Afleveringen
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This week on The Tox Lab, we’re discussing novel benzodiazepines and examining recent trends in their emergence and detection.
We begin by exploring the origins of novel benzodiazepines, including how these compounds have entered the drug market and the factors contributing to their continued appearance.
We then turn to a paper from the Society of Forensic Toxicologists (SOFT) Novel Psychoactive Substances Committee, examining trends in novel benzodiazepine detections between 2021 and 2025. We discuss findings from post-mortem investigations, clinical presentations, driving under the influence of drugs cases, and drug-facilitated crime, highlighting the compounds most commonly encountered, including bromazolam, etizolam, and desalkylgidazepam, and how patterns have changed over time.
We also explore the analytical challenges associated with novel benzodiazepines, including their detection and identification in toxicology laboratories, the limitations of routine testing, and the difficulties associated with interpreting toxicological findings when limited pharmacological, toxicological, and concentration data are available.
Join us as we examine the evolving landscape of novel benzodiazepines, consider the challenges they present for forensic and clinical toxicology, and discuss what these trends may tell us about the future of the drug market.
Hope you enjoy!
Links to the paper we discussed:
https://academic.oup.com/jat/advance-article/doi/10.1093/jat/bkag026/8662327?searchresult=1
https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkag027/8663758?redirectedFrom=fulltext
Disclaimer: All opinions are our own.
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This week on The Tox Lab, we’re discussing kava and examining its history, use, and potential toxicological effects.
We begin by exploring the history of kava and its longstanding cultural and social significance, before discussing reported benefits associated with its use and the reasons it continues to gain popularity.
We then turn to potential harms associated with kava, examining cases of acute liver injury and acute interstitial nephritis linked to its use, before discussing a fatal case involving kava ingestion and the toxicological considerations surrounding these reports.
Join us as we examine the evolving story surrounding kava, from its traditional use and perceived benefits to the clinical and toxicological challenges associated with its increasing use.
Links to the papers we discussed:
https://pmc.ncbi.nlm.nih.gov/articles/PMC12405834/pdf/DAR-44-1601.pdf
https://doi.org/10.1155/crgm/3914876
https://onlinelibrary.wiley.com/doi/10.1111/nep.70051
http://dx.doi.org/10.1016/j.forsciint.2015.01.032
Check out our new website: https://thetoxlab.co.uk/
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Zijn er afleveringen die ontbreken?
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This week on The Tox Lab, we’re discussing poison dart frogs and the alkaloid epibatidine.
We begin by examining recent reports surrounding the death of Alexei Navalny and the suggestion that epibatidine may have been involved.
We then discuss poison dart frogs and the toxins found within them, including the discovery and isolation of epibatidine. From there, we explore its potent analgesic properties, how it acts at nicotinic acetylcholine receptors, and what makes it both pharmacologically interesting and highly toxic.
Finally, we examine attempts to develop epibatidine analogues as novel analgesics and explore the evolutionary question of how poison dart frogs themselves avoid poisoning.
Join us as we examine the pharmacology, toxicity, and evolving story surrounding epibatidine, and consider how a toxin derived from poison dart frogs became linked to drug development, toxicology, and international headlines.
Hope you enjoy!
Links to the papers we discussed:
https://www.gov.uk/government/news/joint-statement-by-the-uk-sweden-france-germany-and-the-netherlands-on-alexei-navalnys-death
https://pubs.rsc.org/en/content/articlelanding/2000/np/a900728h
https://www.science.org/doi/epdf/10.1126/science.aan5061
Check out our new website: https://thetoxlab.co.uk/
Disclaimer: All opinions are our own.
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This week on The Tox Lab, we’re back with a long-awaited update on novel synthetic opioids.
We begin by discussing the April 2026 UNODC announcement on the increasingly varied forms in which synthetic opioids are being encountered, including vapes, powders, and counterfeit tablets marketed as benzodiazepines, oxycodone, and MDMA.
We then turn to the emergence of orphine analogues in both the UK and the US, discussing recent reports and trends associated with these compounds.
Finally, we examine a clinical case involving N-propionitrile chlorphine (cychlorphine), exploring the toxicological features and the challenges these emerging opioids present for clinicians, laboratories, and public health systems.
Join us as we examine the changing landscape of novel synthetic opioids, consider what these developments may mean for toxicology, harm reduction, and public health, and discuss where the market may be heading next.
Hope you enjoy!
