The Tox Lab

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: thetoxlab@gmail.com

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: thetoxlab@gmail.com

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: thetoxlab@gmail.com

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: thetoxlab@gmail.com

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: thetoxlab@gmail.com

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: thetoxlab@gmail.com

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%20effectshttps://onlinelibrary.wiley.com/doi/epdf/10.1111/1556-4029.70012Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: thetoxlab@gmail.com

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%200pubmedhttps://www.tandfonline.com/doi/full/10.1080/15563650.2024.2447500#:~:text=Our%20cases%20are%20consistent%20with,of%20cardiac%20output%20and%20arresthttps://onlinelibrary.wiley.com/doi/full/10.1002/joa3.12061https://erowid.org/experiences/exp.php?ID=63089Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: thetoxlab@gmail.com

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/2829939https://www.sciencedirect.com/science/article/abs/pii/S0376871625002169?via%3Dihubhttps://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%20materialhttps://academic.oup.com/toxsci/article-abstract/77/2/368/1678969?redirectedFrom=fulltexthttps://www.sciencedirect.com/science/article/abs/pii/S0028390809003141?casa_token=Fhh1rnqcuBcAAAAA:YpFG5go4VuiD9gW-cpdH1eipRNS6R104T68cuhwSF-wyp7piS8yp_UvpCi3wbreT_M82npMYVrE4Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: thetoxlab@gmail.com

This week on The Tox Lab, we’re taking a closer look at death cap mushrooms following the recent conclusion of the Erin Patterson case.We explore the toxicology of Amanita phalloides, from the mechanism of amatoxins to the clinical course of poisoning and the challenges of treatment. We also look at poison centre data from California to understand how often suspected exposures are reported—and how they present in real-world cases.Join us as we unpack the toxicology of one of the world’s deadliest mushrooms.Hope you enjoy!Linked to the paper we discussed:https://www.tandfonline.com/doi/full/10.1080/15563650.2023.2276674Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: thetoxlab@gmail.com

This week on The Tox Lab, we’re diving into novel nitazene metabolites in post-mortem toxicology.We discuss findings from our own paper identifying metabolites of protonitazene in post-mortem casework, and highlight the variability in metabolites identified and what this might mean for identifying nitazene exposure. We also examine a post-mortem case report on 5-amino and 5-acetamido metonitazene which discusses if their presence may be the result of metabolism or instability within the sample.Join us as we unpack the complexity of interpreting nitazenes in the post-mortem setting.Hope you enjoy!Links to the papers we discussed:https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkaf042/8128869https://academic.oup.com/jat/article-abstract/48/9/691/7747396?login=falsehttps://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkaf070/8203075?redirectedFrom=fulltextDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: thetoxlab@gmail.com

In this week's episode, we’re exploring the role of AI in toxicology. From large language models supporting drug identification to machine learning tools navigating the vast datasets produced by high-resolution mass spectrometry, we look at how artificial intelligence could be integrated into toxicological workflows.We also discuss the limitations — including bias in training data, challenges with messy or incomplete datasets, and the importance of expert oversight in clinical and forensic applications.Join us as we unpack the promise and pitfalls of AI in the evolving world of toxicology.Hope you enjoy!Link to the letter we discussed: https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkaf036/8123742?redirectedFrom=fulltext&login=falseDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: thetoxlab@gmail.com

This week on The Tox Lab, we're diving into the world of α2 adrenergic receptor agonists. We explore how xylazine, when combined with heroin, can both potentiate drug-seeking behaviour after abstinence and attenuate heroin consumption and motivation during use.We also review a study investigating naloxone and atipamezole as potential treatments for fentanyl–xylazine toxicity and examine two forensic case studies detailing tizanidine and medetomidine concentrations to support interpretation in toxicology casework.Join us as we unpack the clinical, toxicological, and forensic implications of this increasingly encountered drug class.Note: In this episode, we mentioned tizanidine acting on imidazole receptors (26:58) when we meant imidazoline receptors!Hope you enjoy!Links to papers we discussed:https://www.sciencedirect.com/science/article/abs/pii/S0091305725000991https://www.tandfonline.com/doi/full/10.1080/29947448.2025.2493044https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkaf056/8165439?redirectedFrom=fulltext&login=falsehttps://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkaf040/8127063?redirectedFrom=fulltext&login=falseDisclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: thetoxlab@gmail.com

This week, we’re talking about the toxic combination of cocaine and alcohol. We explore the formation of cocaethylene, and the role both cocaine and cocaethylene play in arrhythmias and other cardiac complications. We also examine potential mechanisms of liver injury linked to cocaine use—and how alcohol may amplify this effect.Join us as we break down the pharmacology and clinical consequences of this high-risk pairing.Hope you enjoy!Links to the papers we discussed:https://academic.oup.com/jat/article-abstract/43/3/155/5363995?redirectedFrom=fulltexthttps://www.mdpi.com/2077-0383/13/5/1475https://link.springer.com/article/10.1007/s10565-024-09901-5Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: thetoxlab@gmail.com

This week on The Tox Lab, we're taking a closer look at tianeptine—a drug originally developed as an antidepressant, but now making headlines as “gas station heroin” due to its opioid-like effects and increasing misuse across the U.S.We explore a compelling clinical case of high-dose tianeptine withdrawal, examine national poison control data highlighting common symptoms and severity of presentations, and discuss a recent outbreak in New Jersey involving cases of acute toxicity linked to contaminated tianeptine products.Tune in as we break down the pharmacology, patterns of harm, and public health concerns surrounding this emerging substance.Hope you enjoy!Links to the papers we discussed:https://pmc.ncbi.nlm.nih.gov/articles/PMC11254389/https://link.springer.com/article/10.1007/s13181-024-01053-6https://pmc.ncbi.nlm.nih.gov/articles/PMC11933608/Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: thetoxlab@gmail.com