Anticholinergics
Anticholinergics are a class of substances derived from plants like Jimson weed (Datura stramonium), known for their euphoria- and delirium-inducing properties. These plants contain alkaloids such as atropine, hyoscyamine, and scopolamine, which inhibit the neurotransmitter acetylcholine. Traditionally, anticholinergic plants have been used by Indigenous peoples for medicinal and ritualistic purposes. In contemporary society, Jimson weed is often abused, especially by adolescents, through methods like smoking dried leaves or ingesting seeds, leading to serious adverse effects.
Symptoms of anticholinergic toxicity can occur rapidly and include increased heart rate, dry mouth, and hallucinations. While misuse of these substances is less common than that of opioids or stimulants, the potential for harm remains significant, particularly among individuals with pre-existing mental health conditions. Additionally, there are concerns about the rise in prescriptions for anticholinergic medications, which can exacerbate issues such as cognitive decline in older adults. Understanding the effects and risks associated with anticholinergics is crucial for informed discussions around their use and potential for abuse.
Subject Terms
Anticholinergics
ALSO KNOWN AS: Angel’s trumpet; crazy tea; devil’s seed; devil’s snare; devil’s trumpet; ditch weed; Jamestown weed; Jimson weed; locoweed; madhatter; stinkweed; thornapple
DEFINITION: Anticholinergics, such as Jimson weed, are plants that contain euphoria- and delirium-inducing properties.
STATUS: Legal in the United States (US)
CLASSIFICATION: Noncontrolled substance
SOURCE: Jimson weed is the common name for the plant Datura stramonium, a member of the family Solanaceae. It is native to most of the US.
TRANSMISSION ROUTE: All parts of Jimson weed contain anticholinergic compounds. The plant is abused by smoking the dried leaves, ingesting the seeds, or drinking teas made from its leaves.
History of Use
Anticholinergic medications, directly derived from plants such as Datura species, are used to treat asthma, gastrointestinal disorders, diarrhea, bed-wetting, and motion sickness. Such anticholinergic plants contain the alkaloids atropine, hyoscyamine, and scopolamine, all potent inhibitors of the neurotransmitter acetylcholine.
The anticholinergic plant Jimson weed has been used for hundreds of years by Indigenous Americans as a medicine and in religious and social rituals. The ingestion of Datura species of plants in Jamestown, Virginia, reportedly caused British soldiers during the Revolutionary War to behave bizarrely.
In modern times, Jimson weed is abused mostly by teenagers and adolescents, and it is usually used one time because of its unpleasant adverse effects. Other anticholinergic plants and medications have the potential for abuse, but most people who routinely use these agents have a significant history of drug abuse, personality disorders, or schizophrenia. In many cases, the overuse and inappropriate use of anticholinergic medications are attempts to treat the adverse effects of certain antipsychotic agents. Sometimes, anticholinergic medications are combined with other illegal street drugs, such as heroin, to enhance the effect of the illicit drug.
Effects and Potential Risks
Symptoms of anticholinergic toxicity, which may appear within minutes of ingestion of plant extracts, include increased heart rate, dry mouth, agitation, nausea, vomiting, incoherence, disorientation, auditory and visual hallucinations, dilated pupils, slurred speech, urinary retention, and high blood pressure. High doses may cause seizures, paralysis, coma, or death. Anticholinergic toxicity also may damage the liver and muscle tissues and cause cardiac arrhythmias. The anticholinergic effects may last for several days.
Although anticholinergic abuse is not as widespread as other substances with the potential for abuse, such as opioids, its misuse can still be problematic, especially by adolescents and young adults with mental health issues. Adverse reactions may instead plague users seeking the drug’s euphoric and sedating results. Older adults who misuse anticholinergic medications may have an increased risk of cognitive impairment and dementia. Illegal anticholinergic use is not the only issue. There has been an increase in legal prescriptions of drugs that offer anticholinergic effects as well.
Bibliography
Centers for Disease Control and Prevention. "Jimsonweed Poisoning Associated with a Homemade Stew: Maryland, 2008." Morbidity and Mortality Weekly Report, vol. 59, no. 4, 2010, pp. 102–4.
Chiappini, Stefania, et al. "Misuse of Anticholinergic Medications: A Systematic Review." Biomedicines, vol. 10, no. 2, 2022, p. 355, doi.org/10.3390/biomedicines10020355. Accessed 22 Aug. 2024.
Graeme, Kimberlie A. "Anticholinergic Plants (Tropane Alkaloids)." Wilderness Medicine. Edited by Paul S. Auerbach. 5th ed., Philadelphia: Mosby, 2007.
Robinson, Julia. "'Worrying' Rise in Number of Patients with a High Anticholinergic Burden." The Pharmaceutical Journal, 19 Oct. 2022, pharmaceutical-journal.com/article/news/worrying-rise-in-number-of-patients-with-a-high-anticholinergic-burden. Accessed 22 Aug. 2024.
Wiebe, Tannis H., Eric S. Sigurdson, and Laurence Y. Katz. "Angel’s Trumpet (Datura stramonium) Poisoning and Delirium in Adolescents in Winnipeg, Manitoba: Summer 2006." Paediatric and Child Health, vol. 13, no. 3, 2008, pp. 193–96.