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Jimson weed (Datura stramonium) is a beautiful, witchy plant that begins blooming in late summer and continues through the first frost. A member of the notorious nightshade family, its more famous cousins include tomato, eggplant, pepper, tobacco, and potato. Most members of this plant family are poisonous, and jimson weed is no exception. All parts of the plant are toxic, most particularly the seeds. Potent amounts of alkaloid compounds are present, which potentially cause convulsions, hallucinations, and even death if ingested. And as climate change increases the amount of carbon dioxide in the air, studies have found that the toxicity of plants like jimson weed only increases.
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Jimson weed (Datura stramonium, a member of the Belladonna alkyloid family) is a plant growing naturally in West Virginia and has been used as a home remedy since colonial times. Due to its easy availability and strong anticholinergic properties, teens are using Jimson weed as a drug. Plant parts can be brewed as a tea or chewed, and seed pods, commonly known as "pods" or "thorn apples," can be eaten. Side effects from ingesting jimson weed include tachycardia, dry mouth, dilated pupils, blurred vision, hallucinations, confusion, combative behavior, and difficulty urinating. Severe toxicity has been associated with coma and seizures, although death is rare. Treatment consists of activated charcoal and gastric lavage. Esmolol or other beta-blocker may be indicated to reduce severe sinus tachycardia. Seizures, severe hypertension, severe hallucinations, and life-threatening arrhythmias are indicators for the use of the anticholinesterase inhibitor, Physostigmine. This article reviews the cases of nine teenagers who were treated in hospitals in the Kanawha Valley after ingesting jimson weed. We hope this article will help alert primary care physicians about the abuse of jimson weed and inform health officials about the need to educate teens about the dangers of this plant.
Datura stramonium, known by the common names thorn apple, jimsonweed (jimson weed), devil's snare, or devil's trumpet, is a poisonous flowering plant of the nightshade family Solanaceae. It is a species belonging to the Datura genus and Daturae tribe. Its likely origin was in Central America, and it has been introduced in many world regions. It is an aggressive invasive weed in temperate climates across the world. D. stramonium has frequently been employed in traditional medicine to treat a variety of ailments. It has also been used as a hallucinogen (of the anticholinergic/antimuscarinic, deliriant type), taken entheogenically to cause intense, sacred or occult visions. It is unlikely ever to become a major drug of abuse owing to effects upon both mind and body frequently perceived as being highly unpleasant, giving rise to a state of profound and long-lasting disorientation or delirium (anticholinergic syndrome) with a potentially fatal outcome. It contains tropane alkaloids which are responsible for the psychoactive effects, and may be severely toxic.
In the United States the plant is called "jimsonweed", or more rarely "Jamestown weed" deriving from the town of Jamestown, Virginia, where English soldiers consumed it while attempting to suppress Bacon's Rebellion. They spent 11 days in altered mental states:
All parts of Datura plants contain dangerous levels of the tropane alkaloids atropine, hyoscyamine, and scopolamine, which are classified as deliriants, or anticholinergics. The risk of fatal overdose is high among uninformed users, and many hospitalizations occur among recreational users who ingest the plant for its psychoactive effects. Deliberate or inadvertent poisoning resulting from smoking jimsonweed and other related species has been reported.
Among its sacred and visionary purposes, jimson weed has also garnered a reputation for its magical uses in various cultures throughout history. In his book, The Serpent and the Rainbow, Wade Davis identified D. stramonium, called "zombi cucumber" in Haiti, as a central ingredient of the concoction vodou priests use to create zombies. However it has been noted that the process of zombification is not directly performed by vodou priests of the loa but rather by bokors. In European witchcraft, D. stramonium was also a common ingredient used for making witches' flying ointment along with other poisonous plants of the nightshade family. It was often responsible for the hallucinogenic effects of magical or lycanthropic salves and potions. During the witch-phobia craze in Early Modern times in England and parts of the colonial Northeastern United States it was often considered unlucky or inappropriate to grow the plant in one's garden as it was considered to be an aid to incantations.
Today, jimson weed poisoning is found primarily among adolescents who seek the hallucinogenic effects of the plant.7 In 1998, 152 cases of jimson weed poisoning were reported nationally to the American Association of Poison Control Centers, but the true number of cases is undoubtedly far higher.1
The anticholinergic effects of jimson weed are attributed to the atropine, hyoscyamine, and scopolamine components. Symptoms of jimson weed toxicity usually occur within 30 to 60 minutes after ingestion. Initial symptoms include hallucinations, dry mucous membranes, thirst, dilated pupils, blurred vision, and difficulty speaking and swallowing. 2 Subsequent effects may include tachycardia, urinary retention, and ileus. Rarely, late symptoms may include hyperthermia, respiratory arrest, and episodes of seizure.6 Slowing of gastrointestinal motility may prolong elimination of the toxin, thus causing symptoms to persist for 24 to 48 hours.
A toxicology screen is useful to rule out concomitant use of other drugs. Most documented lethal cases of jimson weed ingestion occur in persons with polysubstance abuse, including use of jimson weed combined with alcohol, marijuana, or cocaine.7 Drug screens usually do not detect pure anticholinergic poisons, and other laboratory tests are usually not helpful for identifying jimson weed as the cause of symptoms.3
Absorption of jimson weed may be minimized either by using an agent that binds to the toxins or through removal of gastric contents by inducing emesis or administering gastric lavage. Activated charcoal binds to the toxins in jimson weed and decreases overall absorption of these toxins.5 The usual oral dose of activated charcoal for adults is 1 g/kg. If medical attention is sought within several hours after ingestion or if the patient has been intubated, removal of the ingested plant by gastric lavage can be considered. Emesis may be induced by using syrup of ipecac if the patient is awake and relatively alert. The usual dose of ipecac is 30 mL for adults and 15 mL for children.3,5
After initial assessment and attempts to eliminate the toxin from the gastrointestinal tract, most cases of jimson weed poisoning can be managed simply with observation until symptoms resolve. However, cardiac monitoring, serial recording of vital signs, and serial neurologic assessment are important for detecting occasional occurrence of life-threatening events and for establishing resolution of symptoms. Serial examinations usually indicate improvement within 24 hours, and most patients need less than 48 hours of observation.10
Routine use of physost