and symptoms of heavy marijuanause.
And here is even a visualgraphic of this syndrome where
(04:50):
someone is vomiting and bathingand they're using cannabis.
So this is definitely asyndrome that is well known in
the recovery community and wecertainly see it all the time in
the emergency department.
So what is cannabinoidhyperemesis syndrome?
The name itself basically sayshyperemesis, meaning a lot of
(05:14):
vomiting from cannabis, and it'sa syndrome, and essentially we
see two things.
We see gastrointestinalsymptoms, usually nausea,
vomiting and abdominal pain whenpeople use cannabis heavily.
And, very interestingly,symptoms are improved with hot
baths or showers, leading tocompulsive bathing, and I'll
(05:39):
actually take you through a casethat we saw in our emergency
department where one person wasbathing compulsively in the
hospital.
But this is really what we seethese two features.
Now why does this happen?
Well, on the screen here infront of you, I have a graphic
that's pointing out the potencyof cannabis over the last 50
(06:02):
years.
So cannabis in the 1970s wasonly 1% THC.
Again, thc is the drug incannabis that makes people high
and humans like THC.
So through farming technology,we've bred stronger strains of
cannabis with stronger strainsof cannabis to help the cannabis
(06:23):
get stronger over time.
So you can see, in 1970, thecannabis was 1% THC.
By the 2000s it was about 4%THC.
By 2010, it was 10% THC and asof 2022, cannabis was 18 to 20%
THC and as of 2025, it's reallyaround 25% to 30% THC.
(06:45):
So why is this happening?
As the cannabis has gottenstronger, it's behaving
differently.
And the best way to think aboutit if you were to compare it to
alcohol if you smoke a jointtoday, it's maybe 30 times
stronger than it was in 1970.
That would be the equivalent,in terms of alcohol, of drinking
(07:09):
a beer today.
That has as much alcohol as 30beers back in 1970.
It's just so much stronger andso you get very different
effects when you consume thesame quantity of substance.
Now I wanted to see what thislooked like, so I went to a
cannabis dispensary in Seasidein the fall and I just wanted to
(07:32):
see what people were buying.
So here's a cannabis product.
You can see that it contains28% THC, and they are now even
adding THC back into the jointsto make them even stronger.
So these are THC-infused joints.
You can see one product is 43%THC and the other is 40% THC, so
(08:00):
this is an incredibly strongcannabis product.
Now, if you didn't know, wedon't actually know the
recreational dose of THC.
We think it's somewhere betweenabout two and a half and 15
milligrams.
As in, if someone went to adispensary and said I'd like to
buy a single serving of cannabis, the dispensary would sell them
(08:21):
somewhere between 2.5 and 15milligrams of THC.
Take a look at the cannabisproduct up in the upper right.
Those four joints have 864milligrams of THC in them.
So that package of four jointshas several hundred times the
recreational dose of THC.
(08:42):
So what we're just seeing isthe amount of THC that's being
sold is just off the charts.
Now, as doctors, we are tryingto understand why this syndrome
happens and what do we do aboutit.
So this was a great scientificpaper published in 2018, and it
(09:03):
was really the best study at thetime.
And you can see cannabinoidhyperemesis syndrome public
health implications and novelmodel treatment guideline.
And Novel Model TreatmentGuideline.
And I put a red mark because,if you remember, at the
beginning of the lecture, Ireferenced our colleague in San
Diego, dr Rani Lev.
There you go, that is.
She was one of the authors onthis paper.
(09:24):
She was definitely reallytrying to help physicians across
the state understand what to dowith this condition and in this
paper they outline what dopeople experience and recommend
treatment protocols that we canuse.
So when people experience thissyndrome, what do they feel?
They usually have diffuseabdominal pain, meaning the
(09:47):
whole abdomen hurts.
We see it much more commonly,believe it or not, when cannabis
is smoked.
At the time that this paper waspublished, we did not really
see it with edibles I don't knowif that's still true and people
might be asymptomatic, meaningthey have no symptoms for days
or even weeks, and then they'llget a random flare-up of nausea,
(10:10):
vomiting and abdominal pain,and these flares usually last 24
to 48 hours.
But there are definitely caseswhere people are not able to
keep things down and havesymptoms for over a week.
And again, there's this veryinteresting feature where people
will bathe compulsively forhours at a time.
Usually it's a hot bath orshower with the stomach under
(10:33):
the hot surface of the water orwith the shower head the hot
surface of the water or with theshower head actually focused on
the abdomen.
We see it in the emergencydepartment, right, people come
in, they're in pain, they'revomiting, they can't keep down
fluids.
That's why we have emergencydepartments.
What's very unfortunate aboutthis syndrome is our normal
nausea meds.
(10:53):
These are called anti-emetics.
Our normal nausea medicinesdon't really work.
So if any of you have beentreated with ondansetron, also
known as Zofran, or given it toa client, it doesn't really work
and this is one of the thingsthat makes it very frustrating
for us as doctors to treat andvery frustrating for patients,
(11:15):
because we really don't have alot of medications that work,
believe it or not.
We have found that strongpsychiatric medication seems to
help.
If any of you have worked withmental health patients.
We use haloperidol, also knownas Haldol, to sedate people when
they're psychotic andhallucinating and agitated,
(11:39):
believe it or not, haloperidolworks for cannabinoid
hyperemesis syndrome.
You might also recognize thename olanzapine, also known as
Zyprexa, as something that weuse for when someone's got mania
from bipolar or psychosis fromschizophrenia.
We sedate them with it andthat's what we end up using for
patients with cannabinoidhyperemesis syndrome.
(12:01):
They tend to be very dehydratedfrom all the vomiting, so we
give them IV fluids and theirbody just needs time.
