Datura stramonium – A Dangerous Weed and Alternative Drug of Abuse: An Overview of Poisoning Cases in 21st Century

Abstract

Datura stramonium is a well-known cosmopolitan weed known by several common names: thorn apple (due to the appearance of its fruits), Angelʼs trumpet (linked to its flowers), loco seed (referring to the hallucinogenic properties of its seeds), jimson weed (originating from the first recorded poisoning involving this plant), and apple of Peru (indicating the plantʼs origin). All parts of the plant contain the tropane alkaloids hyoscyamine, scopolamine, and atropine together with several minor alkaloids, which cause poisoning such as typical anticholinergic syndrome with neuropsychiatric effects. A review of 114 papers from various databases (Scopus, Web of Science, PubMed, and Google Scholar) revealed that poisoning incidents involving this plant have been relatively common from 2001 to 2024. The analysis indicated that all cases of poisoning from D. stramonium can be categorized into two main groups: accidental and misuse. Accidental poisonings are primarily linked to the contamination of other crops in the field, leading to mass poisoning of humans and animals. They can also result from misidentifying the plant as another edible species, childrenʼs curiosity, and self-medication. On the other hand, misuse is typically associated with recreational drug use, suicide attempts, criminal activities, and magico-religious practices. To prevent poisoning from this plant, it is essential to eliminate the weed from fields, yards, gardens, and other disturbed areas. Additionally, it is important to educate the general public about the plantʼs appearance and the dangers associated with its consumption, particularly in the context of self-medication and recreational drug use.

 

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Keywords

accidental poisoning - Datura stramonium - misuse - Solanaceae - tropane alkaloids

Introduction

Datura stramonium L. is a well-known cosmopolitan weed that grows in temperate regions, along roadways, pastures, and other marginal areas, but also on arable land together with many crops [1], [2]. It is annual plant, from the Solanaceae family, with a light beige tap root system (12 – 30 cm in length and 0.5 – 2 cm in diameter) and numerous side roots [3]. The plant is smelly (sometimes called stinkweed), 75 – 90 cm tall, with an erect, stout branching stem [1]. Leaves are alternating, unevenly or sharply toothed, and glabrous [4]. The leaves have a bitter, nauseating taste [5]. The flowers are white, five-lobed, trumpet-shaped, and the fruit is a spinous capsule with tiny, flattened, blackish-brown seeds (in some regions called loco seed) ([Fig. 1]) [5].

Fig. 1 Datura stramonium: flower (a and b), fruit (c), and seeds (d) (photo by Milica Aćimović).

It is commonly known as thorn apple or Angelʼs trumpet, which is associated with the appearance of the fruits and flowers of this plant [6], [7]. Another, very common name for this plant is jimson weed, actually a shortened version of Jamestown weed, introduced after the first recorded accidental ingestion that happened in Jamestown, Virginia (USA) in 1676 [8], [9]. Succinctly, English soldiers sent to Jamestown to quell Baconʼs Rebellion, ate copious amounts of D. stramonium young leaves as a boiled salad and expressed bizarre and foolish behavior during an 11-day period [10]. Additionally, apple of Peru is sometimes used as a name for D. stramonium, referring to the origin of this plant, and its ancient use in surgical operations by Peruvian healers as an anesthetic (600 – 800 AD) [1].

The name of genus Datura is taken from dhattūra, an ancient Arabic word meaning “divine inebriation”, while the name of the species stramonium originates from the Greek language, as a combination of the words: strychnos – deadly and manikos – mad [11], [12], [13].

The whole plant contains the tropane alkaloids L-hyoscyamine and scopolamine, as well as atropine, which is a racemic mixture of L-hyoscyamine and D-hyoscyamine [14]. Practically, L-hyoscyamine is the dominant tropane alkaloid, as a precursor for the synthesis of scopolamine, and an enantiomer of atropine that is formed by racemization during the extraction [15]. Additionally, several minor tropane alkaloids have also been found [16].

Although several alkaloids are present in D. stramonium, atropine is the most widely used in pharmacological formulations because it is stable and does not racemize in solution [17], [18]. In general, tropane alkaloids are reliable antagonists of muscarinic receptors, used in eye therapy, preoperative administration in surgery, and the treatment of organophosphorus and carbamate poisoning [18], [19], [20], [21], [22], [23]. However, overdose with tropane alkaloids can lead to increased antimuscarinic side effects, which are typical of D. stramonium poisoning.

The clinical signs of poisoning with D. stramonium begin within 30 – 60 min after ingestion, as a typical anticholinergic syndrome with neuropsychiatric effects [16], [24]. “Hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hen” is the proverbial saying which, in the best way, describes symptoms of poisoning with tropane alkaloids [24], [25], [26], [27], [28].

The primary toxic manifestations include mydriasis (due to blockades of the papillary sphincter muscle and iris muscle), dry mouth (due to a salivary secretion blockade), tachycardia (due to competition at the muscarinic receptors in the postganglionic parasympathetic neurons and a blockade of receptors in the sinoatrial node), and fever and erythema (due to vasodilatation and inhibition of sweating) [29]. The neuropsychiatric effects occur due to the depressant activity of Datura alkaloids on the central nervous system including speech disorders, agitation, aggression, and hallucinations [16], [30]. Rarely, hyperthermia, respiratory arrest, and convulsions may be observed. It may result in coma if taken at a very high dose [8].

However, sometimes symptoms can be misidentified with some other diagnosis such as stroke [31], encephalitis [32], food poisoning [33], or even “bath salt” intoxication [34]. Therefore, appropriate recognition and management of D. stramonium poisoning is very important especially in pediatrics [35].

