Long-term intentional Datura use and its consequences

Sir,

Datura stramonium is known for its psychoactive and anticholinergic properties.[1,2] The World Drug Report 2013 states a high lifetime prevalence rate of its use (2.6%) among adolescents.[3] We report a case of a 36-year-old male, from northern rural India, who presented with a history of eating Datura seeds for the past 1 year. On consuming, he would experience euphoria, excitement, and increased energy that would last for 3–4 h. Once his intake had increased to 50–70 seeds, he would experience pleasant visual distortions. He reported craving and denied any withdrawal of symptoms. After his use had increased, he began to experience some cognitive deficits, viz., immediate and recent memory loss, and momentary disorientation in time and place while being fully conscious. He had no such complaints before onset of Datura use. He had insight into these complaints and was distressed about not being able to control use. Six months after initiation, he developed gradual onset of hypermetropia, diplopia, and blurred vision. He also had a history of harmful use of cannabis (bhang), opioids (pentazocine), and benzodiazepines (alprazolam). There is also a history of one episode of alcoholic hallucinosis, visual and functional auditory hallucinations and illusions upon the use of pentazocine, and one episode of generalized tonic–clonic seizure after pentazocine overdose.

Apart from consuming 50–70 Datura seeds, his current use included 12–16 standard drinks of alcohol and 40–50 g of bhang by ingestion. The initial presentation was suggestive of alcohol and Datura intoxication. He had drowsiness, slurred speech, hyperpyrexia, hypertension, tachycardia (regular heart rate), and marked pupillary dilatation. Mental status examination revealed reduced psychomotor activity. Higher cognitive functions such as attention and concentration were impaired. He was managed symptomatically by maintaining hydration, propranolol 40 mg twice a day, paracetamol 500 mg twice a day, and diazepam 5–10 mg/day. A week later, he had slurred speech, anisocoria, normal psychomotor activity, intact orientation, but impaired concentration and memory. He continued to have visual disturbances. Examination revealed bilateral posterior subcapsular cataract, but it was not directly attributed to Datura use. No pharmacological management was initiated to prevent relapse into Datura use. Network therapy was initiated to maintain abstinence and engage patient in further treatment.

This report describes intentional Datura use for its hallucinogenic and stimulating effects. Signs of acute poisoning were absent upon presentation, which could be due to pharmacological tolerance. Pattern of use suggests hallucinogen dependence syndrome. An interesting feature is the patient's experience of perceptual abnormalities upon the use of alcohol and pentazocine that might have made the patient more vulnerable to experiencing perceptual distortions. The index patient exhibited anisocoria, loss of eyesight, and cataract. Anisocoria, pupillary dilatation, and impaired vision are documented in Datura toxicity.[4] There is no published report which indicates that Datura could be cataractogenic.

This case describes the consequences of Datura use: dependence, transient psychotic symptoms, visual disturbances, and cognitive sequelae. No specific data exist on the prevalence of Datura use in the Indian subcontinent.

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Conflicts of interest

There are no conflicts of interest.