It's really frustrating forpatients and providers alike,
and I show you a picture herethat I found on Google of a
frustrated physician.
This is how emergencydepartment staff feel about
(12:21):
cannabinoid hyperemesis syndrome.
It's very difficult to treat.
Patients are completelymiserable.
It's very, very frustrating.
Now let's say somebody comesinto the emergency department
and they're miserable, they'revomiting, they're screaming out
in pain and we actually get thembetter and send them home.
How do we treat this?
(12:42):
Well, as you can imagine, ifthe cannabis is causing it, the
treatment is to stop usingcannabis, and what's frustrating
is that symptoms actually canpersist for months after
patients stop using cannabis.
So here's how this looksSomebody stops using cannabis.
They maybe don't use cannabisfor four to six weeks and they
(13:06):
don't feel better.
They have more recurrentepisodes.
So they're like, hey, thedoctor was wrong and they go
back to using cannabis Again.
Fairly frustrating to treat,both short-term and long-term,
just because patients reallyneed to be cannabis-free for a
long time and a lot of them,because of, maybe, cannabis use
disorder, they can't stop, orthey just feel like the doctors
(13:28):
were wrong and it wasn't thecannabis, so they go back to it
and then the cycle restarts.
We do have some medications forcannabinoid hyperemesis syndrome
that can be helpful.
There is an antidepressantcalled amitriptyline.
It's in the class ofantidepressants known as
tricyclic antidepressants.
We use it a lot in chronic pain.
(13:50):
It changes the way that thenerves function that's actually
how it helps with depression soit can sometimes reset the
nerves around pain or migraines.
So we often try it and there issome evidence that
amitriptyline helps the nervechanges related to heavy
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cannabis use go back to normalsooner.
People often have a lot of acidin the stomach when they are
having these episodes of nauseaand vomiting, so I use
acid-reducing medications.
You might know omeprazole.
That's over-the-counter.
My personal preference ispantoprazole, which is very
similar.
It just works a little bitbetter.
It's a prescription that one'scalled Protonix, and then if
(14:33):
someone's on cannabis and tryingto stop, there's really not
good literature on how to treatcannabis withdrawal.
There are some small studiesthat show that gabapentin can be
helpful to treat cannabiswithdrawal, so I often use that.
Some people really cannot giveup cannabis.
Cannabis use disorder used tobe fairly uncommon.
(14:57):
I was always taught growing upthat cannabis wasn't addictive.
That may or may not have beentrue, but what I can tell you is
, in 2025, cannabis use disorderis a legitimate diagnosis and
there are people who cannot stopusing cannabis, despite
consequences.
If someone absolutely says Icannot stop using cannabis,
(15:17):
despite consequences, if someoneabsolutely says I cannot stop
using cannabis, then you couldrecommend that they switch to
edibles, as there's maybe someevidence that cannabinoid
hyperemesis syndrome is lesscommon with edibles as compared
to when cannabis is smoked, andI'm not sure why that happens.
Maybe that's because peoplewere using less when they were
using edibles.
The edible industry has reallyfollowed the rest of the
(15:39):
cannabis industry in that thereare very high potency products
out there, so hard to know.
Okay, so I've talked to youabout how doctors and healthcare
providers feel aboutcannabinoid hyperemesis syndrome
.
What do patients think aboutcannabinoid hyperemesis syndrome
?
And I love this scientificpaper.
(16:02):
It's one of my favorites.
Pardon the expletive, but thisis the actual title of the paper
in the National Library ofMedicine.
I still partly think this isbullshit.
A quantitative analysis ofcannabinoid hyperemesis syndrome
perceptions among people withchronic cannabis use and cyclic
vomiting.
They literally sat down withpeople and interviewed them once
(16:25):
they were diagnosed withcannabinoid hyperemesis syndrome
to see what they thought.
Here's what they found.
A lot of the people who werediagnosed with this syndrome
were very convinced that it wasnot the cannabis, because
symptoms came on randomly.
In other words, they couldn'tcorrelate any particular
cannabis behavior with symptoms.
(16:47):
So they thought, well, shoot,it must not be the cannabis,
because I can't come up with alink.
Most of the people in the studyrelated an experience that
someone came to them and saidyou know, hey, it's the cannabis
, you got to stop.
But no one really explained itto them.
So they questioned thediagnosis.
And then the last two points Ithought were very profound.
(17:08):
People told them that thecannabis was the cause of their
symptoms, but no one actuallytold them how to stop.
So a lot of them weren't reallysure what to do.
What if I can't sleep?
Do I wean myself off of it?
Do I need to go get counseling?
So that's one thing, is that wecan do.
Better is, when someone hasthis is to tell them yeah, let's
(17:29):
actually get you some help onhow to stop cannabis.
And then the other thing is noone asked the people who used
cannabis what they were usingcannabis for.
Were they anxious?
Were they having insomnia?
Was it pain, so that they couldactually address the issue that
was making them use cannabis.
So I think in my mind you know,if somebody has this and I ask
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them why they're using cannabisand they say, well, hey, I'm
using Indica to sleep, myresponse would be well, shoot,
let's put you on a non-addictivesleeping med and see if we can
get you off the cannabis.
So we really have to setpatients up to succeed when it
comes to quitting cannabis.
(18:11):
So the next question is why dowe have this syndrome,
cannabinoid hyperemesis syndrome?
What's the cause?
What's the reason?
Well, the answer is we don'treally know and there's a couple
of theories.
One theory is that cannabis isactive in the brain and nervous
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system and heavy cannabis usechanges how the nerves function
and it creates somehypersensitivity in the nerves
in the gut.
Hard to know if that's what'sgoing on.
This hypothesis here makes alittle bit more sense to me.
So nausea and vomiting is astress response in the body.
