Quick Hits (page 5)
US Court Rules Feds Wrongly Seized Patient's Medical Marijuana
By: Norml
SAN FRANCISCO -- A federal judge ruled that the US government wrongly seized one ounce of medical marijuana belonging to Prop. 215 patient Chris Giauque after a state court had ordered the Humboldt County sheriff to return it to him. Former Humboldt County Sheriff Dennis Lewis had asked the government to seize the pot from his custody so as to avoid returning it to Giauque.
The DEA subsequently obtained a warrant from US District Judge Charles Legge to seize the pot on May 23, 2001. US Judge Marilyn Patel ruled that the seizure violated a federal law barring the federal government from seizing property held in concurrent in rem jurisdiction by a state court. She also ruled that the government had wrongly sought the seizure warrant in US Court and should have made its motion through the state courts instead.
"This is a major victory for medical marijuana patients and for state's rights," said Giauque's attorney, Bryce Kenney of Arcata. He said the decision should protect patients who have a state court order for return of their marijuana from federal seizure of their medicine. Unfortunately, Giauque is not available to celebrate his victory, having disappeared under mysterious circumstances two weeks ago when his pickup truck was found abandoned.
His family suspects foul play. Ironicallly, the Humboldt County Sheriff and FBI are investigating. It is unclear what will happen next to Giauque's marijuana, if it has not been destroyed by the DEA. The government could appeal to the Ninth Circuit to block its return. If not, it should be returned to the Humboldt County Sheriff's Office.
"This marks a major victory for Prop 215," said California NORML Coordinator Dale Gieringer, "We hope and pray Chris returns safe and sound to recover his property."
Growin' Our Own (page 5)
Jimson Weed
By: Amy M. Arnett, MD
Jimson weed (Datura stramonium) is also known as Jamestown weed, Jamestown lily, thorn apple, devil's apple, madapple, stinkweed, stinkwort, devil's-trumpet, fireweed, dewtry.
Habitat and range.This is a very common weed in fields and waste places almost everywhere in the United States except in the North and West.
Description.Jimson weed is an ill-smelling, poisonous plant with stout, much-branched, leafy stems from 2 to 5 feet high. The large, smooth, thin, wavy, toothed leaves are from 3 to 8 inches long. The flowers, which appear from May to September, are white, funnel-shaped, about 3 inches long, and have a pronounced odor. The prickly seed pods which follow are about the size of a horse chestnut. When ripe these pods burst open, scattering numerous poisonous black, kidney-shaped seeds.
Part used. The leaves, collected when the plant is in flower, and the seeds.
The Columbia Encyclopedia, Sixth Edition. 2001.
Jimson weed or Jamestown weed, large, coarse annual plant (Datura stramonium) of the family Solanaceae (nightshade family), native to warm-temperate and tropical regions of the New World, but long widely distributed and often weedy. This and other species of the genus contain a narcotic poison, stramonium, similar to that of the related belladonna, that has been used by many peoples for various purposes, e.g., as a medicine (now chiefly inhaled for the relief of asthma or applied externally as a painkiller) and in the past as a poison and an instrument for obtaining prophetic dreams or messages in various tribes. The amusing antics of soldiers in colonial Virginia who ate Jimson weed have been recorded for history. Stramonium, comprised of several alkaloids (e.g., scopolamine, atropine, and hyoscyamine), may also be obtained from some other species of Datura. Scopolamine is used as a sedative. Jimson weed is classified in the division Magnoliophyta, class Magnoliopsida, order Polemoniales, family Solanaceae.
Jimson weed poisoning
Jimson Weed is a common weed along roadsides, in cornfields and pastures, and in waste areas. Datura stramonium comes from the family Solanaceae, the potato or nightshade family. The plant is native to Asia, but is also found in the West Indies, Canada, and the United States. Of the more than 12 species, Datura stramonium is the most common type found in the eastern United States. Many names have been given to this plant including: Jimson Weed, Locoweed, Angel's Trumpet, Thorn Apple, Devil's Trumpet, Mad Apple, Stink Weed, Sacred Datura, Green Dragon, and Devil's Trumpet.
