More than 40 people in the Tampa Bay area have been hospitalized with severe bleeding after smoking synthetic cannabis products that may have been laced with rat poison. Cases have been increasing over the past few weeks, and two patients have now died, Gizmodo reports.

While there is some confusion as to exactly what the drugs have been spiked with in order to cause such awful side-effects, Alfred Aleguas, co-managing director at the Tampa Florida Poison Control Information Center, told 10 Tampa Bay that some samples appear to be “contaminated with rodenticide.”

Often referred to as Spice or K2, synthetic cannabis usually consists of herbs that have been sprayed with chemicals that mimic the effects of natural cannabinoids. While these products are not illegal in some states, they are not properly regulated and are therefore subject to contamination or inadequate quality control.

In the past, drugs in this class have been linked to psychosis and addiction, as well as an alarming outbreak of severe bleeding that began in Illinois in 2018 and went on to affect 324 people across 11 states, resulting in eight deaths. In that instance, the tainted drugs were found to contain a type of rat poison called brodifacoum, which inhibits blood clotting by depleting the body’s vitamin K reserves.

In an interview with News Channel 8, Alegues explained that “if you happen to cut yourself shaving, then you know how that would usually clot in a minute or two? [if you ingest brodifacoum] it would bleed for hours.”

Sadly, the same anticoagulant rat poison appears to be linked to the current outbreak, which is yet to spread beyond the Hillsborough County area. Victims presenting at emergency rooms across the county have displayed symptoms such as heavy nosebleeds, excessive menstrual bleeding and blood in their urine or stool.

While it’s unclear exactly how the rat poison found its way into these products or whether the contamination was deliberate, it is thought that some drug dealers choose to lace substances with rodenticides in an attempt to increase the potency and prolong the effects of their merchandise.

Florida Poison Control has deployed expert toxicologists to assist in hospitals dealing with affected patients, most of whom are being treated with a course of vitamin K. Recovery, however, can be a lengthy process lasting for several months, and local health officials are advising anyone showing symptoms to contact the emergency services immediately.