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Emergency Toxicology DOI: 10.4103/0974-2700.66565

Anticholinergic following stramonium ingestion: Implications for the Internet age

David Vearrier, Michael I Greenberg Department of Emergency , Drexel University College of Medicine, 245 N 15th St, Mail Stop #1011, Philadelphia, PA, USA

ABSTRACT Recreational use of Datura to deliberately induce an delirium is not uncommon. We present a case of Datura intoxication in a young adult who learned about the recreational use of Datura on the Internet and subsequently purchased from an online vendor. Using the Google search engine, we conducted searches for “Datura,” “jimson ” and “Datura seeds” and reviewed the first 200 search results for each search term. We found 16 websites recommending the recreational use of Datura, 12 vendors selling seeds of Datura and one website that both promoted the recreational use of Datura and also sold Datura stramonium . The promotion of recreational use of Datura on the Internet represents a danger to public health and the ability to purchase Datura seeds from Internet vendors may increase the prevalence of Datura abuse.

Key Words: Cholinergic antagonists, Datura, Internet, street , young adult

INTRODUCTION An initial set of vital signs were remarkable only for mild tachypnea, with a respiratory rate of 26 breaths per minute. of the genus Datura contain with Physical exam was remarkable for a male appearing stated age significant anticholinergic activity in humans. Today, recreational with somnolence interrupted by episodes of psychomotor use of Datura to deliberately induce an anticholinergic delirium agitation, who was not responding appropriately to the questions has been most frequently reported among adolescents and young being asked. His pupils were 9 mm bilaterally and sluggishly adults.[1-3] We report a case of altered mental status in a 22-year- reacted to light to 8 mm. He had an odor of on his breath old man following the ingestion of vodka and seeds of Datura stramonium. After his acute intoxication resolved, the patient reported that he learned about the recreational use of Datura on the Internet and subsequently purchased Datura stramonium seeds from an online vendor.

CASE HISTORY

A 22-year-old man was brought to the emergency department by paramedics for altered mental status. The patient was unable to provide any history secondary to his altered mental status, although a friend relates that the patient drank “10 glasses” of vodka and had been chewing on seeds to “get high.” A search of the patient’s pockets revealed a packet of seeds labelled “Datura stramonium - not for human consumption” [Figure 1].

Address for correspondence: Figure 1: Plastic bag containing Datura seeds found in the Dr. David Vearrier, E-mail: [email protected] patient’s pocket Vearrier and Greenberg: Datura and the Internet and partially chewed black seeds were present in the oropharynx. psychotropic properties. Websites offer information on intended Pulmonary, cardiac and extremity exams were normal. Abdominal effects following Datura use, side-effects, methods of use and exam was significant for hypoactive bowel sounds. His skin share .[8-10] In some cases, quite detailed information was warm, dry and flushed. Neurological exam was limited by is available on how to prepare Datura in , teas and other a lack of patient cooperation, but no gross neurological deficit preparations.[11] While some websites may also discuss adverse- was present, the patient was moving all extremities, the patient effects, others minimize or completely omit this information, in withdrew to pain in all four extremities and biceps and patellar effect, promoting recreational use of substances that may cause reflexes were normal bilaterally. The Glasgow Coma Score was significant harm or death. nine. Laboratory studies were significant only for a serum ethanol level of 330 mg/dl. Historically, procuring Datura involved either foraging for the or purchasing seeds from a gardening store that sells Datura. The patient was diagnosed with anticholinergic toxicity and However, the Internet offers easy procurement of seeds to alcohol intoxication. Two doses of 1 mg were persons wishing to recreationally use Datura. Numerous vendors administered intravenously 5 min apart without significant sell packets of seeds of various Datura . Some vendors improvement in the patient’s mental status. The patient was specifically focus on the sale of seeds, plant parts (e.g., foliage) noted to no longer have a gag reflex and was subsequently and/or extracts of plants with abuse potential.[12] Although endrotracheally intubated for airway protection. these sites may state warnings that the seeds are not for human consumption, this advice is easily ignored. For persons who either After intubation, an orogastric tube was placed and whole bowel do not wish to forage for Datura or cannot purchase those seeds irrigation with polyethylene glycol solution was initiated. The at local gardening stores, the ability to purchase such seeds from remainder of the patient’s clinical course was unremarkable, with Internet vendors makes it substantially easier to recreationally the patient extubating himself 36 h after intubation. The patient use Datura. was able, at that time, to provide us with additional history as to his use of Datura. He learned about the Datura while browsing We informally investigated the availability of information on a website containing information about recreational use of a both the recreational use of Datura and Datura seeds for sale variety of licit and illicit substances. From the website, he learned on the Internet. Using the Google search engine (www.google. about the routes of administration of Datura and the expected com), we conducted searches for “Datura,” “jimson weed” and psychological and physiological effects. He reported that he “Datura seeds” and reviewed the first 200 search results for each subsequently purchased Datura seeds from an Internet vendor search term. The reviewed results included 16 websites with and that he occasionally ingests Datura seeds with alcohol “to unique domain names recommending the recreational use of get high.” Datura, with various recommendations on the administration and descriptions of psychotropic effects. The results also included 12 vendors with unique domain names selling seeds of the genus DISCUSSION Datura. One website both promoted the recreational use of Datura and also sold Datura stramonium leaves. An additional 176 Recreational use of Datura seems to be on the rise among listings for Datura seeds were found at the online vendor, www. adolescents and young adults over the last several decades.[4] ebay.com, and six listings at the online vendor, www.amazon.com. While specific data on the changing rates of Datura abuse in the United States is not available, a review of the epidemiology of intentional anticholinergic plant poisonings, as reported by CONCLUSION the American Association of Control Center’s National Poison Data Base (NPDS), suggests an increasing incidence of The increasing availability of information about Datura on Datura abuse. In the first 5 years of data collection (1983–1987), the Internet and the way in which it is presented represents the NPDS reported an average of 74 intentional anticholinergic a developing public health problem. Sale of Datura seeds by plant poisonings annually, while in the most recent 5 years (2004– Internet vendors may make it substantially easier to recreationally 2008), 427 such poisonings occurred annually. Additionally, the use Datura, potentially increasing the prevalence of Datura abuse. percent of all anticholinergic plant poisonings that were due Public health efforts should be initiated to educate adolescents to intentional exposure increased from 22% to 44% over the and young adults, parents and school health managers about this same period.[5] potentially lethal substance of abuse. Clinicians should maintain a high level of suspicion for Datura abuse in young patients with It has been reported that information on psychoactive substances unexplained anticholinergic toxicity. on the Internet influences -use behaviors in adolescents. [6] Some authors believe that the Internet may be influencing REFERENCES the epidemiology of Datura use.[7] The Internet allows the dissemination of information on Datura to adolescents and 1. Spina SP, Taddei A. Teenagers with Jimson weed (Datura stramonium) young adults who otherwise might not have learned of its poisoning. CJEM 2007;9:467-8. 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