Severe Illness Associated with Eating Mushroom-Containing Chocolate Products - United States, January-October 2024

In late spring 2024, CDC was alerted to an outbreak of poisoning potentially associated with eating Diamond Shruumz microdosing chocolate bars. Diamond Shruumz microdosing chocolate bars are edible products designed so that small doses of mushroom-derived psychoactive compounds and other psychoactive ingredients can be eaten in a presectioned serving. In response to this alert, CDC and the Food and Drug Administration coordinated a nationwide outbreak investigation to characterize the potential poisonings associated with eating Diamond Shruumz microdosing chocolate bars. A case of poisoning was defined as an illness with moderate or major clinical effects (i.e., symptoms) as defined by America's Poison Centers in a person who ate any Diamond Shruumz product or another mushroom-containing chocolate product during January-October 2024. In total, 180 cases were reported in 34 states. Among these, 73 persons were hospitalized, including 38 persons who required intensive care unit (ICU) admission, 29 who required endotracheal intubation, and two deaths. Eating Diamond Shruumz chocolate bars was associated with higher odds of hospitalization (odds ratio [OR] = 3.29; 95% CI = 1.51-7.40), ICU admission (OR = 6.30; 95% CI = 2.17-22.6), seizures (OR = 8.45; 95% CI = 3.00-27.9), and endotracheal intubation (OR = 8.04; 95% CI = 2.24-44.2), compared with eating other mushroom-containing chocolate products. Eating larger amounts of Diamond Shruumz chocolate bars was associated with an increased likelihood of hospitalization, ICU admission, and endotracheal intubation (p-value for trend tests [p-trend] = 0.023, 0.004, and <0.001, respectively). Diamond Shruumz products were recalled, and the public was advised not to eat, sell, or serve any Diamond Shruumz products and to discard any Diamond Shruumz products previously purchased. Testing of some Diamond Shruumz products identified substances present in psychoactive mushrooms, including muscimol, psilocin (a Schedule I controlled substance), kavalactones, and other substances in some, but not all, tested products. Consumers should be aware of the poisoning risk associated with eating Diamond Shruumz products and other mushroom-containing microdosing chocolate products due to variability in ingredient composition, the absence of standardized regulatory oversight for sampling and testing finished products, and the potential toxicity of compounds intended to produce psychoactive effects.