Episode 45

Outbreak: Thebaine Poisoning from Poppy Seed Tea in Australia

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.