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:<ul><li>Dr. Katherine Isoardi, Emergency Physician, Clinical Toxicologist, Medical Director, Queensland Poisons Information Centre</li><li>Dr. Amanda Holford, Clinical Toxicology Fellow & Emergency Physician, Princess Alexandra Hospital</li><li>Dr. Darren Roberts, Medical Director, NSW Poisons Information Centre; Nephrologist; Clinical Pharmacologist</li></ul> 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:<ul><li>Clinical presentation of thebaine toxicity (rigidity, spasms, seizures, metabolic acidosis) and how it differs from classic opioid effects</li><li>Why thebaine behaves like a glycine receptor antagonist (strych­nine-like) rather than a sedating mu agonist</li><li>How early-warning networks (e.g., PRISE in NSW; EDNA in QLD), poison centers, and forensic labs coordinated a rapid response</li><li>Public health trace-back: mislabeled/repacked pharmaceutical poppy seeds entering the food supply; national recalls</li><li>Practical ED management pearls (benzodiazepines, airway/ICU support; recognizing recurrent symptoms) and communication pitfalls during mass poisonings</li></ul> 📍 Resources & Mentions:<ul><li>Dr. Isoardi led <a href="https://pubmed.ncbi.nlm.nih.gov/37855308/" rel="noopener noreferrer" target="_blank">case series on thebaine-contaminated poppy seeds (Queensland Health, NSW Health)</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/37917043/" rel="noopener noreferrer" target="_blank">Dr. Roberts led kinetics study on thebaine</a></li><li>Prior Poison Lab Outbreak episode: <a href="https://www.thepoisonlab.com/episode/outbreak-aconite-poisoning-at-markham-ontario-restaurant" rel="noopener noreferrer" target="_blank">Markham Aconite Poisoning</a></li></ul> 🎧 Listen now: <a href="http://www.thepoisonlab.com/" rel="noopener noreferrer" target="_blank">www.ThePoisonLab.com</a>💬 Have thoughts or questions?Instagram @tox_talk • Twitter @LabPoison • Email toxtalk1@gmail.comDisclaimer: 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.<h2>Support the show</h2>Review the show where ever your listening<a href="https://thepoisonlab.aweb.page/p/cf635c33-5117-4652-abd6-6bedce51444a" rel="noopener noreferrer" target="_blank">Get Messages from Toxo (Join the Newsletter!)</a><a href="https://youtube.com/shorts/gfg6bgxB-ZY" rel="noopener noreferrer" target="_blank">Join as a supporting member</a><ul><li>Ad free episodes</li><li>Bonus content and early access</li><li>Discounts and give aways on GOTA PICCEM Mushroom card game</li></ul> <a href="WWW.GOTTAPICCEM.COM" rel="noopener noreferrer" target="_blank">The GOTTA PICCEM Poisonous Mushroom Game!</a><a href="https://a.co/d/46LP0n9" rel="noopener noreferrer" target="_blank">The Poisonus Fungus Amongus Children's Book!</a><ul><li><a href="https://youtu.be/oLkhJ4L1_4o" rel="noopener noreferrer" target="_blank">Full book reading (6 minutes!)</a></li></ul> <a href="https://www.etsy.com/shop/ThePoisonLab" rel="noopener noreferrer" target="_blank">Tox trinkets (Rep the show at home!)</a><h2>Reach the show</h2><ul><li>Email: Toxtalk1@gmail.com</li></ul> More Show Resources<ul><li><a href="https://the-poison-lab.yolasite.com/" rel="noopener noreferrer" target="_blank">Ryan's Medical Games and Resources</a></li><li><a href="https://www.thepoisonlab.com" rel="noopener noreferrer" target="_blank">Show Website</a></li></ul>

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