Mushroom edibles are making people sick. Scientists still don't know why
Mushroom edibles are making people sick. Scientists still don't know why

        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 substancesFiguring 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?”
      
      Related Story: NPRA mushroom takes center stageThe 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.)
      
      Related Story: NPRMuscimol 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 backlashThe 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.“When you buy a gummy bear that's got Amanita muscaria in it, nobody's regulating it, or if they are regulating it, they're not enforcing it.”
      
      Related Story: NPR
        
        Transcript
        A MARTÍNEZ, HOST:  The wave of public interest in psychedelics has been accompanied by a flood of edibles that claim to contain mind-altering mushrooms that are also legal. It's a murky industry, and now federal authorities are investigating why some people are getting sick from the products. Here's NPR's Will Stone.WILL STONE, BYLINE: Dr. Michael Moss couldn't explain why the man in his hospital's ICU had started convulsing after eating a mushroom-infused chocolate bar, but he knew there was more to the story.MICHAEL MOSS: This does not make sense. Nobody gets put on a ventilator and has a seizure from eating psychedelic mushrooms.STONE: The patient had been flown to the large hospital in Salt Lake City, where Moss is medical director of the Utah Poison Control Center. Curious, he tried to get more intel.MOSS: Had he ever used other psychedelic products before? He said, yeah, no, I've had a mushroom trip before, and this was crazy. I don't know what happened.STONE: The candy bar in question was packaged in trippy artwork and purported to offer a microdosing experience, thanks to a mushroom blend. Moss started calling up other poison centers.MOSS: And then Arizona said, actually, over the weekend, we saw four cases.STONE: Patients with nausea, vomiting, agitation, seizures, loss of consciousness and other symptoms. That was in late spring. Now there are 130 known illnesses, 53 hospitalizations and two suspected deaths, all linked to a brand called Diamond Shruumz, according to the FDA.MOSS: We still don't know the culprit in the Diamond Shruumz case. These products are living in this very strange legal gray area.STONE: These psychedelic-inspired mushroom edibles are sold in convenience stores, smoke shops and online, ostensibly because they do not contain illegal substances. Initial testing in the Diamond Shruumz investigation has turned up various undisclosed ingredients, including herbal supplements like kava, the prescription drug pregabalin and a synthetic version of psilocybin mushrooms. None of these findings surprise Caleb King. His company, Tryptomics, specializes in testing natural psychoactive products. Over the past year, they've analyzed more than a hundred of these kinds of edibles.CALEB KING: People are throwing the kitchen sink into some of these and calling them, you know, a natural blend.STONE: They found stimulants, including precursors to MDMA and other synthetic chemicals, basically spinoffs of popular hallucinogenic drugs.KING: I'm seeing compounds that I hadn't seen yet, and so we're rapidly trying to discover what are they?STONE: Prophet Premium Blends, the maker of Diamond Shruumz, did not return multiple email and phone requests for comment. The company recalled its products in June, citing toxic levels of muscimol. That's a compound found in the iconic red-capped and white-spotted mushroom known as Amanita muscaria. Picture "Alice In Wonderland" or Super Mario.Roy Gerona runs a toxicology lab at the University of California, San Francisco, that works with the Drug Enforcement Administration. He says the investigation here is tricky. Most labs were not ready to test for this mushroom. That's true even for his lab that specializes in finding designer drugs. On top of that, the compounds in it are hard to detect, especially in, say, a chocolate bar.ROY GERONA: That's the reason why, you know, it's taking a little longer than what the public is used to. The analysis itself is very challenging.STONE: The FDA has confirmed muscimol in some of these products, but not all of them. So far, none of the current findings adequately explain these illnesses.GERONA: I think some of us are asking ourselves, what are we missing here?STONE: Gerona says they are doing more testing. Along with muscimol, there's another compound in Amanita muscaria that might play a role. Documented deaths from eating these mushrooms are rare, although compounds in it can be toxic in high doses. On the other hand, he says, it's possible the illnesses could be due to an entirely new designer drug. Kevin Feeney is an anthropologist at Central Washington University. He edited a compendium on the mushroom species, which is not a controlled substance.KEVIN FEENEY: Amanita muscaria is psychoactive. It's not psychedelic in the way that psilocybes are.STONE: Feeney is suspicious of many of these new edible products.FEENEY: The marketing side seems to be heavily focused on Amanita muscaria. This is a legal mushroom. So that's sort of the bait and switch. They draw people in. Nobody really knows what's in it.STONE: The mushroom has not been studied extensively in humans, but it does have a small and growing following, people who believe in its healing properties. He says larger doses can be quite unpleasant, so most people microdose. Christian Rasmussen runs MN Nice Botanicals, a major Amanita retailer.CHRISTIAN RASMUSSEN: It's the Santa Claus mushroom, so it, like, brings kind of a joliness to it.STONE: In the last few years, he's seen a lot more people get into this business, and he worries about a backlash from federal authorities, especially now.RASMUSSEN: It's been a thorn in our side 100%. It detracts from Amanita.STONE: The proliferation of these unregulated products, whether they contain the mushroom or other ingredients, concerned Eric Leas. He's an epidemiologist at the University of California, San Diego.ERIC LEAS: This is an investigation of one company, but there's hundreds who are selling these products.STONE: For now, there's little to help consumers sort out what's safe.Will Stone, NPR News.