The Tox Lab

This week on The Tox Lab, we're taking a closer look at one of the most challenging parts of toxicology: interpreting the results.If we give you a number, can you tell us what it means?We begin by exploring why interpreting a toxicology result is rarely as simple as comparing a concentration with a reference value. We discuss the range of clinical, analytical, pharmacological, and contextual information needed to understand what a result actually means, as well as the biases that can influence the way toxicology results are interpreted.We then turn to recent published work evaluating the performance of AI and large language models in toxicology interpretation. Can these tools accurately interpret toxicology results, or do they reflect the same pitfalls seen when results are considered without sufficient clinical context? We explore some of the common errors and limitations reported in the literature when AI is applied to toxicology result interpretation.Finally, we examine the use of reference intervals in toxicology and ask whether they can really help clinicians interpret drug concentrations. We discuss why reference intervals are not always straightforward and why context matters when deciding whether a toxicology result is clinically significant.Join us as we explore the complexities of toxicology result interpretation, the risks of relying on numbers without context, and whether AI could actually help us make sense of toxicology results.Hope you enjoy!Links to the papers we discussed:https://www.tandfonline.com/doi/full/10.1080/15563650.2026.2698028https://www.sciencedirect.com/science/article/pii/S0379073826001052?via%3Dihub https://pmc.ncbi.nlm.nih.gov/articles/PMC13152082/ Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we're taking a closer look at fentanyl, exploring its clinical use, toxicological risks, and the analytical challenges associated with detecting and interpreting fentanyl exposure.We begin by examining fentanyl patch-related deaths reported in England, Wales and Northern Ireland, including cases highlighted through Prevention of Future Deaths reports. We discuss how fentanyl patches can contribute to fatal toxicity and consider what these cases can tell us about preventing future deaths.We then turn to the laboratory, exploring fentanyl immunoassay cut-offs and why the concentration used to define a positive result matters. We discuss the importance of understanding and clinically assessing analytical cut-offs in different toxicological scenarios, rather than treating a single threshold as universally applicable.Finally, we examine 4-ANPP, a minor metabolite of fentanyl that is also an important precursor and impurity associated with illicit fentanyl manufacture. We explore whether detecting 4-ANPP could help distinguish between exposure to pharmaceutical fentanyl and illicitly manufactured fentanyl, and consider the challenges in interpreting this marker.Join us as we explore fentanyl toxicity, analytical interpretation, and the challenges of distinguishing different sources of fentanyl exposure, and consider what these findings mean for clinical and forensic toxicology.Hope you enjoy!Links to the papers we discussed:https://bpspubs.onlinelibrary.wiley.com/doi/10.1002/bcp.70525 https://academic.oup.com/jat/article-abstract/50/5/bkag025/8658822?redirectedFrom=fulltext https://academic.oup.com/jat/article-abstract/50/3/bkaf111/8415903?redirectedFrom=fulltext Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we're diving into the world of absinthe, the infamous "Green Fairy".We begin by exploring what absinthe actually is, from its botanical origins and traditional preparation to its rise in popularity and the myths that eventually surrounded it. We discuss why absinthe became associated with hallucinations, madness, and toxicity, and how these stories contributed to its controversial reputation and prohibition.We then turn to the toxicology of absinthe and examine thujone, the compound often identified as the toxin responsible for "absinthism". We explore how thujone affects the central nervous system, what the evidence actually tells us about thujone toxicity, and whether reported cases of absinthe-related illness can really be attributed to the compound itself. We also take a closer look at what is known about thujone exposure and toxicity in general, discussing how neurological symptoms can arise at high doses and why interpreting reports of adverse effects is challenging when modern toxicological data is limited or based on experimental models rather than real-world exposure.Finally, we bring these threads together by separating fact from fiction, unpacking some of the most persistent myths surrounding absinthe, including whether it truly causes hallucinations and what ultimately led to its bans in many countries.Join us as we explore the chemistry, pharmacology, and toxicology of absinthe, and ask whether the notorious "Green Fairy" really deserved its dangerous reputation, or if its legacy is more myth than science.Hope you enjoy!Links to papers we discussed:https://pmc.ncbi.nlm.nih.gov/articles/PMC1475830/ https://ift.onlinelibrary.wiley.com/doi/epdf/10.1111/1750-3841.14273 Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we're taking a look at the dark side of decongestants and exploring how seemingly harmless over-the-counter nasal sprays and eye drops can cause severe toxicity.We begin by discussing the pharmacology of imidazoline decongestants, including their effects on alpha-adrenergic receptors and how systemic exposure can lead to cardiovascular and central nervous system toxicity.We then examine a fatal case involving xylometazoline, in which exposure was associated with a haemorrhagic stroke. We explore the possible mechanisms underlying this rare but serious complication, including the effects of sympathomimetic decongestants on vascular tone and blood pressure.Finally, we turn to tetrahydrozoline, an ingredient found in products such as Visine eye drops and some nasal decongestants. We discuss accidental and intentional ingestions, severe bradycardia, hypotension, CNS depression, and cardiac conduction abnormalities, as well as the challenges associated with recognising and detecting tetrahydrozoline toxicity. We also explore the darker forensic history of tetrahydrozoline, including its involvement in cases of drug-facilitated sexual assault and murder, and consider why the role of these compounds in unexpected deaths and criminal investigations may be underestimated.Join us as we examine how everyday over-the-counter decongestants can cause coma, profound cardiovascular toxicity, and even death, and explore the toxicological and forensic challenges posed by compounds that are not routinely included in standard drug screening.Hope you enjoy!Links to the papers we discussed:https://onlinelibrary.wiley.com/doi/abs/10.1111/1556-4029.15416 https://link.springer.com/article/10.1007/s12024-023-00680-9 https://pmc.ncbi.nlm.nih.gov/articles/PMC8118060/ Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we're diving into wastewater-based epidemiology and exploring how wastewater analysis can be used to monitor drug use and emerging drug trends.We begin by discussing the UK national wastewater analysis programme and examining what wastewater data revealed about the use of commonly