Updated August 21, 2024 at 12:41 PM ET
Dr. Michael Moss couldn’t explain why the man in his hospital’s ICU had started convulsing after trying a chocolate bar, but he knew there was more to the story.
The patient recounted eating a mushroomed-infused candy, packaged with trippy artwork — and purchased legally at a local store.
He’d been flown in over the weekend from a rural hospital to the University of Utah Hospital in Salt Lake City, where Moss, a toxicologist, is medical director of the Utah Poison Control Center.
“This was crazy,” he said to himself. “Nobody gets put on the ventilator and has a seizure from eating psychedelic mushrooms.”
Alarmed, he began contacting poison centers around the country and soon discovered similar cases were popping up: Patients with nausea, vomiting, agitation, seizures, loss of consciousness and other symptoms.
There are now more than 140 documented illnesses — including two suspected deaths — all tied to the same brand of mushroom edibles, called Diamond Shruumz, according to the Food and Drug Administration.
It’s one of the many varieties of psychedelic-inspired treats that have proliferated online, in smoke shops and convenience stores, often advertising some kind of proprietary mushroom blend, with words like “nootropic,” “magic” or “microdosing” emblazoned on the packaging.
Prophet Premium Blends, the company that makes Diamond Shruumz, said in a recall notice that it has ceased production and distribution of the products, citing “toxic levels of muscimol.”
Muscimol is a compound in the iconic red-capped mushroom, Amanita muscaria, and was identified by the company as a “potential cause” of the sickness, the recall notice said. The company did not respond to multiple requests for comment.
In spite of the recall, poison centers are still receiving calls, albeit at a slower pace than earlier in the summer, says Kaitlyn Brown, clinical managing director for America's Poison Centers.
While also psychoactive, the Amanita species has quite different effects from the famous (and mostly illegal) psilocybin-containing magic mushrooms and has gained more popularity lately, buoyed by the fact that it’s not a controlled substance.
Yet it’s still not clear that the colorful mushroom is to blame for the illnesses.
According to an ongoing FDA investigation, initial testing has turned up an array of other substances in the recalled products, and muscimol in less than half of them.
At this point, experts say none of the findings adequately explain why people are getting so sick. “We still don't know the culprit,” says Moss. “These products are living in this very strange legal gray area.”
The rise of these unregulated psychoactive products is reminiscent of the boom in synthetic cannabis years back, except now hallucinogenic drugs are increasingly “in fashion,” says Roy Gerona, a chemist at the University of California, San Francisco who runs a toxicology lab that works with the Drug Enforcement Administration.
A "kitchen sink" of substances
Figuring out what’s actually in these candy bars and gummies is proving to be quite tricky.
“The analysis itself is very challenging,” says Gerona. “That's the reason why it's taking a little longer than what the public is used to.”
The difficulties are manifold: Most toxicology labs didn’t have Amanita muscaria on their radar as they would for common street drugs. Even Gerona’s lab that specializes in responding to mass poisonings and detecting designer drugs had to hurry to develop accurate tests.
Beyond that, analyzing something like a chocolate bar is no easy task — and it’s especially difficult to detect muscimol and ibotenic acid, two of the potentially toxic compounds.
But what testing has turned up so far is concerning.
The federal investigation of Diamond Shruumz has found a synthetic version of psilocybin, 4-AcO-DMT, which is not a controlled substance but could be considered illegal under federal law because of its similarity to psilocybin. There are other substances, too, like the anticonvulsant drug pregabalin, which is sold under the brand name Lyrica, and the herbal supplement kava.
The mix of chemicals isn’t all that surprising to Dr. Avery Michienzi, a medical toxicologist at the University of Virginia, who responded to a separate cluster of illnesses about a year ago.
Her analysis of similar products — five brands of mushroom gummies — from smoke shops in Charlottesville found psilocin, ephedrine and the natural plant kratom, which has opioid-like properties.
“People may be intentionally seeking out the psychedelic experience, but getting more than they bargained for,” she says. “It’s scary they’re buying this stuff when they really don’t know what’s in there.”
The market appears to be growing. During surveillance of online tobacco retailers, Eric Leas, an epidemiologist at the University of California, San Diego, noticed an uptick in public interest in these products, which are sometimes sold alongside delta-8, a psychoactive substance derived from hemp, and herbal supplements.
“This is an investigation of one company, but there's hundreds selling these products,” says Leas.
Over the past year, Caleb King and Christopher Pauli have compiled a growing list of chemicals in various mushroom products.
“People are throwing the kitchen sink into some of these and calling them a natural blend,” says King, who along with Pauli runs Tryptomics, a company that tests for psychoactive substances in natural products.
The duo has examined more than 100 of these edibles — largely at the request of consumers — and has found herbal supplements, amphetamines and synthetic chemicals that are essentially spinoffs of popular hallucinogens.
“I’m seeing compounds that I had not seen yet, and we're rapidly trying to discover what they are,” says King.
