What we know about microdosing candy illnesses as death investigation underway

One person may have died from eating Diamond Shruumz microdosing candies, which were recalled last week amid a rash of severe illnesses involving seizures, intubation, and intensive care stays.

According to an update this week from the Food and Drug Administration, the cluster of cases continues to increase across the country. To date, 48 people across 24 states have fallen ill after eating the candies, which include chocolate bars, gummies, and candy cones that were sold online and in retail locations, such as smoke and vape shops. Of the 48 people sickened, 46 were ill enough to seek medical care, and 27 were admitted to a hospital.

For now, the death noted in the FDA's latest update is only "potentially associated" with the candies and is still under investigation. No other information is yet available.

But in an interview with Ars, medical toxicologist Michael Moss was not surprised that the candies may have turned deadly. Moss, who is the medical director of the Utah Poison Control Center, cared for one of the first people reported to be sickened in the cluster.

An early case

The person was sickened in Nevada and transferred to a hospital in Utah, where Moss was a member of his care team. After the person came out of intensive care, Moss sat down with him and tried to piece together what happened. According to Moss, the person had bought a Birthday Cake-flavored chocolate bar at a local store. The bars are sold as "microdosing" candies, suggesting they contain psychedelic compounds, but the exact components and dosages aren't listed.

Though the person told Moss he had some experience with psychedelics before, it was only with actual mushrooms. This was the first time he had eaten such a bar. And the bar's packaging had only vague instructions of how much to eat at one time to achieve certain effects. For instance, eating nine or more squares of the bar was described with an image of an eye with lots of rainbow colors.

"What does that dose mean? And how many milligrams of what is that? Nobody knows," Moss said. "So, he decided, 'It's a chocolate bar.' So why wouldn't you just eat the chocolate bar? Pretty reasonable thing to do."

But, within minutes of eating the bar, the person felt nauseated and very dizzy and tired. He went to lie down and doesn't remember much after that. Fortunately, a family member came home soon after and found him. The family member saw that he had vomited and was possibly aspirating or choking. By the time paramedics arrived, he was having a seizure. He had another in the emergency room. Doctors gave him anti-seizure medications and a breathing tube and put him on ventilation before transferring him to the hospital in Utah.

Moss suggested that if that family member hadn't come home when they did, things could have turned out differently for his case. "If you're able to get to medical care, we can stop the seizures. We can breathe for you and give you oxygen, put you on a ventilator. We can give you supportive care, as we call it, and help you get through it," Moss said. But if someone was alone and didn't get care or had some other underlying medical conditions, death "is plausible, from what we've heard about from some of these cases," Moss said. He was careful to note, however, that he didn't have any information about the specific death that is under investigation.

Luckily, the person who Moss treated made a full recovery, which seems to be the norm. After experiencing seizures, many cases are back to normal 24 to 48 hours later, Moss said.

Unusual suspects

But the cause of the severe, albeit short-lived, illnesses remains a mystery. The FDA reported earlier that it found a synthetic psychedelic called 4-AcO-DMT (aka 4- acetoxy-N,N-dimethyltryptamine, O-acetylpsilocin, or psilacetin) in two of Diamond Shruumz's chocolate bars, including the Birthday Cake-flavored bar. But Moss isn't convinced this could explain the illnesses. The synthetic compound 4-AcO-DMT is supposed to be similar to the mushroom-derived psychoactive compound psilocybin. And, in the body, both are likely to get metabolized to psilocin, Moss said. "And people don't have seizures after using magic mushrooms."

The FDA also found compounds from the Kava plant in a Diamond Shruumz dark chocolate bar, but those also are unlikely to explain the illnesses, Moss said. Kava plants have been used in traditional medicines for a long time, he noted. Though they have been linked to liver toxicity in some instances, that was associated with chronic use, not single doses. Moreover, none of the cases linked to the Diamond Shruumz bars have shown liver toxicity.

In the recall notice last week, Diamond Shruumz reported that some lab reports found "higher than normal" amounts of muscimol, which might be the most likely explanation for the illnesses so far, Moss said. Muscimol, along with related ibotenic acid, are both key psychoactive components of some hallucinogenic Amanita mushrooms, including the A. muscaria var. muscaria, which is very recognizable for its bright red-orange caps with white warts. Muscimol resembles the neurotransmitter GABA and leads to sedation, while ibotenic acid resembles the neurotransmitter glutamate and leads to stimulation, including fast heart rate, higher blood pressure, agitation, and, at the end of the spectrum, seizures.

Together, the two compounds produce effects that are similar to the list of symptoms reported in the illnesses linked to Diamond Shruumz's candies, which are: seizures, central nervous system depression (loss of consciousness, confusion, sleepiness), agitation, abnormal heart rates, hyper/hypotension, nausea, and vomiting. But, it's unclear what level of muscimol the company found and whether ibotenic acid was in the candies at all. More testing and analysis is now underway to try to figure it out, Moss said.

In the meantime, he offers some advice for anyone interested in these types of gray market edibles and microdosing foods: "Start low and go slow." Start with the lowest dose—one or two squares of chocolate or one or two gummy bears—and wait to see how it affects you, possibly two hours, before taking any more. And, because these products are not well-regulated, don't have much quality control, and may vary considerably from batch to batch, do this every time, he suggested.