By Daniel Larlham Jr.
Co-published with the Charlotte Ledger
Medical providers in Charlotte and across the state say more patients are landing in emergency rooms with problems stemming from cannabis use.
A lot of them are young patients complaining of nausea, vomiting and abdominal pain. Those are symptoms of Cannabinoid Hyperemesis Syndrome (CHS), a serious disorder brought on by long-term, habitual cannabis use.
CHS is something that doctors now see cases of every week, particularly in young men. It has become so common that the World Health Organization officially recognized it last year, and it received a diagnostic code so health experts can track it.
CHS has become a topic of increasing concern as states legalize marijuana. Although marijuana is still illegal in North Carolina, intoxicating THC products are widely sold in gas stations and convenience stores under a federal loophole. Social media has dubbed CHS’s most volatile symptom “scromiting” — a combination of screaming and vomiting.
While the hemp industry braces for the closure of that loophole, written into the federal spending extension that passed in November, several states have already implemented their own laws to regulate, or even ban, hemp-derived THC products. In October, 39 state and territory attorneys general signed a formal letter to Congress to clarify the federal definition of hemp, citing specifically its marketing towards and accessibility to children.
According to a study of emergency room visits published last year, CHS cases among those aged 18-35 rose 406% nationwide between 2016 and 2022.
Joshua Ring, an emergency medicine physician at Duke Regional Hospital in Durham, says the number of cannabis-related illnesses in his emergency department before and after the pandemic has been night and day.
Ring described patients experiencing CHS as particularly miserable, even compared to typical ER visitors, as they are frequently in severe pain and vomiting uncontrollably.
“People will come in either on an ambulance or drive into the emergency department by themselves, in what appears to be the worst possibly imagined pain that somebody can be in,” he said.
Treatment typically includes anti-nausea medications, hot baths and showers, and pain-relieving creams. But the only cure is to stop cannabis use.
Christopher Griggs, an assistant professor of emergency medicine and medical director of EM pain and addiction quality improvement at Atrium Health, says he has been seeing CHS cases for quite some time. He analyzed Atrium Health emergency room visits in Greater Charlotte in 2025 and found more than 765 instances of cannabis-related issues, based on diagnostic codes.
But, Griggs said, he thinks there were probably even more CHS encounters than that, as cannabis use might not have been reported in every case.
“There’s a lot of stigma around all substance-use disorders, so patients aren’t always forthcoming with information about their substance use,” he continued.
Griggs added that much of medical research suggests that social isolation during the pandemic brought about increases in substance abuse across the board, with factors like increased anxiety and depression, driving people toward not just using cannabis, but alcohol and other illicit substances.
While CHS symptoms tend to last 24-48 hours, they can restart as soon as a patient ingests cannabinoids again. The only way to stop CHS entirely is to stop using the substance itself.
The biggest risk associated with CHS is dehydration. Ring says that the condition causes some patients to vomit upwards of 30 times in one day. While uncommon, deaths have been attributed to dehydration brought on by CHS as far back as 2016.
Concerns about mental health
CHS isn’t the only marijuana-related problem sending patients to the hospital.
According to the North Carolina Childhood Fatality Task Force, the rate of emergency department visits for cannabis ingestion among those 17 and under has risen 600% since 2019.
North Carolina saw 1,424 ED visits for cannabis consumption among those ages 0-24 in 2025, according to data from NC DETECT, the state’s syndromic surveillance system. Visits from those ages 15-24 made up over a quarter of the state’s total of 3,542.
Ring says that he’s also observed an uptick in cases of acute psychosis related to cannabis use, where patients — who are, again, oftentimes young men — come in confused, afraid or even violent, episodes that can put strain on an emergency department’s resources.
More generally, Griggs said, substance use can have far-reaching cognitive effects on the mind, which doesn’t stop developing until the age of 25.
“The cannabis that people were using when I was in high school or even going to college is tremendously different from the cannabis products that are out there right now,” said David Goldston, a clinical psychologist at Duke University.has remained relatively flat among adolescents nationwide
While some research has shown that cannabis use has remained relatively flat among adolescents nationwide, higher potency products that are available now could explain the increase in physical and mental illness related to cannabis use.