This episode is very kindly sponsored by Cayman Chemical. Check out their Synthetic Opioid Analytical Standards Panel here: https://www.caymanchem.com/product/44436/synthetic-opioid-analytical-standards-panel-1
Links to papers we discussed:
https://www.unodc.org/LSS/Announcement/Details/973e194e-f8d6-4b4e-8aca-166aaec4ac7c
https://www.polizei.bayern.de/aktuelles/pressemitteilungen/100413/index.html
https://onlinelibrary.wiley.com/doi/10.1111/dar.70081
https://assets.publishing.service.gov.uk/media/69f3343fab602a88957eef2b/Seventh_addendum_to_the_ACMD_report_on_the_use_and_harms_of_2-benzyl-benzimidazole__nitazene__and_piperidine_benzimidazolone__brorphine-like__opioids_FINAL.pdf
https://www.cfsre.org/nps-discovery/public-alerts/increase-in-fatal-overdoses-linked-to-novel-synthetic-opioid-n-propionitrile-chlorphine-cychlorphine
https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2594070
Link to our paper on N-pyrrolidino Isotonitazene: https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkag027/8663758?redirectedFrom=fulltext
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: [email protected]
Support us here: https://buymeacoffee.com/thetoxlab
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This week on The Tox Lab, we are taking a look at the role of naloxone in risk taking behaviours, harm reduction and disparities surrounding naloxone access.
We begin by discussing a study looking at the expansion of naloxone access laws in the United States, exploring whether increased availability is associated with changes in heroin use among adolescents.
We then turn to a commentary paper examining the benefits and limitations of educating school children recognise an opioid overdose and administer naloxone.
Finally we discuss a paper investigating disparities in naloxone uptake amongst different ethnic and racial groups, and between individuals who inject versus smoke substances.
Join us as we explore the impact of naloxone access, education, and disparities, and consider what these findings mean for harm reduction and public health.
Hope you enjoy!
Links to the papers we discussed:
https://www.sciencedirect.com/science/article/abs/pii/S0955395923000294
https://onlinelibrary.wiley.com/doi/abs/10.1111/josh.70089
https://pubmed.ncbi.nlm.nih.gov/41428846/
Disclaimer: All opinions are our own.
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Email us here: [email protected]
Support us here: https://buymeacoffee.com/thetoxlab
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A year after we first took a look at mitragynine (kratom), we are back with an update episode looking at how the landscape surrounding mitragynine is evolving.
We begin by examining poison centre data, exploring trends in reported exposures in the US and internationally, and the increase in its use.
We then discuss a case involving semi-synthetic mitragynine derivatives, including 7-hydroxymitragynine and mitragynine pseudoindoxyl, highlighting the clinical features including dose escalation, and challenges associated with withdrawal.
Finally, we turn to reports of combined use of kratom and kava, and consider how this may influence toxicity and withdrawal.
Join us as we examine emerging data, evolving patterns of use, and the clinical implications of mitragynine and its derivatives, and consider what these findings mean for toxicology and public health.
Hope you enjoy!
If you'd like us to cover an episode on Kava, please let us know in the comments!
Links to the papers we discussed:
https://www.cdc.gov/mmwr/volumes/75/wr/mm7511a1.htm
https://www.cureus.com/articles/467977-severe-early-onset-withdrawal-following-intentional-use-of-mitragynine-pseudoindoxyl-a-case-report-and-emerging-clinical-considerations#!/
https://www.cdc.gov/mmwr/volumes/75/wr/pdfs/mm7512a1-H.pdf
https://journals.lww.com/journaladdictionmedicine/abstract/9900/kava_potentiated_withdrawal_in_persons_using.687.aspx
Disclaimer: All opinions are our own.
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This week on The Tox Lab, we’re examining the controversial 2006 Lancet paper on codeine and fatal opioid toxicity in a breastfed infant.
We begin by introducing the paper and the case at its centre, in which an infant developed fatal opioid toxicity following exposure to codeine via breast milk.
We then explore the proposed mechanism, focusing on the role of CYP2D6 metabolism and how variability in this pathway may lead to higher-than-expected morphine concentrations.
We also discuss the limitations and criticisms of the paper, including questions around causality, alternative explanations, and the extent to which pharmacogenetics alone can account for the outcome.
Finally, we consider the wider impact of this publication, including changes to clinical guidance, prescribing practices, and the ongoing debate around codeine use in breastfeeding individuals.
Join us as we examine the pharmacology, pharmacogenetics, and controversy surrounding this landmark case, and consider what this means for clinical toxicology and patient safety.
Hope you enjoy!
Links to the papers we discussed:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69255-6/abstract
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00245-X/fulltext
https://www.thelancet.com/journals/lancet/article/PIIS0140673608612544/abstract https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.1882
Link to the New Yorker Article : https://www.newyorker.com/magazine/2026/02/02/did-a-celebrated-researcher-obscure-a-fatal-poisoning
Disclaimer: All opinions are our own.
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This week on The Tox Lab, we’re examining pesticides and their role in toxicology.
We begin by discussing a study investigating pesticide exposure in florists, highlighting occupational risks and the potential for chronic low-level exposure.
We then turn to a paper analysing pesticide residue levels in commonly consumed fruits, including kiwifruit and bananas, and consider what this may mean for dietary exposure. Finally, we discuss a study examining pesticide-related fatalities in Turkey, exploring the clinical and toxicological features associated with these cases.