(18:59):
Like we see it, when someone'sin really bad pain, they might
vomit, or when people exercisereally hard, they might vomit.
In other words, nausea andvomiting is one of the ways that
the body responds when it'sunder stress.
Interestingly, low-dosecannabis acts like a downer.
It lowers the stress responseand that can explain why
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cannabis has often been used tohelp people with nausea and
vomiting, like if they have AIDSor if they have cancer, and
that's actually another reasonwhy a lot of patients who have
this syndrome don't believe itis.
Cannabis is known to help withnausea and vomiting.
What's interesting is that asthe cannabis potency has
(19:47):
increased and people are usinghigher doses of cannabis, the
intoxicating effects ofhigh-dose THC have a paradoxical
stimulating effect.
It's almost like an upper, andwe see this when people consume
a lot of THC.
They sometimes get reallyparanoid, and so the thought is
(20:08):
that high-dose THC actually is astress response on the body
which brings out the nausea andvomiting and get this.
This is really interesting.
When we are under stress, thebody needs to mobilize as much
energy as possible to be able todo our fight or flight response
(20:28):
right.
If a lion jumps through mywindow and I have to basically
run for my life or fight back, Ineed every bit of energy I can
so my muscles can function, andso when the body is stressed, it
starts breaking down fat tissuefor energy, and you may know
that THC deposits in our fattissue.
(20:50):
So when we start to get in thisstress response, the body
breaks down fatty tissue that'scalled lipolysis and it actually
releases some of the stored THCin the fatty tissue, which
brings the levels of THC in thebody up and actually worsens the
stress response and leads tomore nausea and vomiting.
I thought that was prettyinteresting.
(21:11):
And vomiting, I thought thatwas pretty interesting.
So still trying to work out thedetails.
There's one other hypothesis asto why this happens, which is
that as cannabis has gottenstronger, there's now a
withdrawal syndrome.
So traditionally, when cannabiswas weak, we didn't really
(21:31):
think of cannabis withdrawal.
But take a look, this is agraphic from the Cleveland
Clinic, which is a veryrespected hospital system in
America.
And here you go Marijuanawithdrawal.
The most common symptomsinclude decreased appetite,
nausea and vomiting andabdominal pain.
(21:52):
So there's probably a componentof some cannabis withdrawal
that underlies this cannabinoidhyperemesis syndrome.
People will say that sometimessmoking cannabis makes them feel
better while they'reexperiencing the syndrome
symptoms.
It's a little bit all over theplace, but what we do know is
(22:14):
that it's very clearly present.
We see quite a bit of it and,again, my hypothesis is that
there's probably some cannabiswithdrawal that factors into
this syndrome as well.
So let's go through a clinicalcase and we can actually talk
through what this looks likewhen people come into the
(22:35):
emergency department and thenactually a symptoms resolve.
So we had a 28-year-old femalewho was presenting to our
emergency department in Montereyover about 18 months with
multiple episodes of abdominalpain, nausea and vomiting.
And the way this works as adoctor in the ER or in the
hospital is you assume the worstcase scenario right?
(22:56):
Is it appendicitis?
Is it a kidney stone?
Is it the gallbladder?
Is it stomach flu?
So every time this patientwould come in we had to evaluate
what is this.
So we did CAT scans, we didultrasounds, we did blood work,
urine testing, we did all sortsof tests and they would all come
back that they couldn't findanything.
And so she provided a historyof heavy cannabis use, recurrent
(23:22):
nausea, vomiting and abdominalpain and compulsive bathing and
all her tests came back negative.
So we were able to tell herthis is cannabinoid hyperemesis
syndrome and the patient wasjust absolutely not.
You guys are totally wrong.
Cannabis is fine, cannabis isgreat, I'm going to keep using.
(23:42):
And she just kept coming back tothe hospital with flares of
these symptoms.
A lot of times it's hard totreat the symptoms.
Like I mentioned, a lot of ourusual medications don't work
that well.
So on one occasion we admittedher to the observation unit and
she wanted to bathe because thatwas soothing to her and she
(24:03):
showered for so long that sheactually used up all of the hot
water in one area of thehospital, which was very
disruptive to care elsewhere inthe hospital, of the hospital,
which was very disruptive tocare elsewhere in the hospital.
And we actually had to put apolicy for the ER that she
wasn't allowed to bathe if shewas at the hospital because she
used up the hot water and otherpatients needed it and obviously
(24:25):
she wasn't happy, which Itotally get.
And I've sometimes wondered whypatients come to the ER because
they can bathe at home andthey're much more comfortable
there.
And what I can tell is theyseem to just overwhelm the
ability to have hot water soothethem and they get too
dehydrated.
So they come in.
But I've had a number ofpatients over the years that are
(24:47):
just like doc, I understand youguys are trying, but I'm just
going to go home and get in theshower and I'll feel better and
I have to respect that.
We're just wanting to feelbetter.
So just to give you a sense ofhow bad people feel when they
have this syndrome.
This particular patient cameback to the emergency department
again.
(25:08):
I actually took care of her andwe started an IV and we gave
her some fluids and we startedsome medicine and she said I
need to take a shower.
And I said I'm really sorry, wecan't.
You showered so much last timethat you used up water in
another area of the hospital andthe hospital told us no.
And she was completelymiserable, still very nauseated,
(25:29):
and she said well, I have tobathe.
I feel horrible and poor thing.
She started bargaining with melike, well, what circumstances
could a patient bathe under?
And I was saying well, you know, if a patient is contaminated
with pesticide, we have to bathethem.
And she was asking me can youlie?
Can you tell the charge nursethat I was contaminated with
(25:49):
pesticides?
And I just was like no, no, Ican't lie.
And I felt horrible because shewas completely miserable and
she ended up actually leavingthat day to go home and bathe.
