The Poison Lab

In Episode 5, we put the morel mushroom on trial. This bonus episode shows how we built the case.

Dr. Grant Comstock joins me for the full, unfiltered causation breakdown using the Bradford Hill criteria, a public health framework used to separate true causation from simple association. We walk through the CDC data step by step, looking at strength of association, timing, dose response, plausibility, consistency, specificity, and the places where the morel theory starts to strain.

This is the deeper dive behind the trial: how toxicologists stress-test an outbreak theory when there is no smoking gun, no known toxin, and no easy answer.

Select references

1. CDC Bozeman Montana Outbreak Data
2. Ryan's paper on the Bradford hill criteria in EVALI

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The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

• Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

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In this bonus episode, we go deeper into the public health machinery behind a mass poisoning investigation.

Dr. Michael Yeh, a medical toxicologist at the CDC’s National Center for Environmental Health, explains how the CDC gets pulled into unusual outbreaks, how poison centers and health departments help spot early signals, and what happens once a local cluster starts looking like something bigger.

We also explore several real-world investigations, from lead-contaminated applesauce to synthetic cannabinoid poisonings to Diamond Shruumz chocolate products, and ask a practical question: when something strange is happening, who do you call?

This is a behind-the-scenes look at the systems, people, and detective work that help identify poisoning outbreaks before they spread.

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The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

• Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

• Email: [email protected]

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In this bonus episode, Dr. Rob Bassett from Philadelphia Poison Control walks us through one of the most useful teaching tools in mushroom toxicology: GOTTA PICCEM.

This mnemonic organizes toxic mushrooms by their clinical syndromes and, most importantly, by the timing of symptom onset. That timing can be one of the biggest clues toxicologists use to decide whether a mushroom exposure is likely to be mild, dangerous, or potentially life-threatening.

Dr. Bassett is a gifted educator, and in this episode he breaks down the major mushroom toxins in a way that is practical, memorable, and useful for anyone who might someday need to recognize a serious mushroom poisoning.

Select Resources:

1. Richard Hamilton's Original Mnemonic

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• Full book reading (6 minutes!)

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Who actually treats mushroom poisoning?

In this short mini episode, we answer a surprisingly important question: when someone gets sick after eating a mushroom, who do they call, and who helps the doctors figure out what to do next?

We break down the role of poison centers, medical toxicologists, emergency clinicians, and why the most important number to remember is 1-800-222-1222.

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• Full book reading (6 minutes!)

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This bonus episode takes a deeper look at the muscarine poisoning case discussed by Dr. Matthew Stanton. We break down how muscarine causes toxicity, why its symptoms can become life-threatening, and why its important for foragers to recognize so they can be treated.

Select References:

1. Dr. Stanton's case report
2. Wisconsin Muscarine Case Series (Not yet available)

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• Full book reading (6 minutes!)

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As reports of severe illness and death come in, the Bozeman outbreak moves from medical mystery to full public health investigation. Local and state investigators race to identify the source, shut down the risk, interview patients, collect food samples, and figure out whether anyone else could still be in danger.

The early signal points toward one unlikely ingredient: morel mushrooms. But for toxicologists, that raises more questions than answers. Morels are supposed to be edible. Rapid vomiting and diarrhea usually suggest foodborne illness, not a deadly mushroom poisoning. So investigators have to ask the question that will drive the rest of the series: is the morel really the culprit, or is something else hiding in the meal?

In Episode 2 of A Morel Dilemma, we meet the public health team on the front lines, hear how the outbreak was contained, and begin testing the first theories behind what made diners so sick.

Select references:

1. False Morel Text Book
2. FDA Survey of Imported Mushrooms Contamination with Toxic Species
3. Dr. Vohra' study
4. Bonus Episode on Remembering Toxic Mushrooms
5. Dr. Stanton's Muscarine Case
6. Bonus Episode on Muscarine

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A deadly outbreak begins with a single meal at a sushi restaurant in Bozeman, Montana. Within hours, diners develop severe nausea, vomiting, and diarrhea. Some collapse. Two people die. At first, it looks like food poisoning, but investigators quickly notice one strange ingredient connecting many of the sick patients: morel mushrooms.

In the first episode of A Morel Dilemma, we meet the people caught in the earliest moments of the outbreak and begin following the investigation as it unfolds in real time. What starts as a suspected restaurant-associated illness quickly becomes a much stranger question: how could a prized edible mushroom, eaten for centuries, suddenly be linked to death?

This is not a retrospective summary. It is the beginning of a poisoning mystery, told the way investigators experienced it: with urgency, uncertainty, and more questions than answers.

Select references

1. CDC Report on Bozeman Morel Mushroom Outbreak
2. Rat Poison Contaminated synthetic cannabis
3. E cigarette and vaping assosciated lung injury
4. Enoki-Listeria outbreak
5. Aconite outbreak in Canada mentioned in the introduction
6. Arsenic Coffee Pot Poisoning in Maine
7. Leongatha Mushroom Murders

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Available June 3rd- A deadly outbreak begins at a sushi restaurant in Bozeman, Montana. Diners develop rapid, severe gastrointestinal illness. Some collapse. Two people die. And the only clue pointing investigators toward a cause is also the hardest one to believe: morel mushrooms.

