[NFBP-Talk] Fwd: CDC Advisory - Severe Illness Potentially Associated with Consuming Diamond ShruumzTM Brand Chocolate Bars, Cones, and Gummies

Wed Jun 26 23:49:26 UTC 2024

FYI

Stacie

*Stacie Leap*
stacie.leap at gmail.com | 215.776.6741

---------- Forwarded message ---------
From: PDPH <health.notifications at phila.gov>
Date: Wed, Jun 26, 2024 at 1:54 PM
Subject: CDC Advisory - Severe Illness Potentially Associated with
Consuming Diamond ShruumzTM Brand Chocolate Bars, Cones, and Gummies
To: stacie.leap at gmail.com <stacie.leap at gmail.com>

The CDC has released a Health Advisory regarding severe illnesses
potentially associated with consuming Diamond Shruumz*TM* Brand chocolate
bars. It is available from https://hip.phila.gov, is appended to this email
and is attached as a PDF document. If you have any questions or problems,
please contact the Philadelphia Department of Public Health at
publichealthpreparedness at phila.gov.
------------------------------

*Centers for Disease Control and PreventionHealth Advisory*

*Severe Illness Potentially Associated with Consuming Diamond ShruumzTM
Brand Chocolate Bars, Cones, and GummiesJune 12, 2024*

*Summary*
The Centers for Disease Control and Prevention (CDC), Food and Drug
Administration (FDA), America’s Poison Centers <https://poisoncenters.org/>,
and state and local partners are investigating reports of severe acute
illnesses potentially associated with consuming Diamond Shruumz*TM* brand
chocolate bars, cones, and gummies marketed as containing a proprietary
blend of mushroom. As of June 11, 2024, 12 total illnesses and 10
hospitalizations have been reported in eight U.S. states with ongoing
efforts to identify other potential cases. The cause of the reported
illnesses is not known at this time. Individuals should not eat, sell, or
serve any flavors of Diamond Shruumz*TM* brand chocolate bars, cones, or
gummies, and should discard products that have been purchased. CDC and FDA
are working to determine whether other products from this company are
associated with adverse health effects.

*Background*
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. These products are distributed online and
at retailers including those that 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, chocolate, 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.
Mushroom-containing products have been marketed for promoting health or for
achieving nonspecific physical or psychoactive effects. Examples of health
claims have included improving focus and increasing energy. Advertising for
these products has also implied that consumption would lead to feelings of
euphoria, hallucinations, or psychedelic effects. Common terms used in
marketing include “microdosing,” “adaptogens” (substances to help the body
adapt to stress), “nootropics” (substances that enhance memory or cognitive
function), or “functional mushrooms.”

Adverse effects reported to U.S. poison centers in 12 patients who sought
medical attention after consuming Diamond Shruumz*TM* brand chocolate bars,
cones, or gummies as of June 11, 2024, include central nervous system
depression with sedation, seizures, muscle rigidity, clonus, tremor,
abnormal heart rate (bradycardia or tachycardia), abnormal blood pressure
(hypotension or hypertension), gastrointestinal effects (nausea, vomiting,
or abdominal pain), skin flushing, diaphoresis, and metabolic acidosis with
increased anion gap. Ten patients were hospitalized, and several patients
required intubation, mechanical ventilation, and admission to an intensive
care unit. None have died.

CDC, FDA, and America’s Poison Centers <https://poisoncenters.org/> are
continuing to monitor cases of illness reported to poison centers
nationwide. Any suspected cases or adverse effects after consuming any
Diamond Shruumz*TM* brand products should be reported to the Poison Help
Line (1-800-222-1222).

*Recommendations for Clinicians*

   - Counsel patients, caregivers, and guardians not to purchase, consume,
   or serve Diamond Shruumz*TM* brand chocolate bars, cones, or gummies.
   - Counsel patients, caregivers, and guardians to avoid consuming
   mushroom-containing edible products claiming to produce neurologic,
   cognitive, or psychoactive effects.
   - Be aware that “edibles” or food-like products marketed with
   nonspecific health benefits or implied psychoactive effects might contain
   undisclosed, misformulated, or unapproved ingredients that can cause severe
   adverse health effects.
   - Have a high index of suspicion for severe illness in any patient who
   recently consumed any of these products presenting to a healthcare facility
   with any adverse effects. Symptoms might include, but are not limited to,
   central nervous system depression with sedation, seizures, muscle rigidity,
   clonus, tremor, abnormal heart rate (bradycardia or tachycardia), abnormal
   blood pressure (hypotension or hypertension), gastrointestinal effects
   (nausea, vomiting, or abdominal pain), skin flushing, diaphoresis, and
   metabolic acidosis with increased anion gap.
   - Obtain early consultation with a medical toxicologist with expertise
   in managing patients with acute unknown ingestions. Contact your local
   poison center (1-800-222-1222) for advice on medical management of these
   patients.
   - Managing symptoms from an unknown exposure primarily involves
      supportive care and consultation with a poison center or toxicologist.
      Common treatments include IV fluid hydration, supplemental oxygen, and
      ventilatory support for respiratory failure. Benzodiazepines might be
      indicated as first-line medications to treat seizures, muscle
rigidity, or
      agitation. Consider the possibility of concomitant ingestion of
other drugs
      or medications and be aware that other specific antidotes (e.g.,
naloxone)
      might be indicated.
      - Consider routine diagnostic testing if indicated based on the
      patient’s clinical presentation. Examples might include, but are not
      limited to, a comprehensive metabolic panel (CMP), including serum
      electrolytes, liver enzymes and BUN/creatinine; complete blood count;
      arterial blood gas; urinalysis; and urine drug screen.
      - Consider consulting a neurologist for evaluation and further
      diagnostic workup such as electroencephalogram (EEG) or imaging
studies if
      there is any concern for status epilepticus. [4]
      - Consider retaining urine and blood samples for further testing.
      Urine drug screens commonly used in healthcare facilities usually only
      detect a limited number of compounds. Decisions to perform
further testing
      may be based on discussions and coordination with a poison
center or local
      health authorities.
      - Contact your local public health authority or regional poison
   center to report cases of illness after consuming mushroom-containing
   chocolate or other similar edible products.