The treatment of D. stramonium intoxication includes gastrointestinal decontamination (emesis, gastric lavage, and activated charcoal), hydration via intravenous fluids, sedation (diazepam), oxygen supplementation, and physostigmine as an antidote in severe cases where the patient has resistant delirium or agitation [36], [37]. In all cases, symptoms regressed after approximately 24 h, leading to a full recovery after 48 h [37].

Nevertheless, D. stramonium possesses medicinal purposes as well. In traditional medicine worldwide, it is mainly used to treat respiratory ailments (asthma and bronchitis), skin conditions (ulcers, wounds, inflammation, bruises, hemorrhoids) and musculoskeletal disorders (rheumatism and gout, sciatica) [38], [39], [40], [41]. However, sometimes a wider range of usages is stated in ethnomedicine (headache, toothache, menstrual blood, sexual stimulant, sedative, swellings, fever, etc.) and ethnoveterinary practices (nerve problems, yoke sore, wounds, dermatophytosis, mastitis, trypanosomiasis, blackleg, anthrax, nasal bleeding, and diarrhea) [42], [43], [44], [45]. On the other side of the spectrum, modern pharmacological studies proved that D. stramonium possesses antioxidant, antimicrobial, anti-inflammatory, and antitumor activities [46].

The aim of this study was to conduct a thorough search of scientific databases (Scopus, Web of Science, PubMed, and Google Scholar) to comprehensively review all documented cases of D. stramonium poisoning in the 21st century. Additionally, an analysis was performed to systematically assess the findings of the selected 114 articles and draw conclusions regarding the causes of poisoning.

 

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Material and Methods

Search strategy

The literature was searched (in November 2024) within article titles, abstracts, and key words using “Datura stramonium poisoning” through three databases (Scopus, Web of Science, and PubMed) to identify relevant case studies published during the 21st century (period between 2001 and 2024). To obtain a complete overview, the relevant publications available from the Google Scholar database were also taken in account. Descriptive statistics were applied throughout the manuscript to summarize and characterize the data.

 

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Selecting studies

A total of 360 studies were retrieved from the following databases: Scopus (146 results), Web of Science (90 results), Pub Med (124 results). After removing duplicates, 216 studies remained. Subsequently, after screening the titles and abstracts, 131 studies were excluded (review articles, out of scope, unavailable documents, referring to the same case, referring period before range of observation). The remaining 85 studies were further reviewed, together with additional relevant studies from the Google Scholar database (29). A total 114 studies were finally included in the analysis.

 

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Results of the Study

The review of the 114 articles ([Table 1]) showed that poisoning with D. stramonium could be divided into two groups: accidental and misused ([Fig. 2]). Moreover, some articles referred to different causes of poisoning [47], [48]. Therefore, it is duplicated in different groups. However, several articles have not specified the exact cause of poisoning with this plant (N/A), while case studies were presented in five articles.

Table 1 Case reports of Datura stramonium poisoning (references are displayed from newest to oldest, and within the same year in alphabetical order).