encountered recreational drugs in 2022. We explore what these measurements can tell us about population-level drug use and how wastewater analysis can provide a different perspective from more traditional sources of toxicological data.We then turn to the use of wastewater analysis for monitoring novel psychoactive substances, discussing the detection of emerging compounds including nitazenes and xylazine.Finally, we examine the recent detection of N-propionitrile chlorphine, also known as cychlorphine, in wastewater in the United States. We discuss what these findings may tell us about the emergence of this novel synthetic opioid and the potential for wastewater monitoring to identify new substances as they begin to appear in the illicit drug supply.Join us as we explore how wastewater analysis is being used to monitor drug use, track emerging synthetic opioids and novel psychoactive substances, and consider whether wastewater could play an increasingly important role in early warning systems, harm reduction, and public health.Hope you enjoy!Links to papers we discussed:https://onlinelibrary.wiley.com/doi/10.1111/add.70398 https://pubs.acs.org/doi/10.1021/acsestwater.5c01173?ref=PDF https://pmc.ncbi.nlm.nih.gov/articles/PMC12319643/ https://pubs.acs.org/doi/10.1021/acs.estlett.6c00529 Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we're discussing silver toxicity and the toxicological consequences of using silver outside its established medical applications.We begin by exploring the legitimate uses of silver in medicine, including wound dressings, topical preparations, and antimicrobial coatings on medical devices. We then turn to the claims surrounding colloidal silver, including its promotion as a treatment for a wide range of conditions despite a lack of evidence supporting many of these uses.We then examine argyria, a condition caused by the accumulation of silver in the body that can lead to permanent blue-grey discolouration of the skin. We discuss the case of Paul Karason, better known as "Papa Smurf", and explore how his use of colloidal silver made him one of the most recognisable examples of the potential consequences of long-term silver exposure.Finally, we examine a case of severe anaemia associated with colloidal silver ingestion, discussing the potential mechanisms of toxicity and the challenges of recognising the role of alternative and unregulated products in serious clinical presentations.Join us as we explore the medical uses, alternative claims, and toxicological consequences of silver exposure, and consider how a substance with legitimate applications in medicine can become harmful when used in ways that are not supported by the evidence.Hope you enjoy!Link to papers we discussed:https://jamanetwork.com/journals/jamadermatology/fullarticle/2214158  https://onlinelibrary.wiley.com/doi/10.5694/mja2.52687  https://www.sciencedirect.com/science/article/pii/S221475002300104X?via%3Dihub  Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we're discussing cross-tolerance, focusing on the relationship between benzodiazepines and alcohol.We begin by exploring how alcohol acts at the GABA-A receptor, the neuroadaptations that occur with chronic alcohol use, and why the sudden cessation of alcohol can lead to withdrawal. We then discuss why benzodiazepines are the mainstay of treatment for alcohol withdrawal and the pharmacological basis for their effectiveness.We then turn to the concept of cross-tolerance, examining how long-term alcohol use can influence the response to benzodiazepines, and whether chronic benzodiazepine use provides similar cross-tolerance to the effects of alcohol. We discuss the pharmacological mechanisms underlying these interactions, the similarities and important differences between the two drugs, and why cross-tolerance is only partial.Finally, we consider the clinical implications of these findings, including why combining alcohol and benzodiazepines remains particularly dangerous despite any degree of tolerance.Join us as we examine the pharmacology, clinical toxicology, and misconceptions surrounding benzodiazepine and alcohol cross-tolerance, and consider what these interactions mean for patient care and overdose risk.Hope you enjoy!Link to papers we discussed:https://pmc.ncbi.nlm.nih.gov/articles/PMC3321276/ https://journals.healio.com/doi/10.3928/00485713-20251202-02?__cf_chl_f_tk=QOyw_fXXLTUEXO4ZHEuX5s6eAN_jQeaCPemdwZ_Ygdc-1783254633-1.0.1.1-n9t5ECBcZIAn9EM4ia88JllcRLiCinRKSrG5LRy3D94Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we’re discussing MDMA, examining its pharmacology, toxicity, and the factors that influence individual susceptibility to harm.We begin by exploring how MDMA works, focusing on its effects on serotonin release, reuptake, and signalling, and the pharmacological mechanisms responsible for its desired effects and adverse reactions.We then examine a case of severe MDMA toxicity resulting in hyperthermia and multi-organ failure, discussing the clinical features, management, and the toxicological mechanisms underlying these life-threatening complications.Finally, we turn to the role of the polymorphic enzyme CYP2D6 in MDMA metabolism, examining how genetic variation and MDMA-induced inhibition of CYP2D6 can influence drug concentrations, toxicity, and the risks associated with repeat dosing and drug interactions.Join us as we examine the pharmacology, clinical toxicology, and pharmacogenetics of MDMA, and consider what these findings mean for understanding both its desired effects and its potential harms.Hope you enjoy!Links to the papers we discussed:https://pmc.ncbi.nlm.nih.gov/articles/PMC11470468/pdf/main.pdfhttps://pmc.ncbi.nlm.nih.gov/articles/PMC3495276/pdf/fgene-03-00235.pdfhttps://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/dta.2605 Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we’re discussing grey market peptides and examining the growing interest in these compounds for performance enhancement, recovery, and cosmetic purposes.We begin by exploring peptides linked to musculoskeletal healing, focusing on BPC-157 and the evidence surrounding its proposed effects. We discuss the claims made about these compounds, the current state of the research, and the challenges of separating marketing from scientific evidence.We then turn to melanotan II, examining its pharmacology, patterns of use, and a rare case of priapism associated with its administration.Finally, we discuss the broader risks associated with grey market peptides, including product quality, dosing uncertainty, adverse effects, and the challenges posed by purchasing compounds from unregulated online sources.Join us as we examine the evidence, harms, and controversies surrounding grey market peptides, and consider what their increasing popularity means for toxicology, public health, and consumer safety.Hope you enjoy!Links to the papers we discussed:https://link.springer.com/article/10.1007/s12178-025-09990-7 https://academic.oup.com/smoa/article/9/1/100298/6956707  https://www.health.vic.gov.au/health-alerts/toxicity-linked-to-unapproved-peptide-retatrutide  Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

