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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 DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

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 DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

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 StudySwiss Poison Center StudyPeter Dayton A Morel DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

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 DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

This preview features the opening conversations from two supporting member bonus episodes in The Poison Lab outbreak series. First, we head to Ontario, where a mass aconite poisoning unfolded after a restaurant spice was contaminated with one of the most dangerous plant toxins in the world. Then we travel to Australia, where the poppy seed supply was contaminated with thebaine, triggering seizures and severe poisonings across the country. These are the kinds of outbreak stories that show how quickly a routine exposure can become a public health emergency, and how clinicians, poison centers, laboratories, and public health teams work together to figure out what went wrong.

In this bonus episode of A Morel Dilemma, Ryan shares his recent interview on WTMJ Conversations with Libby Collins. The conversation goes behind the scenes of the series and explores why Ryan spent two years investigating the 2023 Bozeman, Montana morel mushroom outbreak, one of the strangest poisoning outbreaks in recent history. Ryan discusses how the outbreak challenged long-held assumptions about morels, why mushroom poisonings are not all the same, and how public health investigators work through uncertainty when people become seriously ill from a shared exposure. The episode also covers mushroom foraging safety, the difference between true and false morels, why raw or undercooked morels can be dangerous, and what Wisconsin poison center toxicologists commonly see during mushroom season. Ryan also talks about broader poisoning outbreaks, including vape-associated lung injury, contaminated synthetic cannabinoids, pediatric exploratory ingestions, THC edibles, and other toxicology problems that show up far more often than mushrooms. This is a good episode for anyone who wants a more conversational introduction to A Morel Dilemma, the public health stakes behind poisoning outbreaks, and the strange world of mushroom toxicology. Topics covered include: Why foraging is becoming more popularWhy you should never eat a mushroom unless you are 100% sure of its identificationTrue morels vs. false morelsWhy morels should never be eaten raw or undercookedThe Bozeman morel mushroom outbreakHow investigators think through foodborne poisoning mysteriesMushroom poisonings seen by poison centers in WisconsinDeath caps, destroying angels, and amatoxin poisoningPediatric poisoning risks, including laundry pods, THC edibles, and household chemicalsWhy poisoning outbreaks are difficult to recognize and investigateWhat A Morel Dilemma is really trying to uncover You can learn more about the series at ThePoisonLab.com or TheMorelDilemma.com. A Morel DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

The case against the morel mushroom is starting to come together, but there are still major problems. Not everyone who got sick ate morels, and not everyone who ate morels got sick. If the mushroom is really the culprit, those gaps have to be explained. In Episode 5 of A Morel Dilemma, we put the CDC data on trial with Dr. Grant Comstock and stress-test the evidence linking morels to the Bozeman outbreak. We look at case definitions, dose response, why some may have gotten sick but not others, Because the question is no longer just whether morels can make people sick. It is why this is happening now. and whether this is truly a new danger or something that has been hiding in plain sight. Select references: Dr. Beck's Study Dr. Leang's Case Series A Morel DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

When every obvious test comes back negative, investigators have to look for another way to prove what caused the outbreak. So this episode takes a step sideways, from Bozeman, Montana to a small mountain village in the French Alps, where researchers faced a different kind of mystery: a cluster of ALS cases with no clear cause. What they found there may help explain how scientists can link a mushroom to a devastating illness, even without finding a toxin. In Episode 4 of A Morel Dilemma, we follow the investigation into Montchavin, mushrooms, environmental exposure, and the kind of epidemiologic detective work that becomes necessary when the lab tests do not give you the answer. Select resources Mt Chavin investigationMushroom Identifcation A Morel DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

With the restaurant closed and the first interviews underway, investigators bring in the CDC and FDA to help answer the question at the center of the outbreak: what actually made people sick? The leading suspect is still the morel mushroom, but proving that is not simple. The symptoms could fit bacterial food poisoning, spoiled fish, a chemical contaminant, a mislabeled spice, or even a toxic mushroom mixed in by mistake. So the team starts testing everything they can: patient samples, food samples, bacteria, pesticides, heavy metals, classic mushroom toxins, and more. In Episode 3 of A Morel Dilemma, we go inside the science of a poisoning investigation and ask what happens when every obvious test comes back negative. Because when there is no toxin to find, the mystery does not end. It gets harder. A Morel DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

In Episode 5, we put the morel mushroom on trial. This bonus episode shows how we built the case. Dr. Grant Comstock joins me for the full, unfiltered causation breakdown using the Bradford Hill criteria, a public health framework used to separate true causation from simple association. We walk through the CDC data step by step, looking at strength of association, timing, dose response, plausibility, consistency, specificity, and the places where the morel theory starts to strain. This is the deeper dive behind the trial: how toxicologists stress-test an outbreak theory when there is no smoking gun, no known toxin, and no easy answer. Select references CDC Bozeman Montana Outbreak DataRyan's paper on the Bradford hill criteria in EVALI A Morel DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

In this bonus episode, we go deeper into the public health machinery behind a mass poisoning investigation. Dr. Michael Yeh, a medical toxicologist at the CDC’s National Center for Environmental Health, explains how the CDC gets pulled into unusual outbreaks, how poison centers and health departments help spot early signals, and what happens once a local cluster starts looking like something bigger. We also explore several real-world investigations, from lead-contaminated applesauce to synthetic cannabinoid poisonings to Diamond Shruumz chocolate products, and ask a practical question: when something strange is happening, who do you call? This is a behind-the-scenes look at the systems, people, and detective work that help identify poisoning outbreaks before they spread. A Morel DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

In this bonus episode, Dr. Rob Bassett from Philadelphia Poison Control walks us through one of the most useful teaching tools in mushroom toxicology: GOTTA PICCEM. This mnemonic organizes toxic mushrooms by their clinical syndromes and, most importantly, by the timing of symptom onset. That timing can be one of the biggest clues toxicologists use to decide whether a mushroom exposure is likely to be mild, dangerous, or potentially life-threatening. Dr. Bassett is a gifted educator, and in this episode he breaks down the major mushroom toxins in a way that is practical, memorable, and useful for anyone who might someday need to recognize a serious mushroom poisoning. Select Resources: Richard Hamilton's Original Mnemonic A Morel DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

This bonus episode takes a deeper look at the muscarine poisoning case discussed by Dr. Matthew Stanton. We break down how muscarine causes toxicity, why its symptoms can become life-threatening, and why its important for foragers to recognize so they can be treated. Select References: Dr. Stanton's case reportWisconsin Muscarine Case Series (Not yet available) A Morel DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website

Who actually treats mushroom poisoning? In this short mini episode, we answer a surprisingly important question: when someone gets sick after eating a mushroom, who do they call, and who helps the doctors figure out what to do next? We break down the role of poison centers, medical toxicologists, emergency clinicians, and why the most important number to remember is 1-800-222-1222. A Morel DilemmaSupport the showReview the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodesBonus content and early accessDiscounts 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!) Tox trinkets (Rep the show at home!) Reach the showEmail: [email protected] More Show Resources Ryan's Medical Games and ResourcesShow Website