No	Reference	Location	Intoxication cause	Intoxication way	Person	Symptoms
DS – Datura stramonium; N/A – no data; GCS – Glasgow Coma Score; 1 Same as reported in Roberts et al. [56]; 2 Other family members who had eaten the same food also developed similar complaints and went to the adult emergency room; 3 Same as reported in Mutebi et al. [65]; 4 Two more members within the same family who ate salad experienced vertigo
1	[49]	Italy	Contamination in the field – humans	Spinach contaminated with DS leaves	Mass poisoning (4 families; 13 persons)	N/A
2	[50]	Turkey	N/A	Ingestion DS seed tea	23-y ♂	Restlessness, altered mental state, hallucinations, tachypnea, tachycardia, disorientation, and bilaterally mydriatic pupils.
3	[51]	Ethiopia	Childrenʼs curiosity	Ingestion DS seeds	3-y ♂	Altered mental status, agitation, seizures, tachycardia, and dilated pupils.
4	[52]	India	Predatory use	(Robbing) apple juice with DS	17-y ♂	Visual hallucinations, disorientation, incomprehensible and nonsensical speech, dilated pupils, urinary retention, and aggressive behavior.
5	[53]	Michigan, USA	Mistaken identity	Ingestion soup with DS leaves	Family poisoning (3 members)	Vomiting, dry mouth, blurred vision, flushed skin, breathing difficulties, and hallucinations.
6	[54]	Algeria	Childrenʼs curiosity	Ingestion DS seeds	7-y	Agitation, visual hallucinations, and bilateral mydriasis.
7	[55] 1	Australia	Contamination in the field – humans	Baby spinach contaminated with DS leaves	Mass poisoning (over 100 patients)	Hallucinations, delirium, and unusual behavior.
8	[32]	Greece	Contamination in the field – humans	Αmaranthus blitum contaminated with DS	71-y ♂	Encephalitis-like symptoms including confusion, speech disturbances, tachycardia, and mydriasis.
9	[57]	China	Contamination in the field – humans	Broomcorn flour contaminated with DS	Mass poisoning (64 patients)	Dry mouth, fatigue, headache, nausea, vertigo, dilated pupils, blurred vision, and difficulty speaking.
10	[37]	Syria	Childrenʼs curiosity	Ingestion DS	7 children (1 – 8-y)	Skin rash and diffuse redness, dry mucous membranes, pupillary mydriasis, abdominal pain, nausea, and vomiting. In two children with a more severe clinical presentation, a change in consciousness occurred.
11	[58]	Italy	Self-medication	Smoking DS cigarettes (diagnosed asthma)	52-y ♂	Acute respiratory syndrome, characterized by worsening dyspnea and chest tightness. Chronic use of DS cigarettes masks the progression of chronic obstructive lung damage.
12	[59]	Turkey	Self-medication	Ingestion DS seeds for treatment of diarrhea	40-y ♂	Agitation, restlessness, altered consciousness, irritability, self-harm and harm to others, impaired orientation, senseless self-talking, hallucinations, pupillary mydriasis, blurred vision, dry skin and mouth, tachycardia, and decreased bowel sounds.
13	[60]	Trinidad	Magico-religious	Ingestion DS tea + milk wit 400 – 500 seeds DS, marijuana, honey	75-y ♂	Unconscious and incontinent, GCS: 8 – 9, flushed skin.
14	[61]	Iran	Mistaken identity	Ingestion DS herbal tea for refreshing	Family poisoning (6 members)	Agitation, restlessness, hallucinations, nausea, dry mucous membranes and skin, flushing, dilated pupils, dizziness, and drowsiness.
15	[62]	Turkey	Mistaken identity	Ingestion meal with DS leaves	8-y ♀ (family poisoning)2	Skin rash and delirium.
16	[63]	Nepal	Magico-religious	Ingestion DS seed pudding	10-y ♂	Incoherent speech, hallucinations, hyperactivity, dry mouth, agitation, aggression, and purposeless movements.
17	[64] 3	Uganda	Contamination in the field – humans	Corn soy blended flour contaminated with DS	Mass poisoning (293 patients; 5 died)	Rapid onset of headache, abdominal pain, dry mouth, sticky saliva, body itching, mental confusion, dizziness, paleness, and dilated pupils.
18	[66]	Turkey	Self-medication	Ingestion DS seeds for treatment of chronic constipation	50-y ♂	Dizziness, restlessness, vomiting, loss of consciousness, GCS: 3, bilateral mydriasis, and tachycardia.
19	[67]	Qatar	Recreational drug use	Ingestion boiled DS seeds with milk	32-y ♂	Dry, flushed skin with dilated pupils; confused, delirious, and unable to communicate.
20	[68]	France	Predatory use	(Robbing): inhalation of DS powder from piece of cloth	58-y ♂	Incoherent and gradually lost consciousness, with clonic movements, bilateral mydriasis, hypertension, tachycardia, GCS: 13 – 15, and visual hallucinations.
21	[69]	Hungary	Case series 2005 – 2017	N/A	162 patients	N/A
22	[70]	Iran	Mistaken identity	Ingestion DS seed instead poppy	52-y ♂	Agitation, headache, nausea, ataxia, visual hallucinations, and facial flushing.
23	[71]	India	Mistaken identity	Ingestion stew contaminated with DS leaves	3 family members (21-y ♂; 24-y ♀; 50-y ♀)	Dry mouth, dry eyes, dilated pupils, and blurred vision.
24	[72]	Germany	Contamination in the field – animals	Maize silage contaminated with DS	30 bulls	A decrease in feed intake within 24 h without an impaired general condition. One day later, some of the bulls displayed signs of ruminal tympany, and the reduction in feed intake became more severe.
25	[31]	Italy	Mistaken identity	Ingestion omelet with DS	64-y ♀	Stroke-like symptoms: dysarthria, dysphagia, mild impairment of consciousness, and GCS: 13.
26	[9]	Turkey	Childrenʼs curiosity	Ingestion DS	6-y	Dry mouth, bilaterally dilated and reactive pupils, agitation, and aggressive, purposeless movements.
27	[73]	Turkey	Mistaken identity	Ingestion DS seeds instead of black cumin in yoghurt	48-y ♀	Wernicke aphasia-like symptoms, including meaningless conversation.