Bonus Episode: EUDA European Drug Report 2026 LivestreamThis is the recording of our YouTube livestream from the 9th June, where we unpacked the 2026 EUDA Drug Report.Join us as we explore some of the key findings from the report, discuss emerging drug trends across Europe, share our insights, and answer your questions.We hope you enjoy!Link to the 2026 EUDA Drug Report: https://www.euda.europa.eu/publications/european-drug-report/2026_enDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we’re discussing gabapentinoids and examining the use, effectiveness, and toxicological considerations surrounding gabapentin and pregabalin.Originally developed as anti-epileptic medications, gabapentinoids have become widely used for the treatment of neuropathic pain and a range of other conditions. We begin by examining prescribing trends and discussing the evidence surrounding their effectiveness, including whether these drugs are as beneficial as once thought in all patient groups.We then explore some of the adverse effects associated with gabapentinoids and discuss the risks associated with their use alongside other central nervous system depressants, including opioids and benzodiazepines.Finally, we turn to the forensic and toxicological aspects of gabapentinoid use, examining their involvement in driving under the influence of drugs cases and post-mortem investigations. We discuss what these findings tell us about the increasing prevalence of gabapentinoids and their role in drug-related deaths.Join us as we examine the benefits, limitations, and toxicological considerations surrounding gabapentin and pregabalin, and consider what their growing use means for patients and healthcare systems.Hope you enjoy!Links to the papers we discussed:https://pmc.ncbi.nlm.nih.gov/articles/PMC11626918/ https://shmpublications.onlinelibrary.wiley.com/doi/full/10.1002/jhm.70286 https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkag040/8703238?redirectedFrom=fulltext https://www.sciencedirect.com/science/article/pii/S037907382100150X?via%3Dihub Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we’re discussing the life and work of one of the most influential figures in psychedelic chemistry, Alexander “Sasha” Shulgin.From his early career at Dow Chemical to his pioneering work with psychoactive compounds, Shulgin’s career helped shape the modern landscape of psychedelic research.We discuss his fascination with psychedelics, his meticulous approach to self-experimentation, and his synthesis and investigation of hundreds of compounds, including his role in the rediscovery of MDMA and the publication of PIHKAL and TIHKAL.Join us as we examine the science, stories, and controversies surrounding Alexander Shulgin, and consider how one chemist helped shape our modern understanding of psychedelic drugs.Link to Shulgin's laboratory notebooks: https://www.erowid.org/library/books_online/shulgin_labbooks/ Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we’re discussing novel benzodiazepines and examining recent trends in their emergence and detection.We begin by exploring the origins of novel benzodiazepines, including how these compounds have entered the drug market and the factors contributing to their continued appearance.We then turn to a paper from the Society of Forensic Toxicologists (SOFT) Novel Psychoactive Substances Committee, examining trends in novel benzodiazepine detections between 2021 and 2025. We discuss findings from post-mortem investigations, clinical presentations, driving under the influence of drugs cases, and drug-facilitated crime, highlighting the compounds most commonly encountered, including bromazolam, etizolam, and desalkylgidazepam, and how patterns have changed over time.We also explore the analytical challenges associated with novel benzodiazepines, including their detection and identification in toxicology laboratories, the limitations of routine testing, and the difficulties associated with interpreting toxicological findings when limited pharmacological, toxicological, and concentration data are available.Join us as we examine the evolving landscape of novel benzodiazepines, consider the challenges they present for forensic and clinical toxicology, and discuss what these trends may tell us about the future of the drug market.Hope you enjoy!Links to the paper we discussed:https://academic.oup.com/jat/advance-article/doi/10.1093/jat/bkag026/8662327?searchresult=1 https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkag027/8663758?redirectedFrom=fulltext Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we’re discussing kava and examining its history, use, and potential toxicological effects.We begin by exploring the history of kava and its longstanding cultural and social significance, before discussing reported benefits associated with its use and the reasons it continues to gain popularity.We then turn to potential harms associated with kava, examining cases of acute liver injury and acute interstitial nephritis linked to its use, before discussing a fatal case involving kava ingestion and the toxicological considerations surrounding these reports.Join us as we examine the evolving story surrounding kava, from its traditional use and perceived benefits to the clinical and toxicological challenges associated with its increasing use.Links to the papers we discussed:https://pmc.ncbi.nlm.nih.gov/articles/PMC12405834/pdf/DAR-44-1601.pdf https://doi.org/10.1155/crgm/3914876 https://onlinelibrary.wiley.com/doi/10.1111/nep.70051 http://dx.doi.org/10.1016/j.forsciint.2015.01.032 Check out our new website: https://thetoxlab.co.uk/Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we’re discussing poison dart frogs and the alkaloid epibatidine.We begin by examining recent reports surrounding the death of Alexei Navalny and the suggestion that epibatidine may have been involved.We then discuss poison dart frogs and the toxins found within them, including the discovery and isolation of epibatidine. From there, we explore its potent analgesic properties, how it acts at nicotinic acetylcholine receptors, and what makes it both pharmacologically interesting and highly toxic.Finally, we examine attempts to develop epibatidine analogues as novel analgesics and explore the evolutionary question of how poison dart frogs themselves avoid poisoning.Join us as we examine the pharmacology, toxicity, and evolving story surrounding epibatidine, and consider how a toxin derived from poison dart frogs became linked to drug development, toxicology, and international headlines.Hope you enjoy!Links to the papers we discussed:https://www.gov.uk/government/news/joint-statement-by-the-uk-sweden-france-germany-and-the-netherlands-on-alexei-navalnys-deathhttps://pubs.rsc.org/en/content/articlelanding/2000/np/a900728h https://www.science.org/doi/epdf/10.1126/science.aan5061 Check out our new website: https://thetoxlab.co.uk/Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we’re back with a long-awaited update on novel synthetic opioids.We begin by discussing the April 2026 UNODC announcement on the increasingly varied forms in which synthetic opioids are being encountered, including vapes, powders, and counterfeit tablets marketed as benzodiazepines, oxycodone, and MDMA.We then turn to the emergence of orphine analogues in both the UK and the US, discussing recent reports and trends associated with these compounds.Finally, we examine a clinical case involving N-propionitrile chlorphine (cychlorphine), exploring the toxicological