Goldston, who is also the director of the Duke Center for Adolescent and Young Adult Substance Use Treatment, says that he has also seen more problems stemming from the usage of marijuana and products like hemp-derived cannabinoids. Many of the people he sees are experiencing co-occurring mental health issues like depression, anxiety, ADHD and trauma, which habitual cannabis use may exacerbate.
Today’s weed products like edibles and vape pens are far more potent than a traditional smokable flower. Goldston said that with increased potency comes an increased risk of dependency — and in turn, an increased likelihood of withdrawal symptoms, which can vary person by person.
High-concentration options are exactly what younger people opt for, says Tobi Gilbert, clinical neuropsychologist and police crisis counselor for Jacksonville, North Carolina’s police department, adding they prefer the instant gratification and quicker highs that vapes deliver as opposed to the less accessible joints, bongs and bowls.
She has seen firsthand the kinds of mental health episodes that can come from youth cannabis use. In one case, she was called to a local school for a student who had smoked an entire THC vape pen. The student could barely walk or speak, and was acting belligerent towards school staff and family. “And I’ve seen that, I can’t even tell you how many times,” she said.
Vapes in particular have become a concern as questions have arisen about what they actually contain. Much like nicotine vapes, toxic metals have been found in THC vapes, especially in unregulated products. There’s also been increasing concern about vapes containing other drugs. In another case described by Gilbert, two students at a local school had overdosed after using a vape containing fentanyl.
Citing prohibition, Gilbert doesn’t necessarily believe that the anticipated ban on hemp is likely to stop adolescents from getting hold of cannabis substances, as a black market will always exist. Likely, she said, it would make it more difficult for children and teens to access it.
Gilbert believes that resources both for schools and police in dealing with students’ substance abuse are lacking, both in education and treatment options.
At least one school district in the Charlotte region, Cabarrus County Schools, has decided to invest resources into the issue of student substance abuse with training for educators and programs for students, said Gordon Palmer, assistant superintendent of high schools at Cabarrus County Schools, in an email to The Ledger.
The school system’s Positive Alternatives to Student Suspension (PASS) program provides targeted education for students found in possession of prohibited substances, including Delta 8 and Delta 9. It also has a Recovery High School Program — with parents’ permission, it offers students an environment designed to support recovery from addiction and substance abuse while allowing them to continue their education.
A regulatory answer?
While nationwide solutions to hemp and cannabis regulation have not been uniform, North Carolina elected officials are considering what other states have done in determining what to do about an industry that has been more or less unregulated in the state since the passage of the 2018 farm bill.
Last year, Gov. Josh Stein formed the North Carolina Advisory Council on Cannabis, tasked with recommending a comprehensive approach to regulate cannabis sales and create a safe, legal market for adults that protects children.
A recent Consumer Safety and Youth Protection Subcommittee meeting of that advisory council provided insight into what North Carolina’s cannabis industry may look like in the future.
The recommendations of the subcommittee were similar to those of the state’s Child Fatality Task Force.
Both groups urge the state to prevent the sale of hemp intoxicants to those under 21 and create regulations on how these products are packaged and advertised, such as child-safe packaging with appropriate warnings.
The subcommittee also discussed in depth the need for regulatory testing of products sold in North Carolina, and whether that should be conducted by a state body or by private enterprises.
A state-run laboratory would require significant investment, as nothing the state currently operates would be able to match the scale of the industry. But concerns about bad actors, as have been found in other states, have spurred some to shy away from private testing laboratories.
And it’s not just THC concentration that experts are concerned about. As with tobacco, contamination is a risk as well. Recalls on commercially available marijuana have been issued in states like Colorado and California for things like unsafe level pesticides and other contaminants.
Daniel Larlham Jr. is a freelance writer. He can be reached at larlhamjr@gmail.com.
This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting. You can support this effort with a tax-deductible donation.
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