She was so uncomfortable and ourmedications weren't helping and
also, as a part of what she wasgoing through, she was really
(26:10):
really anxious during theseepisodes and she couldn't be
left alone and she would ask hernurse to stay with her and talk
to her and you know the nurseshave three other patients and it
just it was.
It was a really difficultscenario for everyone.
She was very uncomfortable andvery anxious.
We were trying to attend to herbut we had limitations on her
(26:31):
ability to bathe and staff'stime to be with her and it was
just.
It was really hard for about 18months when she would come in
and one day we just noticed thatshe hadn't been seeing us for a
while and so I was working inthe ER about 18 months later and
she was visiting anotherpatient who was sick and she
(26:55):
recognized me and said hey, drGrover, can I talk to you?
And I said sure, and she walkedout into the hallway, into a
quiet area with me and she saidI just really want to thank you.
I finally realized it was thecannabis and I got some help and
I quit and all my symptoms wentaway and I wanted to thank you
and the ER staff for taking careof me so many times.
(27:18):
And I didn't actually ask herhow she had gotten treatment,
but I know she had gotten intotherapy to work on her anxiety
and she was able to get back towork and find some purpose and
it ended up having actually agood ending after all.
But good heavens, she wasmiserable for those 18 months.
(27:38):
So you might be asking why theterm scrommeting?
You probably get it.
People are really uncomfortable.
There's actually a little bitmore to the story.
So, having taken care of dozensand dozens of patients with
this syndrome, what actually Iobserve is they have really
(28:01):
intense nausea and pain, morethan vomiting.
In other words, people feel I'mreally nauseated.
Maybe if I would vomit I wouldfeel better, but they can't get
anything out.
Usually they're sitting boltupright and they're sweaty and
they're holding a vomit bucketand they're just putting it
(28:21):
close to their face, hoping thevomit will come out, and
nothing's coming up.
And sometimes patients will puttheir fingers down their throat
that they just want to feelbetter.
They're completely miserableand the best way I can say it is
it's this anguished yell,scream, groan, moan, just hoping
(28:51):
that if they yell loud enough,the vomit will come out.
And it's really unfortunate.
You'll walk into the emergencydepartment and you hear this
very particular noise and you'relike oh, room seven has
cannabinoid hyperemesis syndrome.
It's this deep guttural justhoping, hoping that vomit will
come out.
And yeah, people would tell methat cannabis wasn't addictive
and I would tell them come worka shift with me.
(29:13):
In the emergency department Isee patients with cannabinoid
hyperemesis syndrome.
They are completely miserableand their addiction to cannabis
is strong enough that, despitethis, they will not stop.
Okay, so let's put it alltogether.
Cannabinoid hyperemesis syndromeinvolves recurrent abdominal
(29:36):
pain, nausea and vomiting, as Imentioned, more pain and nausea
and it comes from recurrentcannabis use.
We only make the diagnosisafter we've ruled out other and
more serious causes.
People will bathe compulsivelyto try to relieve their symptoms
.
The treatment is we stopcannabis and we have to help
(30:01):
them stop cannabis.
So they may have withdrawal.
We have to manage that.
They likely need to get intosome counseling, get into groups
, because we want to address theissues that were leading them
to cannabis in the first place.
And then we want to try toaddress things like insomnia,
anxiety and pain that lead tocannabis use.
And then there are somemedications specifically for
(30:22):
cannabinoid hyperemesis syndromethat will allow people to feel
better faster and then, truly,people really are committed that
, hey, cannabis works for me.
I think it's a medicine.
No, I don't think cannabis isthe problem.
People are often reluctant tobelieve that cannabis is the
cause.
(30:43):
Before we wrap up, a huge thankyou to the Montage Health
Foundation for backing mymission to create fun, engaging
education on addiction, and ashout out to the nonprofit
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdosesTo those healthcare providers
(31:06):
out there treating patients withaddiction.
You're doing life-saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn.
Everyone else tuning in.
Thank you for taking the timeto learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together we can make it happen.
Thanks for listening andremember treating addiction
(31:29):
saves lives.
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
Today we are going to becontinuing our discussion about
(00:44):
the hazards of cannabis use.
Last week, we took a look atcannabis overdose.
This week, we're going to belooking at a syndrome that
develops as a consequence ofheavy cannabis use, and that
syndrome is cannabinoidhyperemesis syndrome.
Some people refer to it asscrometing syndrome.
(01:07):
Some people refer to it asscrometing.
I recorded myself giving alecture on this topic to my
colleagues at the drug andalcohol treatment program I work
at, and I wanted to share thislecture with all of you.
So with that, grab your barfbucket and let's get started.
Okay, we're going to discusscannabinoid hyperemesis syndrome
and I was going to give yousome of the history.
So this condition was firstidentified in 2009, and we
(01:31):
really didn't know what it was.
People had reported thissyndrome of recurrent vomiting
and cannabis use and compulsivebathing, and we weren't really
sure what it was, and we weren'treally sure what it was and I
graduated medical school in 2010.
And really in the first fewyears of my training, 2010 to
(01:54):
2013, we didn't know much aboutaddiction and it was really in
the mid-2010s that we started toreally start tackling addiction
as doctors, and particularlydoctors in the emergency
department and in the hospitals,doctors, and particularly
doctors in the emergencydepartment and in the hospitals.
And so the lovely, lovely DrClose, who happens to be my
bride, she started working inMonterey County on trying to
(02:15):
address addiction at thehospitals and in the emergency
department and we met who youcan see on the screen here, dr
Ranit Lev, and Ranit is an ERdoc like us, and she was working
in San Diego while we wereworking in Monterey on trying to
address addiction treatment inthe emergency department.