features and the challenges these emerging opioids present for clinicians, laboratories, and public health systems.Join us as we examine the changing landscape of novel synthetic opioids, consider what these developments may mean for toxicology, harm reduction, and public health, and discuss where the market may be heading next.Hope you enjoy!This episode is very kindly sponsored by Cayman Chemical. Check out their Synthetic Opioid Analytical Standards Panel here: https://www.caymanchem.com/product/44436/synthetic-opioid-analytical-standards-panel-1Links to papers we discussed:https://www.unodc.org/LSS/Announcement/Details/973e194e-f8d6-4b4e-8aca-166aaec4ac7c https://www.polizei.bayern.de/aktuelles/pressemitteilungen/100413/index.html https://onlinelibrary.wiley.com/doi/10.1111/dar.70081 https://assets.publishing.service.gov.uk/media/69f3343fab602a88957eef2b/Seventh_addendum_to_the_ACMD_report_on_the_use_and_harms_of_2-benzyl-benzimidazole__nitazene__and_piperidine_benzimidazolone__brorphine-like__opioids_FINAL.pdf https://www.cfsre.org/nps-discovery/public-alerts/increase-in-fatal-overdoses-linked-to-novel-synthetic-opioid-n-propionitrile-chlorphine-cychlorphine https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2594070 Link to our paper on N-pyrrolidino Isotonitazene: https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkag027/8663758?redirectedFrom=fulltext Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we are taking a look at the role of naloxone in risk taking behaviours, harm reduction and disparities surrounding naloxone access. We begin by discussing a study looking at the expansion of naloxone access laws in the United States, exploring whether increased availability is associated with changes in heroin use among adolescents.We then turn to a commentary paper examining the benefits and limitations of educating school children recognise an opioid overdose and administer naloxone.Finally we discuss a paper investigating disparities in naloxone uptake amongst different ethnic and racial groups, and between individuals who inject versus smoke substances. Join us as we explore the impact of naloxone access, education, and disparities, and consider what these findings mean for harm reduction and public health. Hope you enjoy!Links to the papers we discussed:https://www.sciencedirect.com/science/article/abs/pii/S0955395923000294 https://onlinelibrary.wiley.com/doi/abs/10.1111/josh.70089https://pubmed.ncbi.nlm.nih.gov/41428846/Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] us here: https://buymeacoffee.com/thetoxlab

A year after we first took a look at mitragynine (kratom), we are back with an update episode looking at how the landscape surrounding mitragynine is evolving.We begin by examining poison centre data, exploring trends in reported exposures in the US and internationally, and the increase in its use.We then discuss a case involving semi-synthetic mitragynine derivatives, including 7-hydroxymitragynine and mitragynine pseudoindoxyl, highlighting the clinical features including dose escalation, and challenges associated with withdrawal.Finally, we turn to reports of combined use of kratom and kava, and consider how this may influence toxicity and withdrawal.Join us as we examine emerging data, evolving patterns of use, and the clinical implications of mitragynine and its derivatives, and consider what these findings mean for toxicology and public health.Hope you enjoy!If you'd like us to cover an episode on Kava, please let us know in the comments!Links to the papers we discussed:https://www.cdc.gov/mmwr/volumes/75/wr/mm7511a1.htm https://www.cureus.com/articles/467977-severe-early-onset-withdrawal-following-intentional-use-of-mitragynine-pseudoindoxyl-a-case-report-and-emerging-clinical-considerations#!/ https://www.cdc.gov/mmwr/volumes/75/wr/pdfs/mm7512a1-H.pdf https://journals.lww.com/journaladdictionmedicine/abstract/9900/kava_potentiated_withdrawal_in_persons_using.687.aspx Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we’re examining the controversial 2006 Lancet paper on codeine and fatal opioid toxicity in a breastfed infant.We begin by introducing the paper and the case at its centre, in which an infant developed fatal opioid toxicity following exposure to codeine via breast milk.We then explore the proposed mechanism, focusing on the role of CYP2D6 metabolism and how variability in this pathway may lead to higher-than-expected morphine concentrations.We also discuss the limitations and criticisms of the paper, including questions around causality, alternative explanations, and the extent to which pharmacogenetics alone can account for the outcome.Finally, we consider the wider impact of this publication, including changes to clinical guidance, prescribing practices, and the ongoing debate around codeine use in breastfeeding individuals.Join us as we examine the pharmacology, pharmacogenetics, and controversy surrounding this landmark case, and consider what this means for clinical toxicology and patient safety.Hope you enjoy!Links to the papers we discussed:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69255-6/abstract https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00245-X/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140673608612544/abstract https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.1882 Link to the New Yorker Article : https://www.newyorker.com/magazine/2026/02/02/did-a-celebrated-researcher-obscure-a-fatal-poisoning Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] us here: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we’re examining pesticides and their role in toxicology.We begin by discussing a study investigating pesticide exposure in florists, highlighting occupational risks and the potential for chronic low-level exposure.We then turn to a paper analysing pesticide residue levels in commonly consumed fruits, including kiwifruit and bananas, and consider what this may mean for dietary exposure. Finally, we discuss a study examining pesticide-related fatalities in Turkey, exploring the clinical and toxicological features associated with these cases.Join us as we explore the occupational, environmental, and clinical aspects of pesticide exposure, and consider what these findings mean for toxicology and public health.Hope you enjoy!Links to the papers we discussed:https://pmc.ncbi.nlm.nih.gov/articles/PMC5451977/ https://www.sciencedirect.com/science/article/abs/pii/S0273230026000103?via%3Dihubhttps://link.springer.com/article/10.1007/s12024-026-01220-x Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] us on: https://buymeacoffee.com/thetoxlab