A Morel Dilemma is a serialized outbreak investigation from The Poison Lab, following the story in real time as clinicians, toxicologists, public health officials, mycologists, and families try to answer one unsettling question:

How could a prized edible mushroom suddenly be linked to death?

This is a story about poisoning, public health, uncertainty, and the uncomfortable process of discovering that something we thought we understood may be far more complicated than it seemed.

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The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

• Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

• Email: [email protected]

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In this special co-broadcast episode, The Poison Lab joins forces with The Kratom Sobriety Podcast for a deeper conversation about kratom, regulation, addiction, recovery, and what poison center data can tell us about real-world harm.

Kratom is a plant-derived substance that contains mitragynine and 7-hydroxymitragynine, compounds with opioid-like effects. It is sold in many forms, including powders, capsules, drinks, tonics, and concentrated extracts, often in gas stations, smoke shops, and online. For many people, kratom is encountered with little warning about its risks, including dependence, withdrawal, and toxicity.

This episode grew out of our newly published study in Addiction, which examined kratom-related poison center calls across states with different legal approaches: states with bans, states with kratom consumer protection acts, and states with no specific regulation.

The study began with a real policy question in Wisconsin: is the public better protected by prohibition, by regulated access, or by leaving kratom largely unregulated? As clinical toxicologists and poison center clinicians, our goal was not to write policy, but to add objective data to a debate that often moves faster than the evidence.

Ryan discusses how that question led to a broader debate within medical toxicology and poison center circles: What are the harms of prohibition? What are the risks of unfettered access? Is regulation safer than a ban? And what can poison center data actually tell us about those questions?

After the study was published, people reached out from several directions: journalists, policymakers, people concerned about the risks of prohibition, and people who had experienced harm from easy access to kratom. That included the team behind The Kratom Sobriety Podcast, who wanted to talk about the study and the lived experience of kratom dependence and recovery.

The conversation highlights both the data and the human side of the issue: people who developed kratom dependence, struggled to stop, and found their way into recovery. The episode explores why policy decisions around kratom are so difficult, why easy access to opioid-like substances can be dangerous, and why lived experience matters alongside epidemiologic data.

• What kratom is and why it is often called a “gas station drug”
• Mitragynine, 7-hydroxymitragynine, and opioid-like effects
• Kratom dependence, withdrawal, and recovery
• How poison centers track emerging substances
• Differences between state bans, consumer protection acts, and unregulated access
• What poison center data can and cannot tell us
• Why kratom policy is more complicated than “ban it” versus “leave it alone”
• The importance of listening to people with lived experience

This episode is a longer-form conversation about science, policy, toxicology, and recovery. It is not medical advice, and it is not meant to tell any individual person what they should do. But it is meant to bring more evidence, nuance, and humanity into a debate that needs all three.

If you or someone you know is struggling with kratom or any substance use, help is available. In the United States, you can contact the SAMHSA National Helpline at 1-800-662-HELP.

Extras

1. Free to read version of the study

News articles about the study

1. US Kratom Use Surges 65-Fold in 13 Years
2. Calls to poison centers over 'natural' supplement have skyrocketed by 6,500% since 2010
3. Kratom Use Soars in US, Alters Lives Dramatically | Mirage News
4. Kratom use is surging in the US, with life-changing consequences, study reveals
5. Kratom use is surging in the US, with life-changing consequences | EurekAlert!

In this episode of The Poison Lab Outbreak, Ryan talks with Dr. Alaina Steck about a devastating mass poisoning in Mozambique that began at a funeral and ultimately sickened more than 200 people, with a fatality toll of over 70.

Early reports blamed crocodile bile. Others suspected intentional poisoning. But as the investigation unfolded, the clinical picture, timeline, and exposure history did not fit neatly with the early theories.

Dr. Steck, then a medical toxicology fellow at Emory, joined a CDC-supported outbreak investigation team sent to Mozambique. She walks through what it was like to investigate the outbreak on the ground, including the overwhelmed rural health center, limited medical records, scarce biological and environmental samples, early toxicologic hypotheses, and the eventual role of comparative food testing in identifying the cause.

This episode explores the real-world uncertainty of outbreak investigation: incomplete data, competing theories, community fear, and the importance of epidemiology, toxicology, public health, and analytical chemistry working together.

• Mass poisoning investigation in rural Mozambique
• Early reports of crocodile bile and suspected intentional poisoning
• Clinical presentations including GI symptoms, seizures, pulmonary edema, liver injury, kidney injury, and multisystem disease
• Challenges of interpreting sparse medical records during a mass casualty event
• How toxicologists approach possible intentional poisoning
• Why exposure history and timing matter in outbreak investigation
• The importance of control samples in analytical testing
• Lessons for clinicians, poison centers, and public health teams

Dr. Alaina Steck

Medical toxicologist, Emory University

Former medical toxicology fellow involved in the CDC-supported investigation of the Mozambique outbreak

1. Outbreak paper
2. U.S. Case

Instagram @tox_talk • Twitter @LabPoison • Email [email protected]

Disclaimer: The Poison Lab is for educational purposes only and does not provide medical advice. If you suspect a poisoning, contact your local poison center. In the U.S., call 1-800-222-1222.

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• Ad free episodes
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The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

• Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

• Email: [email protected]

More Show Resources

• Ryan's Medical Games and Resources
• Show Website