From the Datura genus, three species, D. ferox, D. innoxia and D. stramonium are widely distributed and naturalized in several European countries [63]. From Europe, we had access to data of national poison control centers in three countries, Hungary, Italy and Switzerland.

In Hungary, 2464 cases of contact with or ingestion of toxic plant material were registered in the period 2005–2017. During this interval, there has been an increasing tendency in the number of plant exposures (Fig. 1), in contrast to the decreasing tendency observed in the US [4]. Unlike in the US, but similarly to India and Taiwan, Brugmansia and Datura were among the species involved in the largest number of plant-related poisonings in Hungary. The top four plant taxa that regularly caused intoxications in Hungary were Brugmansia and Datura species, Convallaria majalis and Taxus baccata, accounting for 1–7%, 1–16%, 6–20%, and 8–19% of all plant-related intoxications, respectively, in the period 2005–2017 (Fig. 2). As shown in Table 2, the number of Brugmansia and Datura poisoning cases in Hungary was fluctuating from year to year, with no clear-cut tendency for the proportion of anticholinergic exposures. However, in the last five years of the study, the number of such poisoning cases was on the decrease. This could be due to several reasons: (1) Hungarian people became better informed regarding the risks of ingesting Brugmansia or Datura plant parts or extracts, and thus avoided exposure to these plants; (2) adolescents and young adults started to use other natural or synthetic drugs for their hallucinogenic properties; (3) not all cases were reported to the toxicological center, probably due to milder symptoms of intoxication, when the affected individuals did not seek medical attention. In contrast to the US, where Datura intoxications were responsible for one-fifth of plant-related fatalities, in Hungary there were no fatal intoxications related to Brugmansia or Datura for a 13-year time period, even though 12% of major outcomes were related to these species.

Fig. 1 Total annual numbers of all types of toxic herbal exposures in Hungary 2005–2017 Full size image

Fig. 2 Ratios (%) of intoxications caused by the top four poisonous plants in Hungary 2005–2017 Full size image

Table 2 Summary of Brugmansia and Datura poisonings that took place in Hungary in 2005–2017, reported to HTIS Full size table

Between 2005 and 2017 in Hungary, Brugmansia and Datura taxa were responsible for 60% of all plant abuse cases, being the leading plants ingested for their hallucinogenic properties [64] (Tables 1, 2), while they accounted for a much lower proportion (18%) of suicide attempts. Considering all Brugmansia and Datura poisonings (167 cases), the percentage of abuse cases (60%) was double of accidental ingestions (30%), and only 10% was due to suicide attempts (Table 2). Intoxication with Brugmansia and Datura occurred mainly in the months August–October, which suggests that in most cases the fruits, and particularly the seeds are ingested. At this time of the year in temperate climate, the plants are still in bloom, but at the same time several fruits have already developed on these plants. In most cases, Brugmansia and Datura were taken without any co-ingestants, but in a number of cases, they were ingested together with alcohol and/or psychoactive drugs, such as benzodiazepines (Table 2).

With regard to gender, 75% of all Brugmansia and Datura ingestions in Hungary occurred in males and only 25% in females in the period of 2005–2017 (Table 2). This indicates that males are three times more likely to suffer anticholinergic intoxication by plant origin than females, in most cases by taking the risk of ingesting various plant parts or extracts of Brugmansia or Datura for their hallucinogenic properties.

Data on the types, frequency and severity of plant poisonings are available from Switzerland for a 29-year period (1966–1994). From a total of 24,950 registered cases of intoxication with plant material, severe plant poisonings were reported in 152 cases. Out of these, 17 cases (11%) were related to the ingestion of D. stramonium [1]. The Poison Control Center of Milan, the leading toxicological center in Italy, registered 4432 plant exposures for the time period 2001–2005. In the age group of 15–90 years, the second most frequent cause of plant-related intoxications was the recreational use of hallucinogenic species (41 cases, 7%), including D. stramonium (26 cases, 63%) [3].

In addition, we have several reports from other European countries about consuming Brugmansia or Datura for their hallucinogenic effect [28, 35, 38, 65]. Similarly, in Spain, Datura species are mainly used as recreational drugs, but recently the use for criminal purposes is increasing [7]. From the Netherlands, a series of scopolamine-facilitated robberies were reported, including some fatal cases [41] (Table 1).

Cases of accidental intoxication were reported from Italy and Turkey, when D. stramonium flowers were mistaken for the similarly trumpet-shaped pumpkin (Cucurbita sp.) flowers [34, 66], or B. suaveolens flowers were unintentionally ingested [44] (Table 1).