Severe Illness Potentially Associated with Consuming Diamond ShruumzTM Brand Chocolate Bars, Cones, and Gummies

Outbreak investigation summary

CDC and FDA have received reports of severe acute illnesses and other adverse effects following consumption of Diamond Shruumz^TM brand chocolate bars, cones, and gummies reported to multiple poison control centers across the United States.

As of October 31, 2024, 180 total illnesses, including 73 hospitalizations, were reported in 34 U.S. states. There were three (3) potentially associated deaths.

On June 25, 2024, FDA released information regarding test results for product samples (see information below).

The cause of the reported illnesses is not known at this time. People should not buy or eat any flavors of Diamond Shruumz^TM brand chocolate bars, cones, or gummies, and should discard products that have been purchased.

*The case definition used by state health departments for the reported illnesses is as follows:

Illness with moderate or major clinical effects, or death, occurring in a person who ate any Diamond Shruumz product (chocolate bars, cones, gummies or other) or another chocolate product marketed as containing mushrooms, during January 1, 2024, through the present.

Fast facts (as of October 31, 2024)*

• Total cases: 180
  • Total number of cases among people who reportedly ate a Diamond Shruumz product: 118
  • Total number of cases among people who reportedly ate a mushroom chocolate bar of an unspecified brand: 36
  • Total number of cases among people who reportedly ate a mushroom chocolate bar of a non-Diamond Shruumz brand: 26
• Hospitalizations: 73
• Potentially associated deaths: 3
• States with Cases: AL (8), AZ (13), CA (3), CO (1), FL (6), GA (21), IA (6), ID (4), IL (2), IN (8), KS (5), KY (11), MD (2), MI (2), MN (3), MO (1), MT (3), NC (12), ND (3), NJ (3), NV (2), NY (2), OH (6), OK (1), OR (1), PA (2), SC (12), SD (1), TN (9), TX (19), VA (2), WA (2), WI (1), WV (3)
• Recall: Yes
• Investigation: Closed, transitioned to post-incident activities

*The case definition used by state health departments for the reported illnesses is as follows:

Illness with moderate or major clinical effects, or death, occurring in a person who ate any Diamond Shruumz product (chocolate bars, cones, gummies or other) OR another chocolate product marketed as containing mushrooms, during January 1, 2024, through the present.

About the product

On June 27, 2024, Prophet Premium Blends, LLC of Santa Ana, CA, initiated a recall of all flavors of Diamond Shruumz^TM brand chocolate bars, cones, and gummies.

Diamond Shruumz^TM brand products have been distributed online and at retailers, including those that sell hemp-derived (e.g., cannabidiol [CBD], delta-8 tetrahydrocannabinol [THC]) and smoke/vape products nationwide.

Products containing psychoactive compounds such as cannabis or mushroom extracts are increasing in availability. These "edibles" are often sold as gummy candies, chocolates, or other snack foods. They might contain undisclosed ingredients, including illicit substances, other adulterants, or potentially harmful contaminants that are not approved for use in food.

FDA testing and analysis

As part of this investigation, FDA and state partners collected samples of Diamond Shruumz^TM brand products for testing and analysis.

As of November 4, 2024, FDA testing on several Diamond Shruumz^TM brand products identified the presence of multiple substances, including O-acetylpsilocin, psilocin, kavalactones, pregabalin, and muscimol:

• Acetylpsilocin (also known as 4-acetoxy-N,N-dimethyltryptamine, 4-acetoxy-DMT, O-acetylpsilocin or psilacetin) was found in nine (9) chocolate bar samples, five (5) infused cones samples, and 14 gummies samples.
• Psilocin, a Schedule I-controlled substance, was found in four (4) chocolate bar samples, five (5) infused cones samples, and 14 gummies samples.
• Pregabalin, a prescription drug, was found in three (3) chocolate bar samples, five (5) infused cones samples, and four (4) gummies samples.
• Desmethoxyyangonin, dihydrokavain, and kavain (kavalactones found in the kava plant, Piper methysticum), were all present together in 18 chocolate bar samples, all 10 of the infused cones samples, and 11 gummies samples. Although kavalactones were detected in many, but not all products, their presence cannot explain all the signs and symptoms experienced by ill patients.
• Muscimol, a substance found in Amanita muscaria and related mushrooms, was found in nine (9) chocolate bar samples and four (4) infused cones samples. Muscimol was not found in all products and was not listed as an ingredient in all products. Its presence in some samples cannot explain all the symptoms reported by ill patients who consumed the Diamond Shruumz^TM brand chocolate bars.
• Ibotenic acid and muscimol were detected in a raw ingredient that was reportedly used in the manufacturing of some Diamond Shruumz^TM brand products.

