Terra Sigillata

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. A tea made from the plants 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.

i-bea7fb96cdc528b8696ed41c28c684bb-220px-Atropine.svg-thumb-175x105-52732.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, which we discussed here, 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 isn’t all fun and games. 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.

If you are a kid screwing with this stuff and have asthma, or see an asthmatic friend screwing with this stuff, quickly use an albuterol inhaler and call 911.

i-86499be9901f4d1e54d126ca9a8ec4dd-Brugmansia_lg-thumb-500x350-52734.jpg

The photo shown here of Brugmansia ‘Feingold’ is from a Wikimedia Commons gallery of Angel’s Trumpet is one is in need of identifying the plant after treating a poisoning case.

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.

Addendum: Vaughan Bell at Mind Hacks left me a tweet about his local perspective last month on Brugmansia in Colombia.

A belated hat-tip goes to my lovely wife, PharmGirl, MD, for bringing this story to my attention overnight.

Comments

  1. #1 Phillip IV
    July 9, 2010

    The Skynews item seems to be based on the following reports in the Mitteldeutsche Zeitung, a regional but respectable paper:

    http://www.mz-web.de/servlet/ContentServer?pagename=ksta/page&atype=ksArtikel&aid=1063722812233&calledPageId=987490165154

    http://www.mz-web.de/servlet/ContentServer?pagename=ksta/page&atype=ksArtikel&aid=1063722812241&calledPageId=987490165154

    The Skynews item summarizes the details accurately – one additional aspect mentioned in the German articles, but left out by Skynet, is the fact that the teen in question seems to have felt no effect from the tea for several hours after drinking it, then suddenly suffered the violent toxic psychosis that led to his self-mutilation.

  2. #2 Synchronium
    July 9, 2010

    Apparently, the visions brought on by these plants quite often involve the subject flying around, which is probably where the whole “witches on broomsticks” thing came from.

    It might be worth noting in your original article that these plants are *particularly* dangerous. What you’ve said already (“not all fun ‘n’ games”, etc) can apply to most hallucinogens, but in general, those are all pretty safe. These plants, however, have such a tiny window between a recreational dose and a lethal dose that experienced users can encounter difficulty. Also, the alkaloid content will naturally vary a lot between individual plants, exacerbating the problem.

    Here’s a pretty interesting doc about Henbane, another tropane alkaloid-containing plant. It’s quite old and a bit more anthropological than pharmacological, but perhaps worth a watch: http://video.google.com/videoplay?docid=-927931945346301723

  3. #3 The Phytophactor
    July 9, 2010

    Synchromium says:>>These plants, however, have such a tiny window between a recreational dose and a lethal dose that experienced users can encounter difficulty.< <

    That's exactly what I tell my students when teaching about the ethnobotany of these plants. But Brugmansia is a new world genus, and the witch’s flying on brooms is an old world mythology linked to native nightshades: henbanes, deadly nightshade, mandrake.

  4. #4 Liz Ditz
    July 9, 2010

    The various cultivars of brugmansia are widely planted in SoCal as it is a lovely plant and very fragrant.

    Here’s a discussion about one cultivar:

    http://davesgarden.com/guides/pf/go/3017/ on PlantFiles.

    I would imagine that the use of brugmansia as an recreational drug is spreading rapidly via word of mouth.

  5. #5 Tsu Dho Nimh
    July 9, 2010

    It’s such a pretty plant, too. The scent in the evening is delicately sweet.

    stoooopid kids.

  6. #6 Chan Stroman
    July 10, 2010

    Delurking briefly to amend my comment on the “Who are you…” post. Posts like this one (mind-blowing! in all good & pun-intended senses of the term) are why I come back.

  7. #7 fuck you
    July 10, 2010

    >If you are a kid screwing with this stuff and have asthma, or see an asthmatic friend screwing with this stuff, quickly use an albuterol inhaler and call 911.

    Are you fucking retarded? Asthma is not a symptom of anticholinergic intoxication.

  8. #8 ellen
    July 11, 2010

    “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.” You mean like, last week? see, “What Big Eyes You Have, Dear, but Are Those Contacts Risky?”

    http://www.nytimes.com/2010/07/04/fashion/04lenses.html?scp=1&sq=contact%20lenses&st=cse

    Truly creepy picture there, and more evidence that people are still just as nuts as “back when.”

  9. #9 ginger
    July 13, 2010

    Not that I hold with the name-calling, but unless I misunderstand, I think commenter #7 might have a point. Ipratropium bromide is a super-common treatment for asthma and chronic bronchitis, acts by competitively binding muscarinic receptors to relieve bronchospasm and congestion, and thus is an anticholinergic drug. Why would you give an asthmatic who’s overdosing on anticholinergics albuterol, which is a beta-2-adrenergic receptor agonist? The asthmatic’s already maxed out on relaxing the smooth muscles of the bronchioles, right? And even though albuterol mainly acts at beta-2, doesn’t it also act on beta-1-adrenergic receptors, increasing the already high risk of tachycardia from the Angel’s Trumpet?

  10. #10 DuWayne
    July 13, 2010

    I have some fairly extensive experience with the Datura genus and kids + tropane plants scares the shit out of me. I have used Belladona, Jimson weed seeds, Henbane and Mandrake – the Belladonna most frequently, Henbane only once. To say the window between a recreational dose and a fatal dose is putting it mildly.

    My comment started to get rather long and drawn out – and I post little enough to my own blog, so the rest is here…

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