US medics have seen a surge in chronic cannabis users experiencing a potentially devastating vomiting condition.
'Scromiting', which gets its name from sufferers both 'screaming and vomiting' as they seek medical help in agony, is becoming an all-too-familiar site at emergency rooms, doctors say.
Known medically as Cannabinoid Hyperemesis Syndrome (CHS), the condition isn't fully understood by medics, but can also cause seizures, kidney failure and even prove fatal.
Experts believe symptoms appear after people use or consume heavy amounts of marijuana over a long period of time, about a decade.
One doctor said medics now refer to CHS as a 'bread and butter' diagnosis as it has become so common. Another said they see it 'every week, if not every day'.
Advocates of marijuana often purport that is a safe drug because it is 'natural'.
However, scientists have previously suggested the active ingredient in cannabis, THC, triggers the body's fight-or-flight response raising heart rate and blood pressure.
The New York Times probe found doctors are seeing 'more and more' cases of CHS and medics say it is now a 'common' problem.
Symptoms of the CHS include repeated vomiting and retching intense abdominal pain.
One doctor, from Ohio, said 'those patients look so sick' and described them as 'writhing around in pain'.
One tell-tale aspect of the condition, which is still not understood, is how hot water often relieves symptoms.
But ironically this can itself cause injury as sufferers spend hour after hour in scorching hot baths or showers seeking to calm their symptoms, sometimes to the point where they burn themselves.
A similar affect has been observed using special capsaicin, a substance found in chilis which makes them spicy, medical creams.
How long CHS lasts or takes to develop, and why it strikes some people and not others, is still being explored but early signs may last for years.
This later progresses to a point where people suffer the scromiting phase which can last days before fading. However, it can return.
The only known way to stop CHS from occurring again is for users to quit using cannabis products.
Experts are unsure what provokes CHS to develop but the condition has often been spotted in adults who have been using marijuana since their teens.
Current theories as to why the condition occurs in the first place include that long exposure to the drug overstimulates some of the body's receptors, which in turn, destabilises the vomiting reflex.
Rising potency of cannabis products has also been listed by some medics as potential factor for why cases appear to be increasing.
However, medics are unclear exactly how many CHS sufferers there are, but cases have been observed to rise in states where cannabis has been legalised.
The situation is also complicated by some sufferers not disclosing their drug use when they seek help.
But at least eight people are known to have died from complications of CHS in the US since it was first identified in 2004.
In June, a chronic marijuana user died after the condition caused a fatal heart rhythm disorder.
The 22-year-old woman, who was treated in Canada, began using weed at 14 and had been suffering from multiple bouts of severe CHS for three years.
When she was admitted to the hospital with vomiting and abdominal pain, she developed a specific life-threatening irregular heartbeat called torsades de pointes, which caused her heart to stop.
While doctors were able to restart her heart, her brain had already suffered catastrophic loss of oxygen, and she was declared brain dead four days later.
Researchers have estimated that as many as a third of heavy marijuana users may be experiencing symptoms of the condition — roughly 6million Americans.
One woman, from Elgin in the US state Illinois, turned to the drug in 2019, in her 40s when a doctor suggested it could help with her severe migraines.
As such, whenever Jennifer Macaluso felt a headache coming on, she would take a hit of a marijuana vape pen or consume an edible version of the drug.
But after several months, she told the New York Times that she developed stomach aches.
After being advised to increase her intake by a dispensary employee, she claims, she was eventually using the drug nearly every day.
Within months came episodes of nausea and vomiting so debilitating she had to stop working.
Cannabis use has seen a meteoric rise over the past decade, culminating in legal recreational use in 24 states.
Meanwhile, in the UK, laws around the medical use of cannabis were relaxed six years ago.
This has allowed specialist doctors to prescribe medicine made from the drug to some patients with epilepsy, or to treat vomiting related to cancer treatment and symptoms of multiple sclerosis.
THC stimulates areas of the brain involved with mood, attention and memory, while triggering the release of the hormone dopamine, responsible for feelings of reward and pleasure.
Small, infrequent doses have little long-term impact, according to studies.
But with prolonged, regular use, signals in these key brain areas can start to go awry.
Studies have shown that frequent cannabis use can increase the risk of serious mental illness like schizophrenia, as well as insomnia, social anxiety disorder and suicidal thoughts.
A 2019 study by researchers at Kings College London also found daily use of high-potency weed can increase the risk of psychosis among users five-fold.
Latest figures show cannabis remains the most popular drug among 16 to-59-year-olds in England and Wales.
Use was highest among 20 to 24-year-olds last year with almost one in six people in this group using it, official figures show.
Last year, 32 deaths in England and Wales and around 300 in the US were attributable to weed.