There may be variability in test results across products with different formulations as well as potential variability across lots and batches of the same product. FDA and CDC medical officers are interpreting these test results to understand the health risks of ingesting these chemical substances and to determine the appropriate next steps.

For additional information about FDA testing and analysis, please visit the FDA website: Investigation of Illnesses: Diamond Shruumz-Brand Chocolate Bars, Cones, & Gummies (June 2024).

What you should do

• Do not buy or eat Diamond Shruumz^TM brand chocolate bars, cones, or gummies. Discard any product that has been purchased.
• Do not consume chocolate, gummies, snack foods, or other edible products claiming to produce feelings of euphoria, hallucinations, or psychedelic effects. They might contain undisclosed ingredients that might be linked to severe illness.
• If you do purchase edibles and other products that contain mushrooms, THC, or CBD, safely store them away from children. Children may mistake some edibles for candy.
• Seek immediate medical attention or call the Poison Help Line (1-800-222-1222) for advice if you have consumed a product and are having symptoms. Signs and symptoms may include hallucinations, uncontrolled movements, fast or slow heart rate, high or low blood pressure, flushed skin, and gastrointestinal effects (such as nausea, vomiting, or abdominal pain). Other severe adverse effects have been reported, including seizures, decreased level of consciousness, loss of consciousness, confusion, sleepiness, and respiratory failure.
• Consumers are also encouraged to report adverse events related to these products to FDA MedWatch.

Symptoms

A variety of severe health effects have been reported after consumption of Diamond Shruumz^TM brand products, including the following:

• Seizures
• Decreased level of consciousness
• Respiratory failure

Other symptoms people have experienced include the following:

• Nausea
• Vomiting
• Abdominal pain
• Hallucinations
• Uncontrolled movements
• Abnormal heart rate (e.g., too fast or too slow)
• High or low blood pressure
• Excessive sweating or secretions
• Flushed skin

Contact your health care provider or Poison Help Line (1-800-222-1222) if you have symptoms.

Information for clinicians and public health professionals

Clinical effects

Many hallucinogenic mushrooms (also known as "magic mushrooms" or "shrooms") contain psilocybin, a Schedule 1 substance under the Controlled Substances Act that has a high potential for abuse. Psilocybin can temporarily alter a person's mood, thoughts, and perceptions.

Substances such as O-acetylpsilocin (identified during testing of above products), psilocybin, psilocin, dimethyltryptamine (DMT), and lysergic acid diethylamide (LSD) all have similar chemical structures. Individuals who use these substances can experience hallucinations, visual illusions, and other sensory changes. Some patients may have adverse effects such as nausea, vomiting, fast heart rate, anxiety, agitation, lightheadedness, or tremor.

Muscimol is a chemical that can be found in the fly agaric mushroom, Amanita muscaria, and other related mushrooms such as the panther cap, Amanita pantherina. These mushrooms are sometimes consumed intentionally for psychotropic effects, altering a person's mood, thoughts, and emotions. Ingestion of A. muscaria can cause symptoms including hallucinations, drowsiness, and dizziness.

Kava is a plant (Piper methysticum) cultivated in some Pacific Islands. It contains the kavalactones mentioned above (desmethoxyyangonin, dihydrokavain, and kavain) and other compounds. Ingestion of kava can cause numbness of the mouth and skin, loss of coordination, dizziness, and sedation. Ingestion of kava with other substances known to cause sedation, such as benzodiazepines or alcohol, can worsen sedation. Kava can also cause gastrointestinal effects such as nausea and vomiting. Chronic or heavy ingestion of kava has been occasionally associated with certain skin conditions and liver toxicity.

Management

Management of ingestions of these substances is supportive in nature. Patients may require benzodiazepines or other sedative medications for seizures and intravenous fluids or vasopressors for hypotension. Patients with major symptoms of sedation or seizures who are unable to protect their airway may require endotracheal intubation.

Additional information for clinicians and public health professionals can be found in the CDC Health Alert Network Advisory: Health Alert Network (HAN) – 00509: Severe Illness Potentially Associated with Consuming Diamond Shruumz^TM Brand Chocolate Bars, Cones, and Gummies.

Resources

• Health Alert Network (HAN) - 00509 | Severe Illness Potentially Associated with Consuming Diamond Shruumz^TM Brand Chocolate Bars, Cones, and Gummies
• FDA: Investigation of Illnesses: Diamond Shruumz-Brand Chocolate Bars, Cones, & Gummies (June 2024)
• MedWatch: The FDA Safety Information and Adverse Event Reporting Program
• America's Poison Centers
• American College of Medical Toxicology
• Pediatric Environmental Health Specialty Units