28	[74]	Algeria	Childrenʼs curiosity	Ingestion DS seeds	2 children (3-y ♂; 5-y ♂)	Agitation with balance disorders, GCS: 11 – 15, mydriasis, and tachycardia.
29	[75]	Malaysia	Mistaken identity	Ingestion cooked DS seeds	Family poisoning (2 members)	Giddiness, restlessness, aphantasia, and unwillingness to communicate.
30	[76]	Arizona, USA	Case series 2003 – 2010	N/A	14 patients	N/A
31	[77]	India	Self-medication	Ingesting DS root paste for treating hemorrhoids	28-y ♂	Vomiting, restlessness, and disorientation.
32	[78]	Turkey	Self-medication	Ingestion DS tea to treat hemorrhoids	76-y ♀	Changes in consciousness, dizziness, visual and speech impairments, and dilated pupils.
33	[8]	Turkey	Self-medication	Ingestion DS seeds for treating burning sensation upon urination	2 patients (64-y ♂ and 67-y ♂)	Exhaustion, nausea, dry mouth, urinary retention, and agitation.
34	[79]	Turkey	Childrenʼs curiosity	Ingestion DS seeds and leaves	2 children (6-y ♂ and 8-y ♂)	Dry mouth, euphoria, visual hallucinations, and disorientation.
35	[80]	Romania	Recreational drug use	Ingestion DS seeds	22-y ♂	Coma, fever, tachycardia, and urinary retention.
36	[81]	Iran	Recreational drug use	Ingestion DS flower tea	29-y ♂	Hallucinations, vomiting, dry mouth, persecutory delusions, diarrhea, mydriatic pupils, and flushing.
				Ingestion DS seed powder	23-y ♂	Nausea, vomiting, disorientation, delusions, agitation, tachycardia, and mydriasis.
				Smoking cannabis and DS seeds	25-y ♂	Agitation, aggressive behavior, self-harm attempts, mydriasis, flushing, nausea, and thirst.
				Ingestion DS and cannabis herbal tea	17-y ♂	Agitation, hallucinations, flushing, and vomiting.
				N/A (abuse)	17-y ♂	Visual and auditory hallucinations, agitation, mydriasis, and flushing.
37	[82]	Indonesia	Predatory use	(Robbing): Ingestion DS in drink	35-y ♂ (died)	Lethal
38	[83]	Algeria	Childrenʼs curiosity	Ingestion DS seeds	3 children (5 – 10-y)	Two children with behavioral disorders and one who is unconscious.
39	[84]	Turkey	Recreational drug use	Ingestion DS seeds	30-y ♂	Agitation and delirium.
40	[85]	France	Suicide	Ingestion DS seeds	58-y ♀	Loss of consciousness.
41	[86]	Turkey	Mistaken identity	Ingestion dolma (rice with DS flowers instead of pumpkin flowers)	Family poisoning (3 members)	Changes in consciousness, visual impairment and hallucinations, dilated pupils, tachycardia, tachypnea, dry and red mucous membranes and skin, and decreased bowel sounds.
42	[87]	India	Recreational drug use	Ingestion DS seeds (3 – 10 daily) over 3 years	32-y ♂	The patient had been abusing DS over a prolonged period and exhibited aggressive and assaultive behavior, as well as hallucinations, ultimately developing paranoid schizophrenia.
43	[88]	India	Predatory use	(Robbing): Ingestion of prasad (sweet made from ground nut seeds and sugar crystals)	35-y ♂	Giddiness, vomiting, stupor, and drowsiness.
44	[89]	Turkey	Childrenʼs curiosity	Ingestion DS seeds	5-y ♂	Fever, difficulty speaking, decreased level of consciousness, facial and body erythema, nausea and vomiting, blurred vision, and hallucinations.
45	[47]	Argentina	Recreational drug use	Ingestion DS seeds	15-y ♂	Dysarthria, disorientation, ataxia, delirium, and hallucinations.
			Childrenʼs curiosity	Ingestion DS seeds	2 children (3-y ♂; 7-y ♂)
46	[90]	Turkey	Recreational drug use	Ingestion DS tea	7 adolescents (18 – 22-y ♂)	Nausea, vomiting, agitation, visual hallucinations, blurred vision, meaningless speech, tachycardia, flushing, mydriasis, and delirium.
47	[91]	Turkey	Suicide	Ingestion DS seeds	38-y ♂	Confusion, muscle contractions, hallucinations, mydriatic pupils and red eyes, dry mucosal membranes and tongue, and decreased bowel sounds.
48	[34]	West Virginia, USA	Recreational drug use	N/A	15-y ♂	Misdiagnosed as bath salt intoxication.
49	[27]	Madagascar	Childrenʼs curiosity	Ingestion DS leaves and flowers tea	2 children (5-y ♂; 4-y ♂)	Agitation, hallucinations, mydriasis, and coma (GCS: 8 – 15).
50	[92]	Turkey	Contamination in the field – humans	Purslane salad contaminated with DS	8-y ♂ (family poisoning)4	Visual hallucinations, disorientation, slurred speech, and agitation.
51	[93]	Nigeria	Recreational drug use	Ingestion DS seed water extract	2 adolescents (14-y ♂; 12-y ♂)	Tonic-clonic convulsions, restlessness, excessive and incoherent speech, visual hallucinations, inability to recognize familiar people, irrational behavior, confusion, fever, dry mouth, and dilated pupils.
52	[94]	France	Contamination in the field – humans	Organic buckwheat seed flour contaminated with DS	Mass poisoning (24 patients)	Visual disturbances, mydriasis, tachycardia, ataxia, dry mouth, dysphagia, vomiting, nausea, meteorism, urinary retention, tremor, nervousness, dizziness, pruritus, abdominal pain.
53	[95]	Slovenia	Contamination in the field – humans	Buckwheat flour food contaminated with DS	Mass poisoning (73 patients)	Dry mouth, hot, red skin, blurred vision, tachycardia, urinary retention, ataxia, speech disturbances, disorientation, and visual hallucinations.
54	[96]	Morocco	Childrenʼs curiosity	Ingestion DS seeds and leaves	2 children (20 month and 5-y)	Agitation, bilateral mydriasis, skin rash, and fever.
55	[97]	Turkey	Recreational drug use	Ingestion DS	19-y ♂	Altered consciousness, meaningless speech, shouting, disorientation, and agitation.
56	[98]	Iran	Case series 2008 – 2011	N/A	19 patients	N/A