*Recommendations for Public Health Practitioners*

   - Be aware that cases of severe illness have been reported following
   consumption of Diamond Shruumz*TM* brand chocolate bars, cones, and
   gummies.
   - Educate the public about the risks of eating mushroom-containing
   edible products marketed with claims of nonspecific physical effects,
   health benefits, or implied psychoactive effects. Such products might
   contain potentially harmful undisclosed, misformulated, or unapproved
   ingredients.
   - Coordinate with your local poison center (1-800-222-1222) and other
   relevant stakeholders to discuss any suspected cases of illness due to
   these products within your jurisdiction and establish preferred processes
   to collect information on suspected cases.

*Recommendations for the Public*

   - Do not buy, eat, sell, or serve Diamond Shruumz*TM* brand chocolate
   bars, cones, or gummies. Discard and destroy 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.
   - Store edibles and other products that contain mushrooms, THC, or CBD
   safely 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 gastrointestinal effects (nausea,
   vomiting, abdominal pain), hallucinations, uncontrolled movements, fast or
   slow heart rate, high or low blood pressure, coughing, choking, excessive
   sweating or secretions, and flushed skin. Other severe adverse effects have
   been reported, including seizures, decreased level of consciousness, and
   respiratory failure.
   - Consumers are also encouraged to report adverse events related to
   these products to FDA MedWatch
   <https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program>
   .

*For More Information*

   - Investigation of Illnesses: Diamond Shruumz-Brand Chocolate Bars,
   Cones, & Gummies (June 2024) | FDA
   <https://www.fda.gov/food/outbreaks-foodborne-illness/investigation-illnesses-diamond-shruumz-brand-chocolate-bars-cones-gummies-june-2024>
   - MedWatch: The FDA Safety Information and Adverse Event Reporting
   Program | FDA
   <https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program>
   - America’s Poison Centers <https://poisoncenters.org/>
   - American College of Medical Toxicology <https://www.acmt.net/>
   - Pediatric Environmental Health Specialty Units
   <https://www.pehsu.net/index.html>

References
1. Ogozalek S. Mood-Altering Mushroom Sales Bloom Despite Safety
Concerns. *Tampa
Bay Times*. 2023.
https://kffhealthnews.org/news/article/mood-altering-mushroom-sales-bloom-despite-safety-concerns
2. Barrus DG, Giombi K, Cates SC, Gourdet CK, Peiper NC, Novak SP, et al.
Tasty THC: Promises and Challenges of Cannabis Edibles.* RTI Press*. 2016.
No. OP-0035-1611. https://doi.org/10.3768/rtipress.2016.op.0035.1611
<https://www.rti.org/rti-press-publication/tasty-thc-promises-challenges-cannabis-edibles>
3. Huff JS, Melnick ER, Tomaszewski CA, Thiessen MEW, Jagoda AS, Fesmire
FM, et al. Clinical Policy: Critical Issues in the Evaluation and
Management of Adult Patients Presenting to the Emergency Department with
Seizures. *Ann Emerg Med*. 2014. 63(4): 437-47.e15.
https://doi.org/10.1016/j.annemergmed.2014.01.018
<https://linkinghub.elsevier.com/retrieve/pii/S0196064414000808>
4. Santillanes G, Luc Q. Emergency Department Management of Seizures in
Pediatric Patients. EB Medicine Pediatr Emerg Med Pract. 2015. 12(3): p.
1-25. https://www.ebmedicine.net/topics/neurologic/pediatric-seizures

*The Centers for Disease Control and Prevention (CDC) protects people's
health and safety by preventing and controlling diseases and injuries;
enhances health decisions by providing credible information on critical
health issues; and promotes healthy living through strong partnerships with
local, national, and international organization.*
------------------------------

*Categories of Health Alert Network messages*
*Health Alert* Conveys the highest level of importance about a public
health incident.
*Health Advisory* Provides important information about a public health
incident.
*Health Update* Provides updated information about a public health incident.

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