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Natural is not innocuous: the case of Angel’s Trumpet and tropane alkaloid intoxication

With this post, I’m happy to return to Science-Based Medicine on a regular basis, at least monthly and perhaps more depending upon how often commentary is required on natural products, whether they be herbal medicines or single-agent pharmaceuticals derived from natural sources. Next week, I’ll be attending the 2010 Annual Meeting of the American Society of Pharmacognosy being held jointly with the Phytochemical Society of North America in St. Petersburg, Florida. I hope to bring back the latest on novel natural products in preclinical development.

But today, I bring recent news that revisits a timeworn folly of the young (and some older folks): recreational use of toxic plants for the purpose of hallucination.

Toxicity reports are re-emerging in southern California this week after a dozen hospitalizations of kids using teas made from a fragrant flowering plant called Angel’s Trumpet. The tea is used to produce hallucinations, but they can progress to extremely unpleasant experiences. Moreover, Angel’s Trumpet can be deadly, accelerating the heart rate and causing fatal cardiac rhythmic disturbances and bronchoconstriction that can trigger asthma attacks in sensitive individuals.

220px-Atropine.svg.pngAngel’s Trumpet is one of a series of plants in the Brugmansia genus that make a variety of muscarinic cholinergic antagonists such as atropine (dl-hyoscyamine, pictured to the right) and scopolamine (l-hyoscine). These compounds are also known chemically as tropane alkaloids or belladonna alkaloids, the latter derived from their classical isolation from Atropa belladonna. The belladonna name derives from the use of eye drops made from the plants that prevent constriction of the pupils (mydriasis), back when the size of a woman’s pupils was a sign of beauty and arousal.

The tropane alkaloids are ubiquitous in plants and fungi and act as classic hallucinogens when used in high doses. Their legend goes back to witches brews and beyond. A wonderfully colorful history of tropane alkaloids by Robert S. Holzman of Children’s Hospital and Harvard Medical School was offered in this free 1998 paper in the journal, Anesthesiology (1998; 89:241-249).

However, the aftermath of Angel’s Trumpet use is far from colorful. In cases like these, I like to turn to the Erowid site, a respected, user-supported site that offers non-judgmental information on plant-derived and synthetic psychoactive agents. The Erowid Experience Vault has several descriptions of the use of Angel’s Trumpet but this one is the most detailed and representative of the downsides of this plant. (Note that the colloquial term for Angel’s Trumpet in Australia is sometimes “Tree Datura,” although Brugmansia is a closely-related but distinct genus from Datura within the Solanaceae family.)

I also came across a poorly-documented 2003 news article cited a German teenager cutting off his penis and tongue with garden shears after using Angel’s Trumpet.

While I’m NOT a physician, emergency personnel stumbling upon this post would do well to note that physostigmine or pilocarpine are typical antidotes for anticholinergic poisonings with Angel’s Trumpet, Atropa, Datura, and other similar plants that cause dilated pupils with loss of accommodation, xerostomia (dry mouth), and tachycardia. Click on this paragraph to access the Medscape poisoning article with more details on when and where specific treatments should be employed.

From the eMedicine article linked to in the above paragraph:

Remember common signs and symptoms with the mnemonic, “red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hot as a hare.” The mnemonic refers to the symptoms of flushing, dry skin and mucous membranes, mydriasis with loss of accommodation, altered mental status (AMS), and fever, respectively.

I encourage all clinicians to be vigilant about anticholinergic poisonings in the weeks to come. In some cases in the past, I have found that reports such as these from southern California will often give rise to attempts to use the hallucinatory plant elsewhere despite the risks detailed.

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14 thoughts on “Natural is not innocuous: the case of Angel’s Trumpet and tropane alkaloid intoxication

  1. trrll says:

    Sometimes young people end up in the E.R. after smoking Datura stramonium, a.k.a. Jimson weed or loco weed, which also contains belladonna alkaloids. Aside from the unpleasant and potentially dangerous autonomic effects, most people do not seem to find the “high” particularly enjoyable.

    Children are subject to accidental poisoning, as many plants with these alkaloids are widely grown as ornamental plants (Angel’s trumpet is quite lovely), and it doesn’t take very much to produce a toxic effect in a small child. The increase in body temperature seems to be particularly dangerous in childhood belladonna poisoning.

  2. Chris says:

    Poisonings don’t have to be from trying to get, but sometimes just picking what looks like food. There have recent cases of hemlock poisoning people, with at least one death.

