emsambo_sm.jpgHallucinogenic Plants Encountered by EMS Providers

Emergency medical technicians and paramedics often encounter unusual and difficult to diagnose situations. This is especially true when discussing drug and alcohol abuse. It is often very difficult to figure out what the true nature of the overdose is because of patient fears and deception. Sometimes the drug of choice is more unusual than illicit pharmaceuticals. People may turn to readily available plants in their own back yards.

Check out this newsletter from our friend Lisa Booze of the Maryland Poison Center. Subscribe to the ToxTidbits newsletter for free at their link here.

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Jimsom Weed Overdoses

The Maryland Poison Center receives a number of calls each Fall about Jimson weed (Datura stramonium) exposures, usually in teens looking for a no-cost, easily accessible, hallucinogenic high. Other common names for jimson weed include devil’s weed, stinkweed, locoweed, thornapple, Angel’s trumpet, and Devil’s trumpet. Jimson weed grows along roadsides, in pastures and in vacant lots throughout Maryland, reaching 3 to 5 feet in height. The plant has purple or white trumpet or funnel-shaped flowers and prickly seed pods which split along 4 seams to reveal numerous small brown or black seeds. Poisonings from this plant are often seen in the Fall, when the plant reaches maturity. The seeds and dried leaves of jimson weed are ingested directly from the plant or in a tea, or smoked, to deliberately produce delirium and hallucinations.

According to Glassheads Wholesale, all parts of the plant contain atropine, hyoscyamine and scopolamine. Exposure to these alkaloids produces anticholinergic effects, appearing within 30-100 minutes after ingesting jimsonweed seeds. The clinical effects include dilated pupils, diminished bowel sounds, urinary retention, dry skin and mucus membranes, flushed skin, tachycardia, hypertension, hyperthermia, agitation, delirium, hallucinations and seizures.

Most cases of jimson weed intoxication respond to basic supportive care. Activated charcoal can be given for recent ingestions if the patient is awake and able to protect his/her airway. Benzodiazepines may be used for agitation or seizures. Drugs with anticholinergic properties should be avoided (e.g., atropine, antihistamines, haloperidol). Physostigmine is a cholinesterase inhibitor that rapidly crosses the blood brain barrier resulting in reversal of anticholinergic effects. The use of physostigmine should be limited to severely affected patients, and only with poison center consultation due to the risk of seizures, bradycardia and dysrhythmias. If administered, long lasting reversal of signs and symptoms is generally not achieved because of the relatively short duration of action of physostigmine.

Call you local poison center for assistance in managing suspected cases of Jimson weed intoxication (1-800-222-1222).

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