In November 2022, hospitals across Australia began seeing patients with sudden rigidity, spasms, seizures—and in some cases cardiac arrest—after drinking homemade poppy seed tea. The source? Food-shelf poppy seeds contaminated with extraordinarily high levels of thebaine, an opioid alkaloid that acts nothing like morphine. In this Outbreak episode, host Ryan Feldman, clinical toxicologist and emergency medicine pharmacist, investigates how pharmaceutical-grade, thebaine-rich poppy seeds were mistakenly repackaged into the food supply—and how poison centers, clinicians, labs, and public health teams traced and contained the threat within days.

You’ll hear firsthand from the experts who responded:

• Dr. Katherine Isoardi, Emergency Physician, Clinical Toxicologist, Medical Director, Queensland Poisons Information Centre
• Dr. Amanda Holford, Clinical Toxicology Fellow & Emergency Physician, Princess Alexandra Hospital
• Dr. Darren Roberts, Medical Director, NSW Poisons Information Centre; Nephrologist; Clinical Pharmacologist

Together, they walk us through the outbreak timeline—from the first ICU cases and puzzling “strych­nine-like” neuroexcitation to the multi-state investigation, product recall, and lessons for future foodborne poisonings.

Looking for timestamps?

A fully timestamped version—so you can jump to any topic—is available to our supporting members.

💡 Key topics:

• Clinical presentation of thebaine toxicity (rigidity, spasms, seizures, metabolic acidosis) and how it differs from classic opioid effects
• Why thebaine behaves like a glycine receptor antagonist (strych­nine-like) rather than a sedating mu agonist
• How early-warning networks (e.g., PRISE in NSW; EDNA in QLD), poison centers, and forensic labs coordinated a rapid response
• Public health trace-back: mislabeled/repacked pharmaceutical poppy seeds entering the food supply; national recalls
• Practical ED management pearls (benzodiazepines, airway/ICU support; recognizing recurrent symptoms) and communication pitfalls during mass poisonings

📍 Resources & Mentions:

• Dr. Isoardi led case series on thebaine-contaminated poppy seeds (Queensland Health, NSW Health)
• Dr. Roberts led kinetics study on thebaine
• Prior Poison Lab Outbreak episode: Markham Aconite Poisoning

🎧 Listen now: www.ThePoisonLab.com

💬 Have thoughts or questions?

Instagram @tox_talk • Twitter @LabPoison • Email toxtalk1@gmail.com

Disclaimer: The Poison Lab is for educational purposes only and does not provide medical advice. If you suspect a poisoning, contact your local poison center. In the U.S., call 1-800-222-1222.

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

• Ad free episodes
• Bonus content and early access
• Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus...

Get your copy here! https://a.co/d/8QUBmQy

Want to hear it with insights from the author?:

• Poisonous Fungus Among Us | Full Children’...

Don't have time for the full thing: check the highlights:

• Poisonous Fungus Amongus Highlights Reel

Want a clearer picture: Full reading large scale here:

• Poisonous Fungus Amongus- Children's Book ...

From the mind of a toxicologist who treats real mushroom poisonings alongside doctors and poison centers comes Poisonous Fungus Amongus—a playful, rhyming adventure into the fascinating world of poisonous mushrooms!

Inside, readers will find a colorful introduction to mushroom anatomy and ecology—learning the parts of a mushroom and discovering helpful hints for safe foraging and identifying dangerous look-alikes. Every species featured in these pages is a real poisonous mushroom, brought to life through vivid illustrations and engaging verse.

This beautifully illustrated book goes beyond the basics, exploring how mushrooms grow, reproduce, and take shape in nature—from tiny spores to sprawling mycelium to the fruiting bodies we find in forests and fields.

Through rhymes and clear explanations, readers learn to recognize essential mushroom features—caps, gills, pores, rings, bulbs (volvas), veils, warts, scales, spore prints, and gill types like free, adnate, and decurrent. Each detail helps distinguish the edible from the toxic—and shows how some features can fool us!

