The Tox Lab

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...

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 p...

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...

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 co...

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 al...

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 kno...

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 re...

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...

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 cardiotoxicit...

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 ho...

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...

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 wit...

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 foren...

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 o...

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 presentat...

Why is chocolate dangerous for dogs? What makes lilies so toxic to cats? In this episode of The Tox Lab, we explore the fascinating (and sometimes surprising) toxicology of common substances that can harm our pets. From household foods to ornamental plants, we break down the mechanisms behind these poisons, species-specific sensitivities, and what clinicians, pet owners, and toxicologists need to...

This week, we dive into the European Drug Report 2025, breaking down the latest data on drug trends across Europe. From rising cocaine detections and shifting cannabis use patterns to ongoing concerns around heroin, MDMA, synthetic stimulants, and the growing presence of novel psychoactive substances — we explore the substances making headlines and what they mean for toxicologists, clinicians, and...

In this episode, we dive deep into the world of methamphetamine enantiomers—those chemically identical but biologically distinct mirror-image molecules. We examine a paper that looks at the suitability of the 20% D-methamphetamine cutoff used to indicate illicit methamphetamine use in the US, and some of the challenges associated with enantiomer testing. We also break down the differential respira...

In this week's episode, we explore the growing world of delta-8 THC—how it compares to delta-9 THC, what recent research reveals about its effects when consumed orally, and what those differences might mean for users. We also discuss a pediatric case involving the accidental ingestion of delta-8 THC gummies, highlighting the clinical presentation, management, and the testing challenges that can ar...

What started as routine lab work led to one of the most iconic bike rides in scientific history. In this episode, we dive into the story of Albert Hofmann and the accidental discovery of LSD, tracing the events of the first intentional trip—now known as Bicycle Day. We explore LSD’s early promise in psychiatry, its rise as a recreational drug, and the reasons behind its prohibition. Finally, we ex...

In this week’s episode, we explore the evolving role of ketamine in clinical practice—from its antidepressant effects in treatment-resistant depression to its potential use in opioid use disorder. But therapeutic promise comes with toxicologic concerns. We take a closer look at the consequences of chronic ketamine use, including ketamine use disorder, cognitive and urinary complications, and the b...

In this week’s episode, we explore the expanding role of SARMs in the performance-enhancing drug landscape. Often marketed in “research-only” products, these compounds are anything but risk-free. We delve into a recent systematic review outlining their adverse effects and take a closer look at a compelling case study of drug-induced liver injury and rhabdomyolysis linked to SARM use. Tune in as we...

In this week's episode, we turn our focus to mitragynine and 7-hydroxymitragynine, the primary active components of kratom. We explore what these alkaloids are, how they behave post-mortem, and what we know about their stability in biological matrices. We also discuss the evidence around 7-hydroxymitragynine’s role in respiratory depression, and the growing concern around kratom products in the U....

In this week’s episode, we delve into the growing issue of adulterated vapes. We explore a study uncovering synthetic cannabinoid receptor agonists (SCRAs) in THC vape products, and anabolic-androgenic steroids in e-cigarette cartridges seized from Scottish prisons. Join us as we unpack the toxicology behind these substances and what this emerging trend could mean for public health and the future...

In this week's episode, we discuss a couple of interesting case reports including a case series on 'Death Coffee' and a complex suicide case involving penconazole. Hope you enjoy! Links to papers we discussed: https://onlinelibrary.wiley.com/doi/10.1002/npr2.70013 https://clinicaterapeutica.it/ojs/index.php/1/article/view/1195/812 Disclaimer: All opinions are our own. Find us on instagram: @the_to...