The Tox Lab

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/10.1080/15563650.2025.2507357

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2838765

https://www.health.nsw.gov.au/sabs/Documents/2024-sn-015.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 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%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 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.70024

https://pmc.ncbi.nlm.nih.gov/articles/PMC11312422/

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 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%200pubmed

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 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.aspx

https://jamanetwork.com/journals/jama/article-abstract/2821502

https://www.bmj.com/content/383/bmj.p2506.full

https://pmc.ncbi.nlm.nih.gov/articles/PMC10739421/

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 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/10.1080/15563650.2025.2474563

Mass 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.2024.1260

Editor’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_lab

Email us here: [email protected]

This week on The Tox Lab, we’re talking about 2C-B and “Tusi” — two drugs often confused, but very different in composition and effects.

We explore Dutch Poison Information Centre data on 2C-B, examining reported exposures and the spectrum of effects across low, moderate, and high doses. We then turn to casework from the Miami-Dade Medical Examiner Toxicology Laboratory to look at “Tusi” (also known as Tucibi or pink cocaine), discussing what’s actually found in these samples and what this means for interpretation.

Join us as we untangle the realities behind these two commonly misunderstood substances.

Hope you enjoy!

Links to the papers we discussed:

https://www.sciencedirect.com/science/article/abs/pii/S019606442030278X#:~:text=Conclusion,addition%20to%20mild%20somatic%20effects

https://onlinelibrary.wiley.com/doi/epdf/10.1111/1556-4029.70012

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 ibogaine — a plant-derived alkaloid attracting interest as a potential treatment for addiction.

We discuss a study from New Zealand exploring its use in opioid dependence, while also highlighting the serious risks reported in case studies, including severe cardiotoxicity. We then turn to National Poisons Information Service data to examine recent trends in ibogaine use in the UK.

Can the therapeutic potential of ibogaine ever outweigh its dangers? Join us as we unpack the evidence, the risks, and the unanswered questions around this compound.

Hope you enjoy!

Link to the papers we discussed:

https://www.tandfonline.com/doi/10.1080/00952990.2017.1310218?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

https://www.tandfonline.com/doi/full/10.1080/15563650.2024.2447500#:~:text=Our%20cases%20are%20consistent%20with,of%20cardiac%20output%20and%20arrest

https://onlinelibrary.wiley.com/doi/full/10.1002/joa3.12061

https://erowid.org/experiences/exp.php?ID=63089

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 diving into the surprising sides of nicotine.

Beyond its well-known risks, we explore how nicotine might have therapeutic potential in conditions like schizophrenia and dementia—where deficits in nicotinic acetylcholine receptors could play a role. We also discuss the MIND study, which is testing whether nicotine can boost memory, attention, and learning in dementia patients.

Then, we turn to the other side of the story—nicotine as a poison—examining U.S. poison centre data on exposures in children, and what trends and outcomes tell us about the risks.

From possible medicine to dangerous toxin, join us as we explore the full spectrum of nicotine’s impact.

Hope you enjoy!

Links to papers we discussed:

https://pmc.ncbi.nlm.nih.gov/articles/PMC9020415/

https://pmc.ncbi.nlm.nih.gov/articles/PMC10854606/

https://clinicaltrials.gov/study/NCT02720445

https://publications.aap.org/pediatrics/article/156/2/e2024070522/202640/Nicotine-Ingestions-Among-Young-Children-2010-2023?autologincheck=redirected

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 BTMPS.

A compound used as a light stabiliser in plastics, BTMPS unexpectedly surfaced in the U.S. drug supply in the summer of 2024.

We unpack what’s known so far about its emergence, discuss possible reasons for its appearance, and revisit earlier research exploring its activity at nicotinic acetylcholine receptors and signs of cardiotoxicity in animal models.

Join us as we examine what makes this compound so unexpected—and why it’s raising eyebrows in toxicology.

Hope you enjoy!

Links to the papers we discussed:

https://jamanetwork.com/journals/jama/fullarticle/2829939

https://www.sciencedirect.com/science/article/abs/pii/S0376871625002169?via%3Dihub

https://www.cfsre.org/nps-discovery/public-alerts/an-update-on-the-presence-of-btmps-in-the-drug-supply-and-the-discovery-of-tetramethylfentanyl-related-substances#:~:text=in%20April%202025%20and%20since,acquisition%20of%20standard%20reference%20material

https://academic.oup.com/toxsci/article-abstract/77/2/368/1678969?redirectedFrom=fulltext

https://www.sciencedirect.com/science/article/abs/pii/S0028390809003141?casa_token=Fhh1rnqcuBcAAAAA:YpFG5go4VuiD9gW-cpdH1eipRNS6R104T68cuhwSF-wyp7piS8yp_UvpCi3wbreT_M82npMYVrE4

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]