What’s clear from the work done by Tryptomics is that there’s little in the way of consistency. The same type of edible can contain different ingredients and at varying concentrations. Counterfeits abound, especially with popular brands, says Pauli.
Gerona, who has written a book on designer drugs, says his lab is still doing testing and trying to figure out the amount of muscimol in the products. That said, he’s keeping an open mind about the illnesses linked to Diamond Shruumz, including the possibility that a new psychoactive substance could be involved
“None of the data fully explains the symptoms yet,” says Gerona. “Some of us are asking ourselves, what are we missing here?”
A mushroom takes center stage
The mounting safety concerns are bringing new visibility to Amanita muscaria itself.
The mushroom has plenty of folklore surrounding it and was used medicinally in Eastern Europe, Scandinavia and other regions for hundreds of years, though nowadays most recognize it thanks to depictions in popular culture, from Alice in Wonderland to Super Mario to the mushroom emoji.
The compounds work on different receptors than psilocybin. Given the effects, it tends not to have a "high recreational potential,” says Kevin Feeney, a cultural anthropologist at Central Washington University who’s edited a compendium on Amanita muscaria, also known as fly agaric.
People often seek out the mushrooms for microdosing and believe it helps with anxiety, sleep and even more serious problems like addiction to benzodiazepines and alcohol, Feeney says. But there’s little evidence from clinical research on its possible therapeutic benefits in humans.
Christian Rasmussen, who sells Amanita muscaria online, likes to call it the “Santa Claus mushroom” because, in lower doses, it has a “light and jolly” quality, without the feeling of inebriation.
An avid believer in its healing properties, he credits the mushroom for “saving his life” when he was getting off benzodiazepines after years of addiction, and now he runs MN Nice Botanicals.
Still, Feeney cautions, taking the mushrooms at high doses “can be incredibly unpleasant and disturbing.” It provokes a “dissociative, dream-like state,” the closer comparison being ketamine rather than psilocybin, adds Rasmussen.
The Amanita muscaria mushroom is poisonous, but there are not many documented reports of overdose and death. People who eat small amounts are unlikely to get very sick. In concentrated doses, at least two compounds in the mushroom can cause serious health problems, says Moss, who has studied its toxicity. (He warns it can sometimes be confused with other, more deadly species of Amanita.)
Muscimol has a sedating effect because it’s similar to the neurotransmitter GABA and can cause loss of consciousness or even a coma. The other, ibotenic acid, is a neurotoxin that can lead to hallucinations, delirium and, in rare cases, even seizures.
Together, large doses of both might help explain some of the illnesses, but testing for ibotenic acid is difficult, notes Gerona.
That compound has not shown up in the Diamond Shruumz edibles yet, although it has appeared in the raw ingredients (along with muscimol) that were reportedly used in some of the products, according to the FDA.
Fears of a regulatory backlash
The marketing of products touting Amanita strikes Feeney as essentially a “bait and switch,” with manufacturers drawing customers in under the guise of a legal substance.
This bothers people who believe in the mushroom’s health potential. Rasmussen says he noticed what he calls “the smoke shop industry” getting into the Amanita business about three years ago, eyeing it as the next delta-8, which is derived from hemp and sold legally.
“I told them from the beginning, that's not what this is,” he says.
Jeff Stevens worries that the confusion over what’s driving the illnesses could lead to a regulatory backlash.
His publicly traded company, Psyched Wellness, began selling Amanita muscaria tinctures in supplement stores a few years ago, after “spending millions of dollars on preclinical studies.”
While they’re not required to submit data to the FDA, he says their findings were reviewed by a panel of experts in accordance with federal regulations.
Their mushrooms come from foragers in Eastern Europe, are tested by a third party lab and undergo an extraction process to convert most of the ibotenic acid into muscimol, he says. (Feeney is on the company's advisory board.)
“My concern would be if there is a knee-jerk reaction on regulatory enforcement with all Amanita without taking the time to understand what caused the issues [with Diamond Shruumz] and considering how this mushroom can be used safely,” he says.
For now, though, there’s little to help the average consumers navigate the bewildering market that’s sprouted up around these mushroom products.
King at Tryptomics says he wouldn’t recommend trying them without testing what’s in there first. Look for QR codes on the packaging that pull up the actual results, what’s known as a certificate of lab analysis, which should be housed on the lab’s website. But Pauli warns sometimes those documents can be fake, or the analysis may only list the substances that are not present, rather than what’s in there.
“That's a huge issue,” says Pauli.
In a few instances, King says manufacturers have asked them to test a white powder that was bought from overseas under the impression it was muscimol, only to discover it’s actually an amphetamine-based substance.
Like any industry there are “good and bad actors” who are manufacturing and testing these products, says Roger Brown, CEO of ACS Laboratory, which is licensed by the DEA and tests products containing cannabis, muscimol and other compounds.
“We produce the results — whether the results are good or bad for the client, we don't judge that,” he says.
He’s candid about the gaps in oversight.
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