This week on The Tox Lab, we’re examining GHB, its use, and the harms associated with it.

We begin by exploring what GHB is and how it works, before turning to a study from Australia examining trends in use over a 10-year period and the associated increase in harms.

We then discuss a qualitative study focusing on GHB use among individuals identifying as heterosexual, exploring patterns of use, motivations, and the ways in which users perceive and navigate risk, harm, and stigma.

Join us as we examine the pharmacology, patterns of use, and lived experiences associated with GHB, and consider what these findings may mean for understanding its risks.

This is part one of a two-part series. In next week’s episode, we will turn to the forensic aspects of GHB.

Hope you enjoy!

Links to the papers we discussed:

https://onlinelibrary.wiley.com/doi/10.1111/add.70308 https://link.springer.com/article/10.1186/s12954-026-01405-1

Disclaimer: All opinions are our own.

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Email us here: thetoxlab@gmail.com

This week on The Tox Lab, we’re taking a closer look at poison centre data and how it can be used to identify drug trends and support toxicovigilance efforts.

We begin by discussing a study analysing data from six European poison centres in the Netherlands, Freiburg, Austria, Sweden, Switzerland and the UK. The paper examines reports involving the eleven most commonly encountered recreational drugs and highlights how patterns of drug use differ both over time and between countries.

We then turn to a study focusing on reports of novel psychoactive substances submitted to several European poison centres in 2021, exploring how these data can contribute to monitoring emerging substances and strengthening drug early warning systems.

Join us as we explore how poison centre data can provide valuable insights into drug use trends and play an important role in toxicology surveillance and public health.

Hope you enjoy!

Links to the papers we discussed:

https://www.tandfonline.com/doi/full/10.1080/15563650.2026.2628073

https://www.tandfonline.com/doi/full/10.1080/15563650.2024.2430311

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: thetoxlab@gmail.com

This week on The Tox Lab, we’re taking a closer look at one of the world’s oldest drugs, alcohol, and some of the fatal complications associated with chronic misuse.

We discuss several cases that highlight the complex and sometimes unexpected consequences of long-term alcohol use, including hypokalaemic rhabdomyolysis, sudden unexpected death in individuals with alcohol misuse, and a fatal case of delirium tremens.

Using these cases, we explore the underlying mechanisms that may contribute to these outcomes and how chronic alcohol use can predispose individuals to severe and potentially fatal complications.

Join us as we examine the clinical features, mechanisms, and toxicological considerations surrounding the fatal consequences of chronic alcohol misuse.

Hope you enjoy!

Links to the papers we discussed:

https://www.sciencedirect.com/science/article/pii/S1344622326000556?casa_token=b4hFH3pyA7oAAAAA:f55en_CZh6ea1Wf-hG98mab7NfYlMWcqEy_c7SEyio08hDyy5eTwqwFwcMS029YHfZABlCOiMhQ

https://pmc.ncbi.nlm.nih.gov/articles/PMC12665443/

https://journals.sagepub.com/doi/abs/10.1177/00258172261419305

Disclaimer: All opinions are our own.

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Email us here: thetoxlab@gmail.com

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: thetoxlab@gmail.com

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: thetoxlab@gmail.com

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: thetoxlab@gmail.com

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: thetoxlab@gmail.com

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: thetoxlab@gmail.com