Although exposure is sometimes unintentional by gardeners or farmers, its toxic effects are seen most commonly in teens, who intentionally misuse it for its hallucinogenic and euphoric effects, while presenting with serious illness or death from its anticholinergic properties.
Epidemiology
The plant has been described throughout history as a toxin famous for its mind-altering properties. There are references to it in Homer's Odyssey, and Shakespeare's plays: Hamlet, Romeo and Juliet, and Anthony and Cleopatra.
It is one of a group of plants known as "belladonnas," thought to be named from their use by Italian women to dilate their pupils, which was considered beautiful. It was also known to be used for the medicinal treatment of colds and asthma, and for religious purposes. Its most common name, Jimson Weed, is a contracted form of Jamestown Weed, after its use was described in 1676, in Jamestown, Virginia. This was the first record in the United States of physical symptoms following its ingestion by British troops sent to halt Bacon's Rebellion, as noted in Beverly's "History and Present-State of Virginia."
Accidental exposure of adults has also been reported in the literature. An 82 year old male mistakenly ate the root of an Angel's Trumpet, Datura innoxia for a horseradish in his garden. "Gardener's Mydriasis" was reported in a 54 year old male who complained of blurred vision after cutting Angel's Trumpet, Datura suaveolens, in his garden. A 49 year old woman presented with delirium after making a tea to use as a mouthwash for treating gingivitis from a plant in her friend's garden. "Cornpicker's Pupil" is another presentation of mydriasis after exposure during harvesting.
Intentional misuse by teenagers who eat seeds, drink tea and/or smoke cigarettes made of Jimson Weed has been reported by many authors. Although most use is sporadic, there is often clustering or increased use around press reports which increase interest in the drug but do not emphasize risks. Jimson Weed is used in over-the-counter asthma preparations: Asthmador, Barter's Powder, Kinsman's Asthmatic Powder, Green Mountain Asthmatic Compound, and Haywood's Powder, often abused by teens. The American Association of Poison Control Centers' Toxic Exposure Surveillance System reported 318 cases of Jimson Weed poisoning in 1993.
Pharmacology
The toxins in Jimson Weed are tropane belladonna alkaloids which possess strong anticholinergic properties. They include: hyoscyamine (leaves, roots, seeds), hyoscine (roots); atropine (d,l-hyoscyamine) and scopolamine (l-hyoscine). They act as competitive antagonists to acetylcholine at peripheral and central muscarinic receptors at a common binding site. The peripheral receptors are on exocrine glands which affect sweating, salivation, and smooth and cardiac muscle. Poisoning results in widespread paralysis of parasympathetic innervated organs. As tertiary amines they also have central nervous system absorption, inhibit CNS receptors and result in a central anticholinergic syndrome of acute psychosis or delirium.
These toxins are easily absorbed from mucous membranes and the gastro-intestinal tract. The half-life of atropine is approximately 4 hours. Metabolism occurs in the liver by hydrolysis which eliminates approximately half the drug. The remainder is excreted unchanged in the urine.
Toxicology
Datura stramonium is an annual plant. It grows 4 to 6 feet tall and has dark green, long stemmed, lobed leaves which exude a foul odor. Its flower which blooms in late spring is usually white, sometimes lavender, solitary and tubular. A four lobed, thorny, green seed pod fruit ripens in early fall. Each lobe contains 50-100, 2-3 mm, kidney-shaped, black/brown seeds.
All parts of the plant are toxic. They are ingested, smoked and absorbed topically especially through mucous membranes. The exact concentration of specific alkaloids varies with species, cultivation, environment, temperature, moisture, and storage. The range of toxicity is highly variable and unpredictable; toxicity may vary from leaf to leaf, plant to plant and season to season. This contributes to the danger of misuse of the plant since the dose cannot be predicted. The highest concentration occurs in the seeds: approximately 0.1 mg of atropine per seed or 3-6 mg/50-100 seeds. An estimated lethal dose in an adult is >10 mg atropine or >2-4 mg scopolamine.
Clinical effects
The mnemonic for clinical effects of typical atropine poisoning is: "blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone." Symptoms include mydriasis; cycloplegia; flushed, warm, dry skin; dry mouth; ileus; urinary retention; tachycardia; hyper or hypotension; delirium with hallucinations; jerky, myoclonic movements; choreoathetosis; hyperthermia; coma; respiratory arrest; rare seizures; and central stimulation followed by depression. Hallucinations are reported in as many as 83% of cases; typically they are simple visual images in natural colors, but infrequently also tactile hallucinations of crawling insects.
