CHICAGO (CNN/CBS) — Synthetic cannabinoids — often called Spice, K2 or fake weed — have been tied to 56 cases of severe bleeding, including two deaths across Chicago and areas in central Illinois.

CBS 2 reported that at least one store selling the product has been shut down. And today, three store workers were charged with conspiring to sell the drug.

All of the cases required hospitalization related to coughing up blood, blood in the urine, bloody nose, bleeding gums and other symptoms. Nine cases tested positive for brodifacoum, or rat poison, according to a statement from the Illinois Department of Public Health on Saturday.

Now, state officials are working to identify any common synthetic cannabinoid products related to those cases and to determine where the products were obtained.

“This is the first time we’ve seen an outbreak of this magnitude in the area,” Melaney Arnold, a spokeswoman for the Illinois Department of Public Health, said Monday.

“We’re working with numerous different partners across the city and state as we investigate this outbreak,” she said.

Synthetic cannabinoids are sold in convenience stores, gas stations, drug paraphernalia shops, novelty stores and even online.

Health officials warn that anyone who has a reaction to synthetic cannabinoids immediately should call 911 or be taken to an emergency department.

“Synthetic cannabinoids are unsafe,” Dr. Nirav Shah, director of the Illinois Department of Public Health, said in the statement.

“They can contain a variety of chemicals, and users often don’t know what those are, such as rat poison,” he said. “Despite the perception that synthetic cannabinoids are a safe alternative to marijuana, they can cause very severe illness.”

Though many of the recent cases were tied to synthetic cannabinoid products in the Chicago area, contaminated products could be in counties statewide, the Department of Public Health noted.

The deaths that had been reported was the first seen in Chicago related to fake weed, Arnold said.

“There could be additional deaths coming; it is difficult to say,” she added. “We’re doing whatever we can with regards to outreach to notify any who may be impacted by this outbreak.”

Synthetic cannabinoids, or fake weed, are human-made chemicals that can be sprinkled on dried, shredded plant material and smoked, or can be consumed as vaporized liquids inhaled through an e-cigarette or other device.

These mind-altering chemicals are called cannabinoids, since they are similar to the chemicals found in marijuana, though they can cause serious side effects that are different from those of marijuana.

One study of a synthetic cannabinoid found that it was 85 times as potent as tetrahydrocannabinol, or THC, the mind-altering chemical in marijuana. That study was published in the New England Journal of Medicine in 2016.

People who smoke synthetic cannabinoids can have rapid heart rate, vomiting, agitation, confusion and hallucinations, according to the CDC.

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