Persistent nausea and vomiting are characteristic symptoms of Cannabis Hyperemesis Syndrome (CHS), a mysterious malady that showed up in the aftermath of widespread legalization of recreational cannabis use in states such as Colorado.

That’s where we first heard of it. “A genuine medical mystery,” one physician described it. Regular users of cannabis would appear in the ER complaining of recurring episodes of nausea and vomiting, sometimes quite severe.

Through experience, many users had learned to self-treat this by taking hot showers. For some reason, that worked. Not all the time, however, which is how they came to be in the Emergency Room.

Here’s an overview from the Cleveland Clinic on what we know so far about CHS and its treatment.

“Wait a minute, I smoke pot and I’ve never even heard of this,” protested a longtime user on social media.

I”m not surprised. When CHS does come up in the news media, it’s usually described as a “rare” or even “very rare” complication of long-term cannabis use.

In the US, a rare disorder is usually one with fewer than 200,000 reported cases. But given the challenges of tracking something that ordinarily goes unreported, it’s difficult to be sure the count is  accurate.

One group of investigators came up with the idea of surveying hospital patients to identify those who 1) acknowledged smoking marijuana at least 20 days per month and 2), to having used a hot shower in order to relieve nausea.

Out of more than 2000 surveyed, 155 met criteria and were included in the study. Among those, the researchers wrote, “32.9% …met our criteria for having experienced CHS…”

Nearly one third? That won’t qualify as ‘rare’, by anybody’s definition.

The researchers went on to speculate that based on their findings, perhaps 2.75 million Americans could potentially be experiencing Cannabis Hyperemesis Syndrome.

Presumably, most of them simply wouldn’t recognize it. Neither would the healthcare professionals who treated them.  Both would likely blame it on something else.

And the numbers are almost certain to rise. The combination of greater availability, plus the ever-increasing use of extra-high THC content products–  makes that conclusion inescapable.

The word’s out in the Emergency Medicine community to ask about cannabis use when a patient arrives complaining of nausea and vomiting. Makes sense.

So is this a withdrawal-related phenomenon? Apparently not, though some users claim that ingesting still more cannabis has helped (on occasion).

More likely that CHS will be listed as a frequent consequence of chronic cannabis use. Maybe that will motivate some people to give up pot.

Others, no doubt, will just stick close to the shower.