The Tox Lab

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

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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.

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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-n9t5ECBcZIAn9EM4ia88JllcRLiCinRKSrG5LRy3D94

Disclaimer: All opinions are our own.

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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.pdf

https://pmc.ncbi.nlm.nih.gov/articles/PMC3495276/pdf/fgene-03-00235.pdf

https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/dta.2605 

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

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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.

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Bonus Episode: EUDA European Drug Report 2026 Livestream

This 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_en

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

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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_lab

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Check out our new website: https://thetoxlab.co.uk/

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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/

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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_lab

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Check 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_lab

Email us here: [email protected]

Support us here: https://buymeacoffee.com/thetoxlab