57	[99]	Canada	Recreational drug use	Ingestion DS seeds	15-y ♀	Hallucinating, incoherent, tachycardic, confused, with dilated pupils and dry, flushed, hot skin.
58	[100]	Japan	Mistaken identity	Ingestion DS root instead burdock root	Family poisoning (3 members)	Agitation, visual hallucinations, abnormal behavior, inability to speak, and dilated pupils.
59	[101]	Turkey	Self-medication	Ingestion DS tea for hemorrhoids	69-y ♂	Disturbance of consciousness and agitation.
60	[102]	France	Mistaken identity	Ingestion “rougai” with DS instead of wild spinach	Family poisoning (3 members)	Confused, apathetic, agitated, with impaired consciousness, tonic-clonic movements, agitated coma, and reactive bilateral mydriasis.
61	[103]	Turkey	Self-medication	Ingestion DS seeds for hemorrhoidal pain	62-y ♂	Agitative behavior with psychomotor impairment, hallucinations, confusion, urinary retention, dilated pupils, abdominal pain, nausea, dry skin, tachycardia, and tachypnea.
62	[104]	Tunisia	Childrenʼs curiosity	Ingestion DS leaves	3-y ♀	Excitation, agitation, and aggression with purposeless movements, delirium, hallucinations, and dry mouth.
63	[105]	Turkey	Self-medication	Ingestion DS tea for treating upper respiratory tract discomfort and abdominal pain	11-y ♂	Meaningless speech, failure to recognize himself and others, auditory and visual delusions, facial redness, bilateral mydriasis, dry skin, mucous membranes, and tongue, with decreased bowel sounds.
64	[106]	Turkey	Self-medication	Ingestion DS herb	65-y ♀	Acute psychosis and dementia-like symptoms: blurred speech, restlessness, inability to recognize her relatives and surroundings, talking to herself, bizarre behaviors, and dilated pupils.
65	[107]	Turkey	Self-medication	Ingestion DS tea for asthma treatment	37-y ♀	Delirium, agitation, visual hallucinations, disorientation, bilateral mydriasis, and dry tongue and mucous membranes.
66	[108]	Turkey	Recreational drug use	Ingestion DS seeds	22-y ♂	Fever, dryness of the mouth and throat, decreased bowel sounds, and mydriasis.
67	[109]	Ohio, USA	Recreational drug use	Ingestion DS seeds	16-y ♂	Hallucinations, combativeness, agitation, dilated pupils, and flushed skin.
68	[110]	Maryland, USA	Mistaken identity	Ingestion homemade stew contaminated with DS leaves	Family poisoning (6 members)	Hallucinations, confusion, mydriasis, and tachycardia.
69	[11]	Italy	Recreational drug use	Ingestion DS seeds	Patients from abuse treatment center (32-y ♂; 24-y ♂; 33-y ♂)	Delirium, confusion, and disorientation.
70	[111]	Philadelphia, USA	Recreational drug use	Ingestion vodka + DS seeds	22-y ♂	Altered mental status, psychomotor agitation, tachypnea, dilated pupils, hypoactive bowel sounds, warm, dry, and flushed skin, GCS: 9.
71	[112]	Turkey	Childrenʼs curiosity	Ingestion DS leaves	4-y ♂	Fatigue, dry mouth, dilated pupils, urinary retention, and decreased bowel sounds.
72	[113]	Oklahoma, USA	Recreational drug use	Ingestion DS seeds	15-y ♂	Hallucinations, incoherence, mental status changes, dilated pupils, dry skin and mucous membranes, and urinary retention.
73	[114]	Minnesota, USA	Self-medication	Ingestion raw eggs with DS leaves for stomach cramping and irritation	49-y ♂	Altered mental status, intermittent combativeness and somnolence, reddish skin, tachycardia, hypertension, mydriasis, and absent bowel sounds.
74	[115]	Korea	Self-medication	Ingestion DS seed tea for relieving coughing and asthma	2 elderly (71-y ♀; 70-y ♀)	Mental confusion, dysarthria, disorientation, weakness, incoherence, purposeless movements, dilated pupils, dry mouth, and visual blurring.
75	[116]	Lithuania	Recreational drug use	Ingestion pancakes from ground potatoes (national Lithuanian dish) with DS fruit paste	3 persons (14-y ♀; 19-y ♂; 20-y ♂	Dilated pupils, red face, dry mouth, hallucinations, delirium, tachycardia, tachypnea, and slight hypothermia.
76	[117]	Spain	Recreational drug use	Ingestion DS flower infusion	2 adolescents (15 and 16-y)	Vomiting, confusion, disorientation, verbosity with incoherent speech, intermittent psychomotor agitation and visual hallucinations, mydriasis, tachycardia, facial flushing, hot skin, and dry mucous membranes.
77	[7]	Canada	Recreational drug use	Ingestion DS seeds	4 adolescents (16-y ♂; 13-y ♂; 14-y ♂; 13-y ♀)	Disorientation, hallucinations, agitation, aggression, combativeness, and dilated pupils.
78	[118]	Spain	Contamination in the field – animals	Ingestion DS with corn silage	2 dairy cattle	Gastrointestinal disorders and decreased milk production.
79	[28]	Israel	Recreational drug use	Ingestion DS seed tea	2 persons (21-y ♂; 19-y ♂ (died)	Unconsciousness, tachypnea, mydriasis, dry oral mucosa and skin, and a soft abdomen with diminished bowel sounds. One case resulted in death.
80	[119]	California, USA	Childrenʼs curiosity	Local ocular expose to DS plant	12-y ♂	Anisocoria, blurry vision, and mydriasis.
81	[33]	Austria	Contamination in the field – humans	Lunch in a factory canteen: millet-carrot balls contaminated with DS seeds	Mass poisoning (8 employers)	Food poisoning due to DS, mimicking Bacillus cereus food intoxication, with gastrointestinal disorders such as vomiting and nausea.
82	[120]	UK	Recreational drug use	Ingestion DS tea	17-y ♂	Hallucinations and purposeless movements (such as picking motions in the air), dilated pupils, hot and flushed skin, tachycardia, vomiting, hypoactive bowel sounds, and urinary retention.
83	[121]	France	Recreational drug use	Ingestion DS herb tea	2 adolescents (17-y ♂; 17-y ♀)	Agitation, anxiety, and delirium with persecutory ideation and frightening hallucinations of being assaulted by animals, followed by loss of consciousness.
84	[48]	France	Suicide	Ingestion 10 fresh leaves	54-y ♂	Obtunded, confused, dysarthric, with loss of consciousness, GCS: 10, and mydriasis.
			Recreational drug use	Ingestion DS seed infusion	17-y ♂	Agitated and uncooperative, GCS: 10, and mydriasis.
85	[122]	Poland	Case series 2000 – 2003	Children intoxication	28 patients	N/A
86	[123]	Turkey	Childrenʼs curiosity	Ingestion DS	3 children (5-y ♀; 7-y ♂; 5-y ♀)	Incoherent speech, difficulty speaking, and loss of consciousness, followed by briefly awakening for a few seconds before losing consciousness again.
87	[124]	Canada	Recreational drug use	Ingestion DS seeds with alcohol	2 adolescents (16-y ♂; 15-y ♀)	Visual hallucinations, disorientation, incomprehensible and nonsensical speech, dilated pupils, and combativeness.
88	[125]	Bulgaria	Contamination in the field – animals	Ingestion freshly harvested maize for silage contaminated with DS herbs	34 horses (2 died)	Mild hyperthermia, tachycardia, polypnea, dyspnea with shallow breathing, mydriasis, dry oral, rectal, vaginal, and nasal mucosae, acute gastric dilatation with severe intestinal gas accumulation, anorexia progressing to complete refusal of feed, decreased or absent thirst, and absence of defecation and urination.
89	[36]	Texas, USA	Case series 1998 – 2004	N/A	188 patients	N/A
90	[126]	Turkey	Self-medication	Ingestion DS seed tea for to relieve gallstone pain	54-y ♀	Confusion and agitation, GCS: 9, mydriasis, hyperemic mucous membranes, and dry mucous membranes.
91	[127]	Italy	Mistaken identity	Ingestion of DS blossom and leaves fritters instead pumpkin	53-y ♀	Unconscious but later awoke with agitation, confusion, hallucinations, and combative behavior.
92	[128]	Japan	Mistaken identity	Ingestion boiled DS instead Angelica keiskei	N/A	Restlessness and pupillary dilation.
93	[129]	Spain	Contamination in the field – animals	Ingestion dry lucerne contaminated with DS	4 horses (1 died)	Colic with signs of abdominal pain, anxiety, and increased borborygmi; mucous membranes were reddened.
94	[26]	Kingdom of Saudi Arabia	Childrenʼs curiosity	Ingestion DS seeds	6-y ♂	Restlessness, hallucinations, and mydriasis.
95	[130]	USA	Recreational drug use	Ingestion DS seeds	19-y ♂	Combative, panicked, flushed face, drenched in sweat, and experiencing visual hallucinations.
96	[131]	Turkey	Childrenʼs curiosity	Ingestion DS leaves	8-y ♀	Fatigue, loss of consciousness, dry mouth, GCS: 5, dilated pupils, urinary retention, and decreased bowel sounds.
97	[132]	Spain	Recreational drug use	Ingestion DS seed infusion	2 adolescents (16-y ♂; 16-y ♂)	Agitation, disorientation, hallucinations, restlessness, psychomotor agitation (including aggressiveness), verbosity, visual hallucinations, mydriasis, and dry mucous membranes.
98	[133]	South Africa	Contamination in the field – animals	Ingestion dried tef hay contaminated with young DS plants	18 horses	Colic attacks.
99	[134]	Wisconsin, USA	Recreational drug use	Ingestion DS seeds	5 ♂ adolescents (15 – 17-y)	Disorientation, hallucinations, combativeness, unintelligible speech, and blurry vision.
100	[135]	Philadelphia, USA	Recreational drug use	Ingestion DS seeds	16-y ♂	Agitation, delirium, hallucinations, purposeless movements (picking invisible things), incoherence, disorientation, and inability to cooperate.
101	[136]	Greece	Recreational drug use	Chewing and ingestion DS seeds	19-y ♂ (died)	Lethal
102	[137]	Spain	Contamination in the field – humans	Corn flour contaminated with DS seeds (used for preparation “porridge”)	Family poisoning (5 members)	Dryness of the mouth, difficulty initiating urination, dizziness, blurred vision, and, in two of them, gait disturbance.
103	[138]	Turkey	Self-medication	Ingestion DS seeds for hemorrhoids	48-y ♀	Dizziness, dry mouth, visual disturbances, and facial flushing.
104	[139]	Germany	Recreational drug use	Ingestion DS seeds tea	17-y ♂	Altered mental status, agitation, combativeness, slurred speech, dry oral mucosa, rare bowel sounds, and mydriasis.
105	[2]	South Africa	N/A	DS seed ingestion	♂(died)	Lethal
106	[140]	France	Recreational drug use	Ingestion DS seeds	22-y ♂	Confusion and a dreamlike frenzy.
107	[141]	Greece	N/A	Ingestion DS seeds	20-y ♂	Coma, GCS: 5, and dilated pupils.
108	[142]	Austria	Recreational drug use	Beer + DS seed	30-y ♂	Loss of consciousness, unresponsive lower extremities to noxious stimuli, dilated pupils, and GCS: 4.
109	[143]	California, USA	Recreational drug use	Ingestion drink with strawberries, DS flower and alcohol	15-y ♂	Bizarre behavior, hallucinations, and restlessness.
110	[144]	Botswana	Contamination in the field – humans	Sorghum contaminated with DS seeds	Mass poisoning (92 patients)	N/A
111	[145]	Croatia	Recreational drug use	Ingestion DS infusion	Family poisoning (2 members)	Agitated, disoriented, and speaking in a bizarre manner; skin was warm, red, and dry; pupils were dilated.
112	[146]	Brazil	Contamination in the field – animals	Ingestion DS	Poodle toy bitch	Hyperesthesia, high agitation, tachycardia, tachypnea, mydriasis, and coma.
113	[147]	Utah, USA	Recreational drug use	Ingestion DS seeds	16-y ♂	Agitation and hallucinations with purposeless movements (picking things out of the air).
114	[148]	Israel	Recreational drug use	Ingestion DS seeds	2 adolescents (17-y ♂; 16-y ♂)	Uncooperative, agitated delirium, tachycardia, mydriasis, warm and dry skin and mucosa, and non-communicative.

Fig. 2 Illustration of Datura stramonium poisoning (provided in 114 papers, some of which report two or more cases of different types of poisoning, resulting in a total of 116 results).

Accidental poisoning

Contamination in the field – humans

D. stramonium is a common weed through temperate and subtropical regions in many summer crops including cereals, legumes, and leafy vegetables [149], [150]. It is an annual weed that produces a large quantity of seeds (up to 30 000 seeds per plant), stays dormant, and supports prolonged survival in the field for years after the first infestation [150], [151].

There are several cases of large outbreak human poisoning with D. stramonium due to contamination of crops such as buckwheat [94], [95], broomcorn [57], [144], millet [33], corn [64], [65], [137], soybean [64], [65], spinach [49], [55], [56], amaranth [32], and purslane [92]. A total of 11 (actually 13; two papers referred to the same case so we excluded them, but the references are given in the footnote) papers have been published on contamination in the field, with 8 referring to mass poisoning and 3 focusing on individual or family cases. In summary, more than 674 people were poisoned, and 5 fatalities occurred.

 

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Contamination in the field – animals

Similar to human poisoning by D. stramonium entering the food chain, animals are also affected in the same way. Animals in pastures typically avoid consuming this plant, which can be attributed to their natural feeding behavior, anti-nutritive properties, and the repulsive smell of D. stramonium [72], [152]. For this reason, less than 1% of poisonings have been reported in grazing animals [152]. However, poisonings have been reported in housed horses and cattle due to corn silage and hay contaminated with D. stramonium [72], [118], [125], [129], [133]. Additionally, a case of poisoning in a pet poodle was reported after it ingested D. stramonium seeds [146]. A total of 6 studies reported animal poisoning, including 2 studies on cattle (involving 30 bulls and 2 dairy cows), 3 studies on horses (involving 56 horses, 3 of which died), and 1 study on a pet.

 

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Mistaken identity

A review of the literature identified 14 studies where D. stramonium was mistakenly identified as another plant. It is often recognized as a leafy vegetable that is used to make a range of dishes, such as soups, stews, omelets, and rice [31], [53], [62], [71], [86], [102], [128], as well as for brewing herbal tea [61], [75]. Furthermore, there are instances of D. stramonium seeds being applied instead of poppy seeds [70] as well as black cumin seeds [73]. Additionally, D. stramonium root has been mistaken for burdock root [100], and its flowers have been misidentified with pumpkin flowers [127]. The literature reviewed indicates that incorrect identification of the plant frequently leads to poisoning among family members.

 

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Childrenʼs curiosity

Large trumpet-shape flowers and spinous seed capsules are very attractive to children [153]. However, children are particularly susceptible to atropine toxicity, even with small amounts producing marked central nervous system features [93]. A total of 17 papers reported the poisoning of 31 children by D. stramonium. Typically, the cases involve children aged 1 to 10 years, with one instance of ocular poisoning recorded in a 12-year-old boy (average age 5.5 ± 2.39; median age 5).

 

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Self-medication

D. stramonium poisonings are a rare occurrence in the 21st century in comparison to previous periods, especially the 18th and 19th centuries [154]. Today this plant is considered unsafe for self-medication due to its toxicity [99]. However, 16 papers have documented cases of D. stramonium poisoning resulting from self-medication. D. stramonium has been used to treat various conditions, including asthma [58], [107], [115], hemorrhoids [77], [78], [101], [103], [138], diarrhea [59], constipation [66], burning sensation during urination [8], abdominal pain [105], stomach cramps and irritation [114], and to alleviate gallstone pain [126].

According to many cultures, the most popular usage of this plant is in asthma treatment by smoking [155]. Up until 1992, D. stramonium was widely used for treating asthma, by smoking a pipe, medicinal cigarettes, and for nonsmokers and children, by inhaling powder smoke or by nebulization [156]. For these purposes, D. stramonium is commonly combined with potassium nitrite, tobacco, tea leaves, chestnut leaves, and gum benzoin [157]. However, the use of anti-asthmatic cigarettes was discontinued due to their short-term effects (much shorter than those of modern drug therapies) and the risk of addiction from excessive use [158]. Additionally, D. stramonium cigarettes mask the progression of lung damage [58].

D. stramonium has strong analgesic properties and is commonly used in ointments to treat skin conditions such as acne, eczema, burns, fistulas, abscesses, and wounds, as well as hemorrhoids, severe neuralgia, and rheumatism [159], [160], [161]. However, no poisonings have been reported with external application. The issue occurs when D. stramonium is ingested to treat these conditions.

 

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Misuse

Magico-religious

In Indian mythological belief (Hinduism), in the performance of the occasion of Shivratri (a festival celebrating Lord Shiva, also known as the Master of poison and medicine), worshippers offered D. stramonium, among other toxic plants, to offer tribute [38], [162]. In practice, the plant is frequently misused during religious ceremonies [163]. It is common to consume fermented drinks made with D. stramonium leaves, Cannabis sativa, Eleusine coracana seeds, and honey, as well as other ritual foods prepared with D. stramonium [164]. A total of two papers refer to D. stramonium poisoning during this festival [60], [63].