    I also recently read a blog post from someone who is new to food gardening that she was surprised to find out that potatoes get fruit, and that it is poisonous. Well, I knew that only because I like reading myths and legends. One I read was from the Inca where they were given the potato by some god, and told to only eat the roots and let their enemies have the fruit.

    Oh, trrll… ornamental plants and children: when my kids were little I tried to keep the poisonous plants out of the yard (okay, I broke my rule with daffodils and delphiniums, though fortunately the Belladonna Delphiniums tended to die). When I went to a garden landscaping talk I gasped when the speaker put up a slide of elephant ear and castor bean plants as a good decorative pair!

  3. evilrobotxoxo says:

    Anticholinergic delirium can be a very tricky thing to spot. I’ve only seen one really bad case of it in an otherwise healthy person, back when I was an intern on medicine, and all of the typical indicators such as tachycardia, which is supposed to be the most sensitive indicator, were not present. I think that was the first time a patient ever tried to bite me. Inhalants, anticholinergics, NMDA antagonists (e.g. PCP), and GHB are four things that no one should ever fool around with recreationally.

  4. inhaler says:

    When my dad was a kid a group of guys from his high school had made a tea from Jimson Weed and consumed it. The police originally found their car still running with all the doors opened. They later found the guys wandering around through their small rural town naked (they later said they were “hot” so they stripped down). Apparently they had to lock them up in a cell as they were acting like animals.

  5. BillyJoe says:

    The Datura tree is beautiful. My sister-in-law had an magnificent specimen growing in her back yard, but she cut it down as soon as she learned about it’s poisoning potential – a painful but correct decision it seems..

  6. lizditz says:

    Part of the problem is that Angel Trumpets are ubiquitous in Southern California–they are lovely, fragrant, and relatively easy to grow.

    LA City Councilmember Tom LaBonge is half-right…

    LaBonge says kids need to be educated of the dangers, and parents can also do their part by cutting back trees and keeping buds out of reach.

  7. GinaPera says:

    These are indeed beautiful bushes, and ubiquitous in California gardens. I’ve grown several from cuttings and enjoy their graceful, abundant blossoms and sweet fragrance.

    It would be a shame to eliminate Angela’s Trumpets because of its poisoning potential. That is sort of like the millions of dollars we’re spending just to study how to reduce suicide attempts on the Golden Gate Bridge while people struggle to find mental healthcare in SF, where too often dangerous mental illness is romanticized as “neurodiversity” or artistic eccentricity.

    Better to educate about the dangers of ingesting ANY plant whose effect is unknown–and to address the problems of people who do such things impulsively and recklessly. Often, there are underlying mental health issues. If not the plants — or the bridge — it will just be something else.

    Gina Pera
    http://www.ADHDRollerCoaster.org

  8. GinaPera says:

    Oh, and thanks for the well-written, interesting and important post, David.

  9. Chris says:

    I don’t think there is a reason to eliminate them. I was wary of what I put in my garden when my children were small, so I tried to keep away from very poisonous plants.

    I know that it is not always possible. My son was playing with a friend who lived near a very wooded ravine where a plant was growing that produced good branches for fake sword fighting, giant hogweed. This is a plant that was brought in as an ornamental and escaped gardens to become a noxious weed.

    My son got a rash from the sap of that plant. I did tell his friend’s mother to please tell her son to not play with it anymore (for some reason he was not as affected), and she had no idea what it was. Fortunately eight years later the boys (now men) are still friends.

    So you are very right about educating people about the fact that people need education. In fact, I just listened to today’s “Wait! Wait! Don’t Tell Me!” from NPR where they went over the story of a chef who recommended a poisonous plant, henbane, in salads that includes this advice:

    No reports of any casualties yet, but the magazine has posted a warning on its website, as always, check with an expert when foraging or collecting wild plants.

  10. aaronupnorth says:

    And of course there is marijuana, which here in British Columbia is generally considered ‘totally natural’. It seems to be fairly innocuous for many people but I see a fair number of young people with marijuana induced psychosis in the emerg. I am sure that some of these people have underlying predilection towards psychosis, but some seem to be very normal kids who end up with a few days on the psych ward every time they smoke pot.
    Just to be clear, I am not commenting on any potential medicinal use of marijuana, rather on some bad effects I see in young recreational users. Both they and their parents are always surprised that marijuana is the culprit.

  11. For gardener’s, Angel’s Trumpet is also known as Moon Flower. It is in the same family as Morning Glories. I remember some kids awhile back around here that got in trouble eating Morning Glory seeds (recreational, not accidental), ended up in the hospital.

    Honestly, I have not put much thought into the level of poisoning risk in the plants I select for my garden. Maybe I should. I do have an ongoing battle with the nightshade vines that pop up everywhere and the poison ivy that continued to thwart my attempt to eradicate it. Also, I emphasis to the children that they should never eat anything from the outdoors unless we give it to them to eat.

    GinaPera – Although I agree with your discontent on the lack of mental health services, I wanted to mention that I heard an article on the radio* (probably NPR) awhile back that said that at least one anti-suicide prevention alteration on a prominent suicide location (landmark) had actually lowered suicides rates in that city. Why? I don’t think anyone could say. But it does seem like that building alterations may be a worthwhile endeavor.

    *sorry for the lack of source, take it for what it’s worth.

  12. Calli Arcale says:

    I’ve read that sort of thing as well, micheleinmichigan. The reasoning I’ve heard is that suicide is usually impulsive — that is, the person hasn’t really thought it out. Thus, anything that adds a few steps will help reduce the rate, because adding a few steps adds time for the person to think about it.

    A really determined suicide will find a way. But most suicides are not so determined, but really are on a whim. It’s a whim with a very long build-up, in most cases, but still a whim. (Been there myself, so I can speak from personal experience. I didn’t actually do it, but I was seriously thinking about it. Had a perfect opportunity presented itself, I might have seized it.)

    “Romantic” sites (landmarks, places with very good views, etc) tend to attract would-be suicides. The Golden Gate Bridge is especially romantic, so of course it has a disproportionate share. Suicide barriers would make a big difference, it hink.

    As far as gardening goes….

    I wonder which is more dangerous: houseplants or landscaping? Many of the hardy, succulent, shade-tolerant plants preferred as houseplants are very dangerous to eat — and will be more available to pets and toddlers than outdoor plants. Also, more easily confused with toys, which toddlers are often encouraged to gnaw. My hunch is to be more cautious with the indoor plants than the outdoor, especially since outdoor plants can’t be controlled as well — weeds will come, despite your best efforts.

    I, too, have morning glories aplenty in my garden — no matter how often I weed. I never bother planting them. They’re too abundant. Not as much nightshade as at my old house, fortunately. I do have a number of edible plants in my yard: daylillies. I’m an occasional gardener, so I like plants that can tolerate neglect. (And these will tolerate pretty much anything you throw at them. They may even survive being thrown away; I’ve seen them growing happily in mulch piles.) You can eat any part of a daylilly, though some bits are tastier than others. But I teach my children not to eat unknown plants. Plants and fungus should be presumed deadly until proven otherwise. Fortunately, their general antithesis to anything green is actually good in this case. ;-)

  13. Calli Arcale says:

    Ack — I mean antipathy, not antithesis. Saw the wrong word moments after hitting “Submit”.

  14. lizditz says:

    MicheleInMichegan wrote

    For gardener’s, Angel’s Trumpet is also known as Moon Flower. It is in the same family as Morning Glories. I remember some kids awhile back around here that got in trouble eating Morning Glory seeds (recreational, not accidental), ended up in the hospital.

    Well, kinda sorta. This is where the Latin names come in handy, rather than the common names, which can fail to distinguish between plants, and even worse, vary from locality to locality.

    One “Moon Flower” refers to Ipomoea alba Morning Glories are also Ipomoea. The Heavenly Blue varietals of Ipomoea violacea have psychoactive properties, according to Erowid. I believe the Ipomoeas are mostly vines.

    The seeds of several varieties of Morning Glory (Ipomoea violacea) contain a naturally occurring indole called Lysergic Acid Amide (LSA), which is closely related to LSD. Seeds are taken orally, and can be eaten whole or the active alkaloids can be extracted.

    Another “Moon Flower” is Datura inoxia, which is discussed here on Erowid.

    Most parts of the plant contain atropine, scopolamine, and hyoscyamine.

    The Ipomoea and Datura flowers point more-or-less up. Ipomoeas have naturalized and are weedy pests in some parts of the US.

    The plants that are (probably) the subject of Kroll’s article are Brugmansia cubensis — I say “probably” because the brugmansias evidently are easy to hybridize and who knows what the actual species really are. Erowid says:

    Most parts of the plant contain atropine, scopolamine and hyoscyamine.

    Brugmansia flowers point mostly down (are pendant). I haven’t found any reports of brugmansias naturalizing in the continental US, although they may have in Hawaii.

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