This week on The Tox Lab, we continue our discussion on GHB, focusing on its role in forensic toxicology.We begin by examining a study investigating GHB in drug‑facilitated crime in Paris, highlighting patterns of reported incidents and toxicological findings.We then turn to post‑mortem toxicology, discussing the challenges of interpreting GHB concentrations after death and exploring research aimed at distinguishing post‑mortem formation from exogenous intake.Join us as we explore the forensic applications, interpretive challenges, and analytical considerations associated with GHB, and consider how these factors impact casework.This is part two of a two‑part series on GHB. In last week’s episode, we explored patterns of use, harms, and user perspectives.Hope you enjoy!Links to the papers we discussed:https://www.sciencedirect.com/science/article/abs/pii/S0379073825003780?via%3Dihub https://www.sciencedirect.com/science/article/pii/S2589871X24000925?via%3Dihub https://www.sciencedirect.com/science/article/pii/S0379073825001306?via%3Dihub Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re examining GHB, its use, and the harms associated with it.We begin by exploring what GHB is and how it works, before turning to a study from Australia examining trends in use over a 10-year period and the associated increase in harms.We then discuss a qualitative study focusing on GHB use among individuals identifying as heterosexual, exploring patterns of use, motivations, and the ways in which users perceive and navigate risk, harm, and stigma.Join us as we examine the pharmacology, patterns of use, and lived experiences associated with GHB, and consider what these findings may mean for understanding its risks.This is part one of a two-part series. In next week’s episode, we will turn to the forensic aspects of GHB.Hope you enjoy!Links to the papers we discussed:https://onlinelibrary.wiley.com/doi/10.1111/add.70308 https://link.springer.com/article/10.1186/s12954-026-01405-1 Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at poison centre data and how it can be used to identify drug trends and support toxicovigilance efforts.We begin by discussing a study analysing data from six European poison centres in the Netherlands, Freiburg, Austria, Sweden, Switzerland and the UK. The paper examines reports involving the eleven most commonly encountered recreational drugs and highlights how patterns of drug use differ both over time and between countries.We then turn to a study focusing on reports of novel psychoactive substances submitted to several European poison centres in 2021, exploring how these data can contribute to monitoring emerging substances and strengthening drug early warning systems.Join us as we explore how poison centre data can provide valuable insights into drug use trends and play an important role in toxicology surveillance and public health.Hope you enjoy!Links to the papers we discussed:https://www.tandfonline.com/doi/full/10.1080/15563650.2026.2628073 https://www.tandfonline.com/doi/full/10.1080/15563650.2024.2430311 Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at one of the world’s oldest drugs, alcohol, and some of the fatal complications associated with chronic misuse.We discuss several cases that highlight the complex and sometimes unexpected consequences of long-term alcohol use, including hypokalaemic rhabdomyolysis, sudden unexpected death in individuals with alcohol misuse, and a fatal case of delirium tremens.Using these cases, we explore the underlying mechanisms that may contribute to these outcomes and how chronic alcohol use can predispose individuals to severe and potentially fatal complications.Join us as we examine the clinical features, mechanisms, and toxicological considerations surrounding the fatal consequences of chronic alcohol misuse.Hope you enjoy!Links to the papers we discussed:https://www.sciencedirect.com/science/article/pii/S1344622326000556?casa_token=b4hFH3pyA7oAAAAA:f55en_CZh6ea1Wf-hG98mab7NfYlMWcqEy_c7SEyio08hDyy5eTwqwFwcMS029YHfZABlCOiMhQ https://pmc.ncbi.nlm.nih.gov/articles/PMC12665443/ https://journals.sagepub.com/doi/abs/10.1177/00258172261419305 Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re exploring dopamine agonists and their role in the development of impulse-related conditions such as gambling disorder, hypersexuality, and hobbyism.We cover a couple of case studies where dopamine agonists have led to these behavioural changes before discussing a review paper that examines the role of these medications in the development of addiction and gambling disorder.Finally, we turn to the potential legal implications and discuss a High Court judgement examining a breach of duty following the development of impulse control disorder and psychosis during dopamine agonist therapy, and the importance of counselling patients about these risks.Join us as we explore how dopaminergic therapies can influence behaviour, and the clinical and legal considerations that arise when pharmacology intersects with addiction and impulse control.Hope you enjoy!Links to the papers we discussed:https://journals.lww.com/md-journal/fulltext/2021/02120/pathological_gambling_in_a_patient_on_piribedil__a.46.aspx https://link.springer.com/article/10.1007/s40290-022-00453-9 https://pmc.ncbi.nlm.nih.gov/articles/PMC2880944/ https://vlex.co.uk/vid/hazel-kennedy-v-dr-841086105 Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re discussing tetrodotoxin, the potent neurotoxin most commonly associated with pufferfish.We cover a clinical case of tetrodotoxin poisoning following ingestion of pufferfish stew, which initially followed the expected progression of symptoms before the emergence of unusual neurological features. We then turn to alternative sources of tetrodotoxin, including its presence in trumpet shells off the coast of Portugal, and explore how tetrodotoxin and its analogues may appear in unexpected places.Finally, we put our forensic hats on and examine a case in which tetrodotoxin was used in a homicide.Join us as we explore how a well-known marine toxin can present in unexpected ways across clinical and forensic toxicology. Hope you enjoy!Links to the papers we discussed:https://www.signavitae.com/articles/10.22514/sv.2026.015https://www.sciencedirect.com/science/article/pii/S0956713525002221?via%3Dihubhttps://www.sciencedirect.com/science/article/abs/pii/S1752928X21000378?via%3Dihub Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at CBD and its effects on sleep.CBD is widely marketed for insomnia and sleep disturbance, but what does the evidence actually show? In this episode, we begin by examining survey data demonstrating that some individuals report improvements in sleep with CBD use.We then unpack the pharmacology, focusing on CBD’s inhibition of adenosine uptake and how this may influence sleep regulation. We also discuss a randomised controlled trial investigating CBD in insomnia, highlighting findings that may contradict anecdotal evidence. Finally, we propose a mechanism through which CBD may be more beneficial for improving sleep in individuals who consume caffeine.Join us as we explore the intersection of pharmacology, perception, and clinical data, and consider what the current evidence really tells us about CBD and sleep.Hope you enjoy!Links to the papers we discussed:https://link.springer.com/article/10.1186/s42238-021-00061-5www.pnas.orgcgidoi10.1073pnas.0511232103 https://pmc.ncbi.nlm.nih.gov/articles/PMC11063694/Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at monoamine oxidase inhibitors and their interactions with other substances.We begin by revisiting how MAOIs work and why inhibition of monoamine oxidase can create significant risks when combined with other drugs. Using a recent review paper as our guide, we explore reported interactions between MAOIs and commonly used psychoactive substances, and what this means for toxicity and clinical risk.We then turn to emerging research on the psychedelic compound APBT, examining its in vitro and in vivo metabolism and