So we started by working onopioids and we started to
(02:36):
identify more of this syndromecannabinoid hyperemesis syndrome
and she was working ontreatment guidelines and trying
to come up with a way to helpthese patients.
And we were on a meeting and wewere talking about it and I had
just read a magazine articlewritten by a physician just
reflecting on some recent casesthat he had seen and he heard a
(02:57):
staff member say that patientisn't just vomiting, they're
scrommeting, because they werescreaming and vomiting at the
same time.
And so Ranit and Reb and myselfwere just brainstorming on how
to help some of these patientsand Ranit said scrommeting,
that's genius.
That's exactly what thissyndrome is.
(03:18):
And she ran with it and you cansee here on the screen this is
a picture of her on the newsannouncing her efforts in San
Diego County to try to treataddiction.
And Ranit is much morewell-connected than we are.
She served in the White Houseas an advisor on drug policy.
She's written articles, she'sbeen on the news getting the
(03:46):
word out that there's thisreally bad syndrome that happens
when people smoke too muchcannabis, where they get this
horrible syndrome of nausea andvomiting and abdominal pain
called cannabinoid hyperemesissyndrome, and she popularized
this term scrommeting to reflectjust how miserable patients
with cannabinoid hyperemesissyndrome are.
So now, if you google the termscrommeting, it's a thing.
(04:08):
So I googled the termscrommeting when I was preparing
for this lecture and I'm goingto read here Some people call
symptoms of cannabinoidhyperemesis syndrome scrommeting
.
The term combines vomiting andscreaming.
You may have intense pain whichcauses you to scream while you
vomit.
And here you go.
(04:29):
This is another graphic from arecovery website scrommeting
hazards of cannabis use.
Here's another one from anotherrecovery website scrommeting
and symptoms of heavy marijuanause.
And here is even a visualgraphic of this syndrome where
(04:50):
someone is vomiting and bathingand they're using cannabis.
So this is definitely asyndrome that is well known in
the recovery community and wecertainly see it all the time in
the emergency department.
So what is cannabinoidhyperemesis syndrome?
The name itself basically sayshyperemesis, meaning a lot of
(05:14):
vomiting from cannabis, and it'sa syndrome, and essentially we
see two things.
We see gastrointestinalsymptoms, usually nausea,
vomiting and abdominal pain whenpeople use cannabis heavily.
And, very interestingly,symptoms are improved with hot
baths or showers, leading tocompulsive bathing, and I'll
(05:39):
actually take you through a casethat we saw in our emergency
department where one person wasbathing compulsively in the
hospital.
But this is really what we seethese two features.
Now why does this happen?
Well, on the screen here infront of you, I have a graphic
that's pointing out the potencyof cannabis over the last 50
(06:02):
years.
So cannabis in the 1970s wasonly 1% THC.
Again, thc is the drug incannabis that makes people high
and humans like THC.
So through farming technology,we've bred stronger strains of
cannabis with stronger strainsof cannabis to help the cannabis
(06:23):
get stronger over time.
So you can see, in 1970, thecannabis was 1% THC.
By the 2000s it was about 4%THC.
By 2010, it was 10% THC and asof 2022, cannabis was 18 to 20%
THC and as of 2025, it's reallyaround 25% to 30% THC.
(06:45):
So why is this happening?
As the cannabis has gottenstronger, it's behaving
differently.
And the best way to think aboutit if you were to compare it to
alcohol if you smoke a jointtoday, it's maybe 30 times
stronger than it was in 1970.
That would be the equivalent,in terms of alcohol, of drinking
(07:09):
a beer today.
That has as much alcohol as 30beers back in 1970.
It's just so much stronger andso you get very different
effects when you consume thesame quantity of substance.
Now I wanted to see what thislooked like, so I went to a
cannabis dispensary in Seasidein the fall and I just wanted to
(07:32):
see what people were buying.
So here's a cannabis product.
You can see that it contains28% THC, and they are now even
adding THC back into the jointsto make them even stronger.
So these are THC-infused joints.
You can see one product is 43%THC and the other is 40% THC, so
(08:00):
this is an incredibly strongcannabis product.
Now, if you didn't know, wedon't actually know the
recreational dose of THC.
We think it's somewhere betweenabout two and a half and 15
milligrams.
As in, if someone went to adispensary and said I'd like to
buy a single serving of cannabis, the dispensary would sell them
(08:21):
somewhere between 2.5 and 15milligrams of THC.
Take a look at the cannabisproduct up in the upper right.
Those four joints have 864milligrams of THC in them.
So that package of four jointshas several hundred times the
recreational dose of THC.
(08:42):
So what we're just seeing isthe amount of THC that's being
sold is just off the charts.
Now, as doctors, we are tryingto understand why this syndrome
happens and what do we do aboutit.
So this was a great scientificpaper published in 2018, and it
(09:03):
was really the best study at thetime.
And you can see cannabinoidhyperemesis syndrome public
health implications and novelmodel treatment guideline.
And Novel Model TreatmentGuideline.
And I put a red mark because,if you remember, at the
beginning of the lecture, Ireferenced our colleague in San
Diego, dr Rani Lev.
There you go, that is.
She was one of the authors onthis paper.
(09:24):
She was definitely reallytrying to help physicians across
the state understand what to dowith this condition and in this
paper they outline what dopeople experience and recommend
treatment protocols that we canuse.
So when people experience thissyndrome, what do they feel?
They usually have diffuseabdominal pain, meaning the
(09:47):
whole abdomen hurts.
We see it much more commonly,believe it or not, when cannabis
is smoked.
At the time that this paper waspublished, we did not really
see it with edibles I don't knowif that's still true and people
might be asymptomatic, meaningthey have no symptoms for days
or even weeks, and then they'llget a random flare-up of nausea,
(10:10):
vomiting and abdominal pain,and these flares usually last 24
to 48 hours.
But there are definitely caseswhere people are not able to
keep things down and havesymptoms for over a week.
And again, there's this veryinteresting feature where people
will bathe compulsively forhours at a time.
Usually it's a hot bath orshower with the stomach under
(10:33):
the hot surface of the water orwith the shower head the hot
surface of the water or with theshower head actually focused on
the abdomen.
We see it in the emergencydepartment, right, people come
in, they're in pain, they'revomiting, they can't keep down
fluids.
That's why we have emergencydepartments.
What's very unfortunate aboutthis syndrome is our normal
nausea meds.
(10:53):
These are called anti-emetics.
Our normal nausea medicinesdon't really work.
So if any of you have beentreated with ondansetron, also
known as Zofran, or given it toa client, it doesn't really work
and this is one of the thingsthat makes it very frustrating
for us as doctors to treat andvery frustrating for patients,
(11:15):
because we really don't have alot of medications that work,
believe it or not.
We have found that strongpsychiatric medication seems to
help.
If any of you have worked withmental health patients.
We use haloperidol, also knownas Haldol, to sedate people when
they're psychotic andhallucinating and agitated,
(11:39):
believe it or not, haloperidolworks for cannabinoid
hyperemesis syndrome.
You might also recognize thename olanzapine, also known as
Zyprexa, as something that weuse for when someone's got mania
from bipolar or psychosis fromschizophrenia.
We sedate them with it andthat's what we end up using for
patients with cannabinoidhyperemesis syndrome.
(12:01):
They tend to be very dehydratedfrom all the vomiting, so we
give them IV fluids and theirbody just needs time.
It's really frustrating forpatients and providers alike,
and I show you a picture herethat I found on Google of a
frustrated physician.
This is how emergencydepartment staff feel about
(12:21):
cannabinoid hyperemesis syndrome.
It's very difficult to treat.
Patients are completelymiserable.
It's very, very frustrating.
Now let's say somebody comesinto the emergency department
and they're miserable, they'revomiting, they're screaming out
in pain and we actually get thembetter and send them home.
How do we treat this?
(12:42):
Well, as you can imagine, ifthe cannabis is causing it, the
treatment is to stop usingcannabis, and what's frustrating
is that symptoms actually canpersist for months after
patients stop using cannabis.
So here's how this looksSomebody stops using cannabis.
They maybe don't use cannabisfor four to six weeks and they
(13:06):
don't feel better.
They have more recurrentepisodes.
So they're like, hey, thedoctor was wrong and they go
back to using cannabis Again.
Fairly frustrating to treat,both short-term and long-term,
just because patients reallyneed to be cannabis-free for a
long time and a lot of them,because of, maybe, cannabis use
disorder, they can't stop, orthey just feel like the doctors
(13:28):
were wrong and it wasn't thecannabis, so they go back to it
and then the cycle restarts.
We do have some medications forcannabinoid hyperemesis syndrome
that can be helpful.
There is an antidepressantcalled amitriptyline.
It's in the class ofantidepressants known as
tricyclic antidepressants.
We use it a lot in chronic pain.
(13:50):
It changes the way that thenerves function that's actually
how it helps with depression soit can sometimes reset the
nerves around pain or migraines.
So we often try it and there issome evidence that
amitriptyline helps the nervechanges related to heavy
(14:11):
cannabis use go back to normalsooner.
People often have a lot of acidin the stomach when they are
having these episodes of nauseaand vomiting, so I use
acid-reducing medications.
You might know omeprazole.
That's over-the-counter.
My personal preference ispantoprazole, which is very
similar.
It just works a little bitbetter.
It's a prescription that one'scalled Protonix, and then if
(14:33):
someone's on cannabis and tryingto stop, there's really not
good literature on how to treatcannabis withdrawal.
There are some small studiesthat show that gabapentin can be
helpful to treat cannabiswithdrawal, so I often use that.
Some people really cannot giveup cannabis.
Cannabis use disorder used tobe fairly uncommon.
(14:57):
I was always taught growing upthat cannabis wasn't addictive.
That may or may not have beentrue, but what I can tell you is
, in 2025, cannabis use disorderis a legitimate diagnosis and
there are people who cannot stopusing cannabis, despite
consequences.
If someone absolutely says Icannot stop using cannabis,
(15:17):
despite consequences, if someoneabsolutely says I cannot stop
using cannabis, then you couldrecommend that they switch to
edibles, as there's maybe someevidence that cannabinoid
hyperemesis syndrome is lesscommon with edibles as compared
to when cannabis is smoked, andI'm not sure why that happens.
Maybe that's because peoplewere using less when they were
using edibles.
The edible industry has reallyfollowed the rest of the
(15:39):
cannabis industry in that thereare very high potency products
out there, so hard to know.
Okay, so I've talked to youabout how doctors and healthcare
providers feel aboutcannabinoid hyperemesis syndrome
.
What do patients think aboutcannabinoid hyperemesis syndrome
?
And I love this scientificpaper.
(16:02):
It's one of my favorites.
Pardon the expletive, but thisis the actual title of the paper
in the National Library ofMedicine.
I still partly think this isbullshit.
A quantitative analysis ofcannabinoid hyperemesis syndrome
perceptions among people withchronic cannabis use and cyclic
vomiting.
They literally sat down withpeople and interviewed them once
(16:25):
they were diagnosed withcannabinoid hyperemesis syndrome
to see what they thought.
Here's what they found.
A lot of the people who werediagnosed with this syndrome
were very convinced that it wasnot the cannabis, because
symptoms came on randomly.
In other words, they couldn'tcorrelate any particular
cannabis behavior with symptoms.
(16:47):
So they thought, well, shoot,it must not be the cannabis,
because I can't come up with alink.
Most of the people in the studyrelated an experience that
someone came to them and saidyou know, hey, it's the cannabis
, you got to stop.
But no one really explained itto them.
So they questioned thediagnosis.
And then the last two points Ithought were very profound.
(17:08):
People told them that thecannabis was the cause of their
symptoms, but no one actuallytold them how to stop.
So a lot of them weren't reallysure what to do.
What if I can't sleep?
Do I wean myself off of it?
Do I need to go get counseling?
So that's one thing, is that wecan do.
Better is, when someone hasthis is to tell them yeah, let's
(17:29):
actually get you some help onhow to stop cannabis.
And then the other thing is noone asked the people who used
cannabis what they were usingcannabis for.
Were they anxious?
Were they having insomnia?
Was it pain, so that they couldactually address the issue that
was making them use cannabis.
So I think in my mind you know,if somebody has this and I ask
(17:51):
them why they're using cannabisand they say, well, hey, I'm
using Indica to sleep, myresponse would be well, shoot,
let's put you on a non-addictivesleeping med and see if we can
get you off the cannabis.
So we really have to setpatients up to succeed when it
comes to quitting cannabis.
(18:11):
So the next question is why dowe have this syndrome,
cannabinoid hyperemesis syndrome?
What's the cause?
What's the reason?
Well, the answer is we don'treally know and there's a couple
of theories.
One theory is that cannabis isactive in the brain and nervous
(18:37):
system and heavy cannabis usechanges how the nerves function
and it creates somehypersensitivity in the nerves
in the gut.
Hard to know if that's what'sgoing on.
This hypothesis here makes alittle bit more sense to me.
So nausea and vomiting is astress response in the body.
(18:59):
Like we see it, when someone'sin really bad pain, they might
vomit, or when people exercisereally hard, they might vomit.
In other words, nausea andvomiting is one of the ways that
the body responds when it'sunder stress.
Interestingly, low-dosecannabis acts like a downer.
It lowers the stress responseand that can explain why
(19:25):
cannabis has often been used tohelp people with nausea and
vomiting, like if they have AIDSor if they have cancer, and
that's actually another reasonwhy a lot of patients who have
this syndrome don't believe itis.
Cannabis is known to help withnausea and vomiting.
What's interesting is that asthe cannabis potency has
(19:47):
increased and people are usinghigher doses of cannabis, the
intoxicating effects ofhigh-dose THC have a paradoxical
stimulating effect.
It's almost like an upper, andwe see this when people consume
a lot of THC.
They sometimes get reallyparanoid, and so the thought is
(20:08):
that high-dose THC actually is astress response on the body
which brings out the nausea andvomiting and get this.
This is really interesting.
When we are under stress, thebody needs to mobilize as much
energy as possible to be able todo our fight or flight response
(20:28):
right.
If a lion jumps through mywindow and I have to basically
run for my life or fight back, Ineed every bit of energy I can
so my muscles can function, andso when the body is stressed, it
starts breaking down fat tissuefor energy, and you may know
that THC deposits in our fattissue.
(20:50):
So when we start to get in thisstress response, the body
breaks down fatty tissue that'scalled lipolysis and it actually
releases some of the stored THCin the fatty tissue, which
brings the levels of THC in thebody up and actually worsens the
stress response and leads tomore nausea and vomiting.
I thought that was prettyinteresting.
(21:11):
And vomiting, I thought thatwas pretty interesting.
So still trying to work out thedetails.
There's one other hypothesis asto why this happens, which is
that as cannabis has gottenstronger, there's now a
withdrawal syndrome.
So traditionally, when cannabiswas weak, we didn't really
(21:31):
think of cannabis withdrawal.
But take a look, this is agraphic from the Cleveland
Clinic, which is a veryrespected hospital system in
America.
And here you go Marijuanawithdrawal.
The most common symptomsinclude decreased appetite,
nausea and vomiting andabdominal pain.
(21:52):
So there's probably a componentof some cannabis withdrawal
that underlies this cannabinoidhyperemesis syndrome.
People will say that sometimessmoking cannabis makes them feel
better while they'reexperiencing the syndrome
symptoms.
It's a little bit all over theplace, but what we do know is
(22:14):
that it's very clearly present.
We see quite a bit of it and,again, my hypothesis is that
there's probably some cannabiswithdrawal that factors into
this syndrome as well.
So let's go through a clinicalcase and we can actually talk
through what this looks likewhen people come into the
(22:35):
emergency department and thenactually a symptoms resolve.
So we had a 28-year-old femalewho was presenting to our
emergency department in Montereyover about 18 months with
multiple episodes of abdominalpain, nausea and vomiting.
And the way this works as adoctor in the ER or in the
hospital is you assume the worstcase scenario right?
(22:56):
Is it appendicitis?
Is it a kidney stone?
Is it the gallbladder?
Is it stomach flu?
So every time this patientwould come in we had to evaluate
what is this.
So we did CAT scans, we didultrasounds, we did blood work,
urine testing, we did all sortsof tests and they would all come
back that they couldn't findanything.
And so she provided a historyof heavy cannabis use, recurrent
(23:22):
nausea, vomiting and abdominalpain and compulsive bathing and
all her tests came back negative.
So we were able to tell herthis is cannabinoid hyperemesis
syndrome and the patient wasjust absolutely not.
You guys are totally wrong.
Cannabis is fine, cannabis isgreat, I'm going to keep using.
(23:42):
And she just kept coming back tothe hospital with flares of
these symptoms.
A lot of times it's hard totreat the symptoms.
Like I mentioned, a lot of ourusual medications don't work
that well.
So on one occasion we admittedher to the observation unit and
she wanted to bathe because thatwas soothing to her and she
(24:03):
showered for so long that sheactually used up all of the hot
water in one area of thehospital, which was very
disruptive to care elsewhere inthe hospital, of the hospital,
which was very disruptive tocare elsewhere in the hospital.