 

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Predatory

D. stramonium is occasionally mixed with food and given to unsuspecting individuals or travelers to aid in robberies or sexual assaults, earning it the nickname “roadside poison” [165], [166]. A total of four papers document this form of D. stramonium misuse. It includes mixing D. stramonium seeds with juice or other drinks [52], [82] and incorporating them into sweets made from groundnut seeds and sugar crystals (known as prasad) [88], as well as cookies [167]. Additionally, inhaling D. stramonium powder from a piece of cloth is also reported [68].

 

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Suicide

Intentional poisoning with D. stramonium has been documented in three attempted suicide cases [48], [85], [91], all of which involved individuals with prior suicide attempts. One case featured a 58-year-old female patient with depression who ingested D. stramonium seeds [85]. Similarly, a 38-year-old man consumed D. stramonium seeds [91], and a 54-year-old man ingested ten raw D. stramonium leaves [48]. Fortunately, none of the cases mentioned were fatal.

 

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Recreational drug use

The psychedelic effects of D. stramonium have been recognized for centuries across various cultures and regions [24]. This plant is commonly used as an alternative drug due to its hallucinogenic and euphoric effects, particularly among adolescents and young adults [81], [104], [168]. Additionally, it is an easily available weed and is not classified as an illegal substance [130]. Furthermore, the widespread availability of information on the Internet and communication among youth has led to an increase in the use of D. stramonium for recreational purposes, often in combination with alcohol and other substances such as cannabis [16], [132], [169].

In the 21st century, 36 case reports documented poisoning incidents resulting from the recreational use of D. stramonium. These studies reported a total of 65 patients who exhibited typical anticholinergic syndrome and neuropsychiatric effects due to D. stramonium poisoning. Unfortunately, two of the cases were fatal, involving two 19-year-old males from Greece and Israel, repsectively [28], [136]. Generally, the cases of recreational use of D. Stramonium involve patients ranging from 12 to 33 years old, with an average age of 19.3 ± 5.55 years and a median age of 17. It is crucial to highlight that D. stramonium can cause toxicity in multiple organs, including the liver, heart, kidneys, and brain. Moreover, due to the prolonged abuse of D. stramonium seeds, in addition to aggressive and assaultive behavior and hallucinations, paranoid schizophrenia could develop [87]. As a result, the recreational use of this plant among young people should be strongly discouraged [170].

 

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N/A Cases

In three cases, the exact cause of D. stramonium poisoning was not specified. For example, the case involves a previously healthy 23-year-old male who experienced restlessness, an altered mental state, and hallucinations 2 h after consuming herbal tea [50]. The focus of the case report was on using artificial intelligence software to determine the identity of the plant. Furthermore, Parissis et al. [141] focused on the neurological findings in a case of a coma in a previously healthy 20-year-old male who became unresponsive following the ingestion of D. stramonium seeds. Additionally, the fatal poisoning of an adult Caucasian male due to D. stramonium, with death attributed to a heart attack, highlights the forensic method of identifying atropine and scopolamine through HPLC analysis [2].

 

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Case Studies

Although Forrester [36] reports instances of D. stramonium poisoning from 1998 to 2004, we decided to present it. According to the report, there were 188 recorded cases of D. stramonium poisoning in Texas, USA. The author highlights that the highest number of poisonings occur between June and October, with most cases involving men (82%) and teenagers (72%) who often misuse the plant as a recreational drug (78%). Additionally, Enfield et al. [76] reported 14 cases of poisoning involving Datura species in a regional poison control center in Arizona, USA, covering an 8-year period from 2003 to 2010.

Niewinska et al. [122] documented 28 cases of D. stramonium poisoning in children in Poland. The group was made up of 75.7% males and 14.3% females, with an average age of 14.5 years (ranging from 13 to 17 years). Moreover, in Iran, between 2008 and 2011, 19 cases of D. stramonium poisoning were reported, with most of the incidents involving children who accidentally ingested the plant [98]. Teenagers were the next most common group, using it intentionally for its hallucinogenic effects, while poisoning in adults was rare. The average age of the patients in this study was 12.2 years (ranging from 3 to 29 years), with males making up 67% of the cases.

Between 2005 and 2017, a total of 102 cases of Datura sp. poisoning were reported in Hungary, with the majority occurring from August to October, when the plantʼs fruits and seeds ripened [69]. The authors observed that D. stramonium was consumed both alone and in combination with alcohol, other plants, or psychoactive substances. Males were affected three times more frequently than females. While accidental ingestion was less frequent, it was recorded in young children, as well as in instances of improper use of traditional herbal remedies or suicide. However, most cases involved individuals misusing the plant for hallucinogenic properties.

 

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Conclusion

D. stramonium has been an important mystical plant since ancient times. In contemporary times, poisoning from this plant is mainly attributed to its widespread presence as well as its coexistence and similar appearance to edible plants. Consumption of food and feed contaminated with tropane alkaloids from D. stramonium has resulted in poisoning in both humans and animals. Children are especially at risk, often poisoned after being attracted to the plantʼs capsules and seeds. Furthermore, drug users are familiar with the plant, using it recreationally for its hallucinogenic properties.

Data availability

Data will be made available on request.

 

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Contributorsʼ Statement

The M. A. confirms sole responsibility for the following: conception and design of the work; data collection; analysis and interpretation of the data; statistical analysis.

 

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Conflict of Interest

The authors declare that they have no conflict of interest.

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Eingereicht: 03. Januar 2025

Angenommen nach Revision: 20. Februar 2025

Artikel online veröffentlicht:
14. März 2025