its activity as a potent monoamine oxidase inhibitor. This raises important questions about unrecognised MAOI activity in novel psychoactive substances and the potential for unexpected interactions.Join us as we unpack the pharmacology of MAO inhibition, interaction-driven toxicity, and what this evolving evidence means for clinical and forensic toxicology.Hope you enjoy!Links to the papers we discussed:https://pubmed.ncbi.nlm.nih.gov/41546846/ https://www.sciencedirect.com/science/article/abs/pii/S0300483X26000090?via%3Dihub Link to the article Rob mentioned: https://metro.co.uk/2018/05/16/brieing-is-the-new-cheese-and-mdma-drug-craze-middle-class-women-are-trying-7548127/Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re exploring the stability of nitazenes in post-mortem samples and what this means for toxicological interpretation.We discuss a recent study we have been involved in, from the unusual toxicology findings that first raised questions through to controlled stability experiments in animal models. We also examine data from the National Programme on Substance Use Mortality (NPSUM), highlighting evidence that nitazenes may be under-detected in casework and the challenges this creates for forensic toxicology.Join us as we unpack how stability influences post-mortem results, what this means for detecting nitazenes in real-world cases, and the wider implications for surveillance and forensic practice.Hope you enjoy!Links to the papers we discussed:https://doi.org/10.1080/15563650.2025.2601141 Link to the BBC documentary:https://www.bbc.co.uk/programmes/m0021qslDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at bupropion and its distinctive toxicity profile in overdose.We explore a case of bupropion overdose to examine the often complex clinical presentation, including seizures and cardiovascular complications, as well as the challenges of management and potential longer-term consequences. We then unpack the mechanism underlying bupropion-associated seizures and how these differ from other antidepressants.We also turn our attention to the cardiac effects seen in overdose, focusing on QRS widening, why traditional treatments such as sodium bicarbonate may be ineffective, and what current evidence suggests about the underlying mechanism.Join us as we examine how bupropion behaves in overdose, what makes its toxicology unique, and what this means for clinical management and interpretation.Hope you enjoy!Links to the papers we discussed:https://pmc.ncbi.nlm.nih.gov/articles/PMC12735355/ https://pmc.ncbi.nlm.nih.gov/articles/PMC12281246/ https://www.tandfonline.com/doi/full/10.1080/15563650.2023.2218029https://pmc.ncbi.nlm.nih.gov/articles/PMC4294106/pdf/bph0171-4808.pdf Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at quaaludes and their modern analogues.Once synonymous with a particular era of drug use, quaaludes have largely disappeared from the illicit market. But have they really gone away? We explore the history of methaqualone, how and why it fell out of use, and what has appeared in its place.We then dive into a review examining a wide range of methaqualone analogues, focusing on how these substances are described by users, the variability in their effects, and what this means for interpretation.Join us as we unpack the legacy of quaaludes, the chemistry behind their analogues, and what user experiences can tell us about substances that are often poorly characterised.This episode is very kindly sponsored by Cayman Chemical. Check them out here: https://www.caymanchem.com/ Hope you enjoy!Links to the paper we discussed:https://ejournals.eu/en/journal/amsik/article/review-of-the-experiences-of-users-of-methaqualone-and-methaqualone-derivatives-an-analysis-of-online-forums Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re exploring naloxone and its effectiveness in the context of novel synthetic opioid overdoses.Naloxone remains a cornerstone of opioid overdose management, but the emergence of highly potent synthetic opioids has raised important questions about whether standard approaches are still sufficient. We discuss clinical nitazene exposure data from Australia, examining the concentrations detected in patients and how naloxone was used in these cases.We also review a striking case of occupational carfentanil exposure in a veterinarian, where reversal was achieved with naltrexone. To tie this together, we dive into the pharmacology, exploring what may be happening at the receptor level.Join us as we unpack the clinical data, receptor dynamics, and real-world challenges of managing overdoses in an ever-evolving synthetic opioid landscape.Hope you enjoy!Links to the papers we discussed:https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.13998 https://www.sciencedirect.com/science/article/abs/pii/S0735675710001178?via%3Dihub https://pmc.ncbi.nlm.nih.gov/articles/PMC10912486/ Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re exploring early warning systems and their growing role in toxicology and public health.We break down the core principles that underpin early warning systems, before focusing on how these frameworks are applied to drug early warning systems aimed at identifying emerging substances and harms. We then discuss a recent paper examining the value of incorporating experiential reports from people who use drugs, and how these insights might strengthen surveillance and response efforts.Join us as we unpack how early warning systems are built, what makes them effective, and how listening to lived experience could help detect and prevent harm sooner.Hope you enjoy!Links to the papers we discussed:https://www.sciencedirect.com/science/article/pii/S0955395925002427https://www.sciencedirect.com/science/article/pii/S0955395925003949 Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

Welcome back to The Tox Lab! We are kicking off 2026 by exploring drugs that disrupt metabolism and the consequences that can follow.In this episode, we focus on compounds that alter glucose metabolism and the interplay between toxicology and biochemistry. We discuss a fatal case of metformin toxicity and the analytical and interpretive challenges involved in recognising this diagnosis.We then turn to amphetamine-like weight loss drugs, examining the risks they pose to individuals with diabetes and the evidence linking methamphetamine use to an increased risk of fatal diabetic ketoacidosis. Finally, we explore a case involving SGLT2 inhibitor therapy and unexpected positive urine ethanol results, highlighting the importance of pre-analytical factors and careful interpretation in toxicology.Join us as we unpack how drugs can interfere with metabolic pathways, why these effects matter clinically, and what toxicologists need to consider when metabolism goes wrong.Hope you enjoy!Links to the papers we discussed:https://www.sciencedirect.com/science/article/pii/S037907382500324Xhttps://onlinelibrary.wiley.com/doi/10.1155/2015/917869https://journals.sagepub.com/doi/10.1177/00258024211020936?