Join us as we explore the occupational, environmental, and clinical aspects of pesticide exposure, and consider what these findings mean for toxicology and public health.
Hope you enjoy!
Links to the papers we discussed:
https://pmc.ncbi.nlm.nih.gov/articles/PMC5451977/
https://www.sciencedirect.com/science/article/abs/pii/S0273230026000103?via%3Dihub
https://link.springer.com/article/10.1007/s12024-026-01220-x
Disclaimer: All opinions are our own.
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Email us here: [email protected]
Support us on: https://buymeacoffee.com/thetoxlab
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This week on The Tox Lab, we continue our discussion on GHB, focusing on its role in forensic toxicology.
We begin by examining a study investigating GHB in drug‑facilitated crime in Paris, highlighting patterns of reported incidents and toxicological findings.
We then turn to post‑mortem toxicology, discussing the challenges of interpreting GHB concentrations after death and exploring research aimed at distinguishing post‑mortem formation from exogenous intake.
Join us as we explore the forensic applications, interpretive challenges, and analytical considerations associated with GHB, and consider how these factors impact casework.
This is part two of a two‑part series on GHB. In last week’s episode, we explored patterns of use, harms, and user perspectives.
Hope you enjoy!
Links to the papers we discussed:
https://www.sciencedirect.com/science/article/abs/pii/S0379073825003780?via%3Dihub
https://www.sciencedirect.com/science/article/pii/S2589871X24000925?via%3Dihub
https://www.sciencedirect.com/science/article/pii/S0379073825001306?via%3Dihub
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: [email protected]
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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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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.
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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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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.
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Email us here: [email protected]
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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: [email protected]
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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: [email protected]
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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.
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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
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This week on The Tox Lab, we’re taking a closer look at bupropion and its distinctive toxicity profile in overdose.
We explore a case of bupropion overdose to examine the often complex clinical presentation, including seizures and cardiovascular complications, as well as the challenges of management and potential longer-term consequences. We then unpack the mechanism underlying bupropion-associated seizures and how these differ from other antidepressants.
We also turn our attention to the cardiac effects seen in overdose, focusing on QRS widening, why traditional treatments such as sodium bicarbonate may be ineffective, and what current evidence suggests about the underlying mechanism.
Join us as we examine how bupropion behaves in overdose, what makes its toxicology unique, and what this means for clinical management and interpretation.
Hope you enjoy!
Links to the papers we discussed:
https://pmc.ncbi.nlm.nih.gov/articles/PMC12735355/
https://pmc.ncbi.nlm.nih.gov/articles/PMC12281246/
https://www.tandfonline.com/doi/full/10.1080/15563650.2023.2218029
https://pmc.ncbi.nlm.nih.gov/articles/PMC4294106/pdf/bph0171-4808.pdf
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: [email protected]
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This week on The Tox Lab, we’re taking a closer look at quaaludes and their modern analogues.
Once synonymous with a particular era of drug use, quaaludes have largely disappeared from the illicit market. But have they really gone away? We explore the history of methaqualone, how and why it fell out of use, and what has appeared in its place.
We then dive into a review examining a wide range of methaqualone analogues, focusing on how these substances are described by users, the variability in their effects, and what this means for interpretation.
Join us as we unpack the legacy of quaaludes, the chemistry behind their analogues, and what user experiences can tell us about substances that are often poorly characterised.
This episode is very kindly sponsored by Cayman Chemical. Check them out here: https://www.caymanchem.com/
Hope you enjoy!
Links to the paper we discussed:
https://ejournals.eu/en/journal/amsik/article/review-of-the-experiences-of-users-of-methaqualone-and-methaqualone-derivatives-an-analysis-of-online-forums
Disclaimer: All opinions are our own.
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Email us here: [email protected]
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This week on The Tox Lab, we’re exploring naloxone and its effectiveness in the context of novel synthetic opioid overdoses.
Naloxone remains a cornerstone of opioid overdose management, but the emergence of highly potent synthetic opioids has raised important questions about whether standard approaches are still sufficient. We discuss clinical nitazene exposure data from Australia, examining the concentrations detected in patients and how naloxone was used in these cases.
We also review a striking case of occupational carfentanil exposure in a veterinarian, where reversal was achieved with naltrexone.
To tie this together, we dive into the pharmacology, exploring what may be happening at the receptor level.
Join us as we unpack the clinical data, receptor dynamics, and real-world challenges of managing overdoses in an ever-evolving synthetic opioid landscape.
Hope you enjoy!
Links to the papers we discussed:
https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.13998
https://www.sciencedirect.com/science/article/abs/pii/S0735675710001178?via%3Dihub
https://pmc.ncbi.nlm.nih.gov/articles/PMC10912486/
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: [email protected]
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