The story encourages safe and curious observation: note each feature, dig gently to look for bulbs, observe nearby trees and seasons, and check for bruising or color changes. Along the way, readers also discover fungi’s hidden ecological roles, from tree-nurturing mycorrhizae to the saprotrophs that recycle the forest floor.

With rhythm, rhyme, and a spark of scientific wonder, Poisonous Fungus Amongus blends accuracy with imagination—inviting kids and adults alike to explore and respect the natural world, while learning that curiosity and caution must always grow together when it comes to mushrooms.

Perfect for young readers, nature lovers, teachers, and families who want to explore the mysterious and magical world of fungi!

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

• Ad free episodes
• Bonus content and early access
• Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

• Full book reading (6 minutes!)

In this special live episode from the 2025 North American Congress of Clinical Toxicology (NACCT), Ryan takes you inside the conference to hear directly from the researchers themselves. Covering 11 abstracts that span high-stakes management decisions, surprising case reports, and challenges to toxicology dogma, this year’s highlights feature everything from amlodipine overdoses to naturopathic misadventures, metformin-associated blindness, and more. The show kicks off with a foreword from Ryan and Dr. Jon Cole (abstract co-chair for AACT) discussing some of their favorite research from the conference.

If you couldn’t make it to NACCT or just want to catch up on some of the most impactful new research in our field, this episode will give you a front-row seat. Check below for links to the published abstracts, the full list of studies discussed, and timestamps for where you can hear each one.

Link to published abstract manuscript

10:43 #7. Is beta blocker toxicity associated with hypoglycemia?

• Lead author: Dr. Megan Audette, MD

18:17 #237. V-A ECMO as a treatment for vasoplegic shock in amlodipine poisoning: a comparison

• Lead author: Dr. Daniel Tirado, MD

27:59 #247. Blocked but not beaten: ECMO’s role in severe amlodipine toxicity – a poison center case series

• Lead author: Dr. Carlos Saldarriaga, MD

28:18 #26. Amlodipine double-dose therapeutic errors reported to Poison Centers

• Lead author: Johanne Freeman

30:38 #27. Dosing on the edge: unpacking inadvertent amlodipine ingestions reported to a single poison center

• Lead author: Dr. Tiana Patriarca, PharmD

34:03 #292. Intravenous administration of sodium zirconium cyclosilicate resulting in death

• Lead author: Dr. Stephen Thornton, MD

44:16 – #21. Quantitative analysis of amlodipine removal by plasmapheresis

• Guest: Dr. Keahi Horowitz, MD – Acute and Intensive Care Research Award winner

48:33– #23. Relationship between reported ingestion dose and outcome in amlodipine poisoning

• Guest: Dr. Colleen Cowdery, MD

51:37 – #24. Management of severe amlodipine toxicity with high-dose calcium alone

• Guest: Dr. Vincent Ma, MD
• High dose norepinephrine in amlodipine overdose
• Case report of calcium death

56:56– #70. Iatrogenic exposure to long-acting buprenorphine injectable in an opioid-naïve patient

• Guest: Dr. Conor Young, MD

01:00:11 – #182. Left in the dark: a case of blindness in the setting of metformin toxicity

• Guest: Dr. Madison Bombard, MD

01:12:11 – #169. Just because it’s natural doesn’t mean it’s safe: a case of pediatric toxicity from topical and herbal remedies

• Guest: Dr. Aria Darling, MD

01:04:31 – #203. Serotonin syndrome after vaping Moocah

• Guest: Dr. Connor Murphy, MD

01:07:06 – #307. Intravenous ozone autohemotherapy: a retrospective observational case series

• Guest: Nicole McLarty

01:11:25 – #134. Do they really need n-acetylcysteine? Exploratory analysis of outcomes in patients with elevated...