And we actually had to put apolicy for the ER that she
wasn't allowed to bathe if shewas at the hospital because she
used up the hot water and otherpatients needed it and obviously
(24:25):
she wasn't happy, which Itotally get.
And I've sometimes wondered whypatients come to the ER because
they can bathe at home andthey're much more comfortable
there.
And what I can tell is theyseem to just overwhelm the
ability to have hot water soothethem and they get too
dehydrated.
So they come in.
But I've had a number ofpatients over the years that are
(24:47):
just like doc, I understand youguys are trying, but I'm just
going to go home and get in theshower and I'll feel better and
I have to respect that.
We're just wanting to feelbetter.
So just to give you a sense ofhow bad people feel when they
have this syndrome.
This particular patient cameback to the emergency department
again.
(25:08):
I actually took care of her andwe started an IV and we gave
her some fluids and we startedsome medicine and she said I
need to take a shower.
And I said I'm really sorry, wecan't.
You showered so much last timethat you used up water in
another area of the hospital andthe hospital told us no.
And she was completelymiserable, still very nauseated,
(25:29):
and she said well, I have tobathe.
I feel horrible and poor thing.
She started bargaining with melike, well, what circumstances
could a patient bathe under?
And I was saying well, you know, if a patient is contaminated
with pesticide, we have to bathethem.
And she was asking me can youlie?
Can you tell the charge nursethat I was contaminated with
(25:49):
pesticides?
And I just was like no, no, Ican't lie.
And I felt horrible because shewas completely miserable and
she ended up actually leavingthat day to go home and bathe.
She was so uncomfortable and ourmedications weren't helping and
also, as a part of what she wasgoing through, she was really
(26:10):
really anxious during theseepisodes and she couldn't be
left alone and she would ask hernurse to stay with her and talk
to her and you know the nurseshave three other patients and it
just it was.
It was a really difficultscenario for everyone.
She was very uncomfortable andvery anxious.
We were trying to attend to herbut we had limitations on her
(26:31):
ability to bathe and staff'stime to be with her and it was
just.
It was really hard for about 18months when she would come in
and one day we just noticed thatshe hadn't been seeing us for a
while and so I was working inthe ER about 18 months later and
she was visiting anotherpatient who was sick and she
(26:55):
recognized me and said hey, drGrover, can I talk to you?
And I said sure, and she walkedout into the hallway, into a
quiet area with me and she saidI just really want to thank you.
I finally realized it was thecannabis and I got some help and
I quit and all my symptoms wentaway and I wanted to thank you
and the ER staff for taking careof me so many times.
(27:18):
And I didn't actually ask herhow she had gotten treatment,
but I know she had gotten intotherapy to work on her anxiety
and she was able to get back towork and find some purpose and
it ended up having actually agood ending after all.
But good heavens, she wasmiserable for those 18 months.
(27:38):
So you might be asking why theterm scrommeting?
You probably get it.
People are really uncomfortable.
There's actually a little bitmore to the story.
So, having taken care of dozensand dozens of patients with
this syndrome, what actually Iobserve is they have really
(28:01):
intense nausea and pain, morethan vomiting.
In other words, people feel I'mreally nauseated.
Maybe if I would vomit I wouldfeel better, but they can't get
anything out.
Usually they're sitting boltupright and they're sweaty and
they're holding a vomit bucketand they're just putting it
(28:21):
close to their face, hoping thevomit will come out, and
nothing's coming up.
And sometimes patients will puttheir fingers down their throat
that they just want to feelbetter.
They're completely miserableand the best way I can say it is
it's this anguished yell,scream, groan, moan, just hoping
(28:51):
that if they yell loud enough,the vomit will come out.
And it's really unfortunate.
You'll walk into the emergencydepartment and you hear this
very particular noise and you'relike oh, room seven has
cannabinoid hyperemesis syndrome.
It's this deep guttural justhoping, hoping that vomit will
come out.
And yeah, people would tell methat cannabis wasn't addictive
and I would tell them come worka shift with me.
(29:13):
In the emergency department Isee patients with cannabinoid
hyperemesis syndrome.
They are completely miserableand their addiction to cannabis
is strong enough that, despitethis, they will not stop.
Okay, so let's put it alltogether.
Cannabinoid hyperemesis syndromeinvolves recurrent abdominal
(29:36):
pain, nausea and vomiting, as Imentioned, more pain and nausea
and it comes from recurrentcannabis use.
We only make the diagnosisafter we've ruled out other and
more serious causes.
People will bathe compulsivelyto try to relieve their symptoms
.
The treatment is we stopcannabis and we have to help
(30:01):
them stop cannabis.
So they may have withdrawal.
We have to manage that.
They likely need to get intosome counseling, get into groups
, because we want to address theissues that were leading them
to cannabis in the first place.
And then we want to try toaddress things like insomnia,
anxiety and pain that lead tocannabis use.
And then there are somemedications specifically for
(30:22):
cannabinoid hyperemesis syndromethat will allow people to feel
better faster and then, truly,people really are committed that
, hey, cannabis works for me.
I think it's a medicine.
No, I don't think cannabis isthe problem.
People are often reluctant tobelieve that cannabis is the
cause.
(30:43):
Before we wrap up, a huge thankyou to the Montage Health
Foundation for backing mymission to create fun, engaging
education on addiction, and ashout out to the nonprofit
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdosesTo those healthcare providers
(31:06):
out there treating patients withaddiction.
You're doing life-saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn.
Everyone else tuning in.
Thank you for taking the timeto learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together we can make it happen.
Thanks for listening andremember treating addiction
(31:29):
saves lives.
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Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
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If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.