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmedhttps://www.nejm.org/doi/full/10.1056/NEJMc2313463Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re closing out the year with a festive twist as we explore the link between marzipan, bitter almonds, and cyanide.We take a closer look at the chemistry linking cyanide to almonds and discuss a case of intentional bitter almond ingestion. We then turn to National Poisons Information Service data to examine patterns of cyanide exposure, clinical outcomes, and the antidotes used in management.To round off the episode, we dip into the archives with a historical case report describing thallium poisoning linked to contaminated marzipan, reminding us that even festive treats can carry hidden toxicological risks.Join us for a seasonal deep dive into poisons, cases, and chemistry as we wrap up the year on a sweet but slightly sinister note.Hope you enjoy!We're taking a little break over the festive season but will be back with a brand new episode on the 5th January!Links to the papers we discussed:https://onlinelibrary.wiley.com/doi/10.1002/ccr3.8418https://www.tandfonline.com/doi/full/10.1080/15563650.2022.2080074https://www.tandfonline.com/doi/abs/10.3109/15563659409017979Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at serotonin and its intriguing role in both depression and epilepsy.We review recent data examining the seizure risk associated with different classes of antidepressants and what this means for clinical decision making. We then explore a case report in which sertraline, an SSRI, appeared to have an anti-seizure effect, challenging some long-held assumptions. Finally, we discuss emerging evidence on the potential use of serotonergic therapies in epilepsy management and even in reducing the risk of SUDEP.Join us as we unravel the complex relationship between serotonin, antidepressants, and seizure disorders, and what this evolving evidence could mean for patient care.Hope you enjoy!Links to the papers we discussed:https://www.sciencedirect.com/science/article/pii/S0165032725005853?via%3Dihubhttps://www.seizure-journal.com/article/S1059-1311(20)30145-X/fulltexthttps://pmc.ncbi.nlm.nih.gov/articles/PMC8478129/Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we are examining the growing evidence around cannabis and cardiovascular risk.We start with a recent systematic review and meta-analysis that explores whether cannabis use is linked to higher rates of cardiovascular disease. We break down the strength of the data and discuss what the current evidence can and cannot tell us.We then move onto research investigating how THC and its metabolites affect cardiac myocyte structure and function. These findings offer a possible mechanistic explanation for cardiac dysregulation and may help connect population-level associations with cellular effects.Join us as we unpack the toxicology, the uncertainties, and what this emerging research means for clinicians, researchers, and anyone interested in the evolving science of cannabis and heart health.Hope you enjoy!Links to the papers we discussed:https://heart.bmj.com/content/111/22/1047.longhttps://www.ahajournals.org/doi/10.1161/JAHA.123.030178https://pmc.ncbi.nlm.nih.gov/articles/PMC8835806/pdf/ijms-23-01401.pdfDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re diving into the emerging world of “space oil”, the anesthetic drug etomidate, which has begun appearing in the recreational drug supply across parts of Asia and beyond.We explore several cases involving etomidate vaping, where repeated exposure led to adrenal insufficiency due to its potent inhibition of 11β-hydroxylase. We also discuss a fatal ingestion case, highlighting just how dangerous this drug can become when used outside controlled medical settings.Etomidate’s presence isn’t limited to Asia: it has recently been detected alongside fentanyl in Philadelphia and identified in a handful of UK seizures, raising important questions about its evolving role in the illicit drug market. With emerging analogues starting to surface, the landscape may become even more complex.Join us as we unpack the pharmacology, the clinical consequences, and why etomidate is now a substance toxicologists are watching closely.Hope you enjoy!Links to the papers we discussed:https://www.hkmj.org/system/files/hkmj2412244.pdfhttps://link.springer.com/article/10.1007/s12024-024-00813-8https://hip.phila.gov/document/4686/PDPH-HAN-429U-Etomidate-08.12.2024-1.pdf/https://www.gov.uk/government/publications/acmd-review-of-the-evidence-on-the-use-and-harms-of-etomidateDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at organophosphates, a diverse group of compounds used everywhere from agriculture to chemical warfare.We walk through two real-world poisoning cases: an accidental exposure from a head lice treatment and an intentional ingestion of phorate, illustrating just how wide the spectrum of organophosphate toxicity can be. Along the way, we break down their mechanism of action, why their effects can be so severe, and the key treatment approaches clinicians depend on.We also revisit the Salisbury poisonings, exploring the devastating impact of organophosphate nerve agents and the wider implications for public health and emergency response.Join us as we unpack the chemistry, the clinical realities, and the far-reaching consequences of these powerful compounds.Hope you enjoy!Links to the papers we discussed:https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkaf096/8300174?redirectedFrom=fulltexthttps://www.frontiersin.org/journals/toxicology/articles/10.3389/ftox.2025.1581362/fullDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re exploring a series of fascinating and unusual poisoning cases, each with its own toxic twist.From hair straightening treatments and bearded fireworms to midodrine, isotocyanozene, and sodium azide, we discuss the mechanisms, clinical presentations, and toxicological challenges behind each case.Join us as we unpack what these cases reveal about the diverse and sometimes surprising ways that chemicals and compounds can cause harm. Hope you enjoy!Links to the papers we discussed:https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2577706?src=https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2541702https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2546073https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2528995https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2528990Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re turning our attention inward to errors in toxicology.From calibration and maintenance mistakes to reporting issues and even instances of fraud, we unpack how things can go wrong in the analytical process and what that means for the credibility of our field.We explore the real-world consequences of these errors and most importantly, what we can learn from them to strengthen toxicology as a discipline.Join us for a candid look at accuracy, accountability, and the human side of science.Hope you enjoy!Link to the paper we discussed:https://www.sciencedirect.com/science/article/pii/S2589871X25000580 Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re discussing brorphine — a novel synthetic opioid that briefly appeared on the drug market around 2020.We explore its emergence and pharmacology, including data on its activity at the µ-opioid receptor. We also discuss one of the few documented case studies describing an individual presenting for detoxification following brorphine use. Finally, we review recent research examining its in vitro and in vivo metabolites, highlighting how these findings may offer new ways to detect this short-lived substance.Although brorphine is now under international control, could other “orphine” analogues step into the spotlight, potentially replacing nitazenes as the next wave of synthetic opioids?Join us as we unpack the chemistry, the risks, and what the story of brorphine reveals about the constantly shifting landscape of synthetic opioids.Hope you enjoy!Links to the papers we discussed:https://academic.oup.com/jat/article-abstract/44/9/937/5879253?login=falsehttps://www.sciencedirect.com/science/article/abs/pii/S0379073821003091?via%3DihubDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re celebrating our 50th episode — and one whole year of toxicology talk! 