Show Notes
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 [email protected] 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. A Morel Dilemma Support the show 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!)
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Production Note: The news-style audio clips featured in the theme song of this podcast, are dramatizations based on real events, not actual news broadcasts. These segments were researched and written by the producer and brought to life using text-to-speech voices which are now generate with AI. This approach was chosen to avoid potential copyright concerns associated with using original news recordings. All scientific research, writing, narration, and interviews are human-created and no other synthetic voices are used.
More from The Poison Lab
A quick Poison Lab update: new episodes are in the works, including a forthcoming NACCT research episode—though Ryan is briefly buried under mushroom-poisoning programming, NACCT, travel, and the start of a new academic year. In the meantime, revisit the back catalog, including outbreak episodes, Toxicologists Versus the Internet, and favorites such as “Should We Give Naloxone in Cardiac Arrest?” and “Leafy Greens and Injured Beans: Nature’s Nephrotoxins.” As a bonus, this episode includes Ryan’s interview with the podcast from the journal Addiction, discussing his recent study on kratom regulation and medical outcomes. For a more informal companion conversation, check out the “Co-Broadcast with the Kratom Sobriety Podcast” episode. A Morel Dilemma Support the show 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
After weeks of investigation, the Bozeman outbreak is contained, but the questions it raised are much harder to close. In the final episode of A Morel Dilemma, we return to Montana to understand how investigators traced the mushrooms, looked for additional cases, communicated risk to the public, and worked to prevent another outbreak. But the ending is not as simple as naming a culprit. Morels have now been linked to severe illness and death, yet we still do not know the toxin, why some people are more vulnerable, or exactly how much cooking is enough. Episode 7 brings the story back to what matters most: what we know, what we still do not know, and what has to happen next so this does not happen again. A Morel Dilemma Support the show 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
When someone eats a mushroom and starts to feel sick, the first instinct is often to figure out exactly what mushroom it was. But mushroom identification is harder, riskier, and more specialized than most people realize. In this bonus episode of A Morel Dilemma, we look at what actually happens after a possible mushroom exposure: who to call, why online apps and social media can be dangerous, and how poison centers work with trained mycologists and mushroom identification experts when the stakes are high. Because in a mushroom emergency, the answer is not to keep scrolling. It is to call the Poison Center at 1-800-222-1222.
The Bozeman outbreak was the first loud signal, but it was not the only one. After the CDC report, toxicologists in other countries started looking back through their own poison center data and found something unsettling: more patients with severe illness after eating morels, including cases of shock, gastrointestinal bleeding, and death. And it did not stop there. In Episode 6 of A Morel Dilemma, we follow that signal beyond Montana and ask whether this was truly an isolated outbreak, or whether morels have been causing severe poisonings for years without anyone recognizing the pattern. We also meet the researchers now trying to answer the harder question: if morels are responsible, what exactly is happening inside this mushroom? The mystery is no longer confined to one restaurant. It is starting to spread. Select referecnces: Dr. Vodovar's Study Swiss Poison Center Study Peter Dayton
Hey everyone, it’s Ryan. I know many of you are patiently waiting for Episode 6 of A Morel Dilemma, and it is coming next week. I genuinely cannot wait for you to hear this one. But it is actually available right now for supporter members. You can go to www.thepoisonlab.com/support and get every single episode right now for as little as $1 a month. And full disclosure, I only get about half of that. It does not go to profit. It just helps repay some of the very real costs of making this show: the interviews, editing, sound design, hosting, and the absurd amount of time that went into producing it. So if you have been enjoying the series, becoming a supporter is an incredible way to help make work like this possible. And if you are already supporting the show, thank you. Truly. It helps more than you know. And for everyone else listening, thank you for being here and for sharing the series. But for today, I wanted to give everyone a small glimpse into the supporter bonus episodes that have been available to members throughout the series. See the episode here https://the-poison-lab.captivate.fm/episode/a-morel-dilemma-preview-supporting-member-bonus-episodes A Morel Dilemma Support the show 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