The onset of symptoms occurs within 30 to 60 minutes after smoking leaves or drinking tea; and 1-4 hours after ingestion of plant material or seeds. Initial symptoms include dry mouth then pupil dilatation. The duration of symptoms is often 24-48 hours because of delayed gastrointestinal motility; symptoms have been reported to last up to 1-2 weeks. Although poisoning may lead to fatal medullary paralysis, arrhythmias and cardiovascular collapse, Jimson Weed-related deaths mainly are as a result of impaired judgment and coordination resulting in risk-taking activities associated with accidental death.
The differential diagnosis of Jimson Weed poisoning includes any other medicines with anticholinergic properties such as: antihistamines, antispasmodic GI preparations, over-the-counter sleep aids, cold preparations, muscle relaxants, antipsychotics, other plants, mushrooms, scopolamine, or cyclic antidepressants.
Laboratory evaluation
Laboratory evaluation is usually considered unnecessary since treatment is based on clinical evaluation. The toxicology screen is not considered helpful for management, although some anticholinergics such as atropine and hyoscyamine may be detected in urine. Elevated aspartate aminotransferase, LDH, bilirubin and prothrombin time have been reported, possibly secondary to muscle breakdown from seizures, increased tone and hyperthermia. EEG changes include prominent lambda activity, increased slow wave activity and a bizarre high voltage pattern.
Thin-layer chromatography and gas chromatography/mass spectrometry may confirm the presence of atropine and scopolamine in samples of the plant. Other tests to identify Jimson Weed have been described where juice from seeds or urine from a patient may be instilled into a rabbit's eye to test for dilatation of the pupils. Another test uses mashed seeds mixed with water; when tested with long-wave UV light, the glycoside scopolin which accompanies the alkaloids fluoresces light blue.
Management
Management of Jimson Weed poisoning is generally conservative beginning with the usual ABC's of resuscitation. If the patient presents with stupor or coma, treatment may include dextrose, thiamine, naloxone, etc. Otherwise the main component of management is support and observation. The patient should be placed in a nonstimulating environment and monitored with frequent vital signs. A cooling blanket can be used for hyperthermia. The patient may require bladder catheterization for urinary retention.
Decontamination should be considered even hours after ingestion secondary to the anticholinergic properties which may delay the gastric emptying and absorption of the vegetable matter. Lavage has been proposed up to 48 hours after ingestion secondary to delayed gastric emptying. Activated charcoal is an effective alternative to lavage in preventing further drug absorption and should be given with a cathartic if no ileus is present. Multidose activated charcoal and hemodialysis are not considered effective, although Haddad has speculated that multidose activated charcoal may decrease continued, delayed absorption secondary to the decreased GI motility. Hemodialysis and forced diuresis do not enhance th elimination of atropine.
Physostigmine is a naturally occurring alkaloid from a West African vine, Physostigma venenosum. It works by reversible inhibition of acetylcholinesterase, the enzyme that degrades acetylchoine. This increases the concentration of acetylcholine which causes the stimulation of muscarinic and nicotinic receptors. The tertiary amine structure allows penetration of the blood-brain barrier to allow exertion of a central cholinergic effect. Cholinergic stimulation of the brainstem reticular activating system causes nonspecific analeptic arousal effects. However physostigmine's use may precipitate seizures, cholinergic crisis, bradyarrhythmias and asystole. Relative contraindications include: history of cardiovascular disease, gangrene, asthma, glaucoma, and GI/GU obstruction. Thus its use as a cholinergic agent in Jimson Weed poisoning is controversial and is generally reserved for life-threatening, intractable, anticholinergic effects including hypertension, seizures, unstable tachycardia, hyperthermia, or pronounced hallucinations unresponsive to other agents. The dose is 0.5 mg every 5 minutes as needed in a child to a maximum total of 2 mg; 2 mg in an adult slow IV Push, or 0.02 mg/kg repeated every 20-30 minutes. Onset of action