🎉Join us as we look back on some of our most memorable moments from the past year, revisit a few topics with new updates, and share what’s next for The Tox Lab.Whether you’ve been here since episode one or you’re just joining us, thank you for being part of our growing community of toxicologists, scientists, and curious listeners. Here’s to another year of exploring the science behind the substances!Hope you enjoy!Link to ketamine paper we mentioned:https://journals.sagepub.com/doi/10.1177/02698811251373058Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re revisiting one of history’s most infamous poisons — arsenic.Once dubbed the king of poisons, arsenic still poses real risks today. We discuss recent research on arsenic in the water supply and how prenatal exposure may influence birth outcomes in the United States. We also review two unusual cases of intentional elemental arsenic ingestion, exploring the unexpected clinical effects observed, along with a case of chronic arsenic toxicity.Join us as we uncover how this Victorian-era poison continues to challenge toxicologists in the modern world.Hope you enjoy!Links to the papers we discussed:https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2835321https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2496223https://link.springer.com/article/10.1007/s12328-024-02045-3Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re embracing autumn and diving into the fascinating, and sometimes dangerous, world of mushrooms.We explore ten years of mushroom exposure data reported to the UK National Poisons Information Service, examining the species most often involved and the mechanisms behind their toxicity. We also take a look at commercial products containing mushrooms and discuss a paper showing that some may not always contain what they claim.Join us as we unpack the science, the surprises, and the toxicology of mushrooms this autumn.Hope you enjoy!Links to papers we discussed:https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2507357https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2838765https://www.health.nsw.gov.au/sabs/Documents/2024-sn-015.pdfDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at clozapine, a highly effective antipsychotic with a complex toxicological profile.We review a study from Western Sydney examining cases of self-poisoning and adverse drug reactions, discuss a case of chronic clozapine toxicity, and explore new research into its effects on cardiac mitochondria.From clinical outcomes to cellular mechanisms, we unpack the risks, challenges, and unanswered questions around this fascinating but unpredictable drug.Hope you enjoy!Links to the papers we discussed:https://pmc.ncbi.nlm.nih.gov/articles/PMC10522536/https://pmc.ncbi.nlm.nih.gov/articles/PMC11954577/https://www.sciencedirect.com/science/article/pii/S2214750025001088?via%3DihubDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re discussing medetomidine and its unexpected association with hallucinations.We review a recent paper highlighting its emergence in the drug supply and the apparent increase in hallucinatory effects reported with its use. Although medetomidine has been linked to reducing post-operative delirium, we also discuss a case report of dexmedetomidine-induced delirium in a patient with schizophrenia — adding to the complexity of this picture. And yes, we even wonder what dogs might be dreaming about when they come round from their vet visit.We then explore a possible mechanism for these effects, including the hypothesis that activity at the kappa opioid receptor could play a role.We'd love to hear your thoughts on this, so please get in touch!Hope you enjoy!Links to the papers we discussed:https://onlinelibrary.wiley.com/doi/10.1111/dar.70024https://pmc.ncbi.nlm.nih.gov/articles/PMC11312422/Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at diphenidine and other diarylethylamines — a class of drugs that briefly emerged as alternatives to ketamine.We explore their history, reported effects, and the fatalities linked to their use before they faded from the drug scene. With current discussions around reclassifying ketamine, we ask: could diphenidine — or similar substances — make a comeback?Join us as we unpack the toxicology, the risks, and the lessons from their short but impactful appearance.Hope you enjoy!Link to the paper we discussed:https://journals.sagepub.com/doi/10.1177/02698811251349203?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmedDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re diving into the world of GLP-1 receptor agonists, including the well-known weight loss drug Ozempic.We explore how these drugs work and their potential benefits beyond weight loss, including effects on heart health. We then discuss a case of intentional Ozempic overdose, examining the clinical presentation and outcomes.Finally, we turn to the growing problem of counterfeit Ozempic — exploring what’s really in these fake products, why people are taking the risk, and the dangers this trend poses for public health.Join us as we unpack both the promise and the pitfalls of this so-called “miracle” drug.Hope you enjoy!Links to the papers we discussed:https://journals.lww.com/practicalpsychiatry/abstract/2024/11000/clinical_manifestations_of_semaglutide_overdose__a.10.aspxhttps://jamanetwork.com/journals/jama/article-abstract/2821502https://www.bmj.com/content/383/bmj.p2506.fullhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10739421/Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]

This week on The Tox Lab, we’re shaking things up with a case-based mystery episode.We walk through four real-life poisoning cases, starting with how each patient presented and progressed, before revealing the substance behind the toxic effects. Can you solve the puzzle before we uncover the cause?If you like this style of episode, let us know in the comments below! Hope you enjoy!⚠️ Spoiler alert! Links to the papers we discussed:A case of glitter poisoning: https://www.thepoisonjournal.com/articles/severe-glitter-poisoning-case-report Snake firework ingestion: https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2474563Mass Aconite poisoning:https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2526115 - Don't forget to check out The Poison Lab podcast for a deep dive into this case!A case of bromism ingestion after AI advice: https://www.acpjournals.org/doi/10.7326/aimcc.2024.1260Editor’s note: Yes, we mixed up “chloride” with “chlorine” and “bromide” with “bromine.” If you do the same, don’t worry — we’ll cover your case in a future episode.Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected]