The Tox Lab

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_lab

Email 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.2026.015

https://www.sciencedirect.com/science/article/pii/S0956713525002221?via%3Dihub

https://www.sciencedirect.com/science/article/abs/pii/S1752928X21000378?via%3Dihub

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email 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/s42238-021-00061-5

www.pnas.orgcgidoi10.1073pnas.0511232103

https://pmc.ncbi.nlm.nih.gov/articles/PMC11063694/

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email 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_lab

Email 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/m0021qsl

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email 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/10.1080/15563650.2023.2218029

https://pmc.ncbi.nlm.nih.gov/articles/PMC4294106/pdf/bph0171-4808.pdf

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email 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_lab

Email 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_lab

Email 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/S0955395925002427

https://www.sciencedirect.com/science/article/pii/S0955395925003949

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email 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/S037907382500324X

https://onlinelibrary.wiley.com/doi/10.1155/2015/917869

https://journals.sagepub.com/doi/10.1177/00258024211020936?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

https://www.nejm.org/doi/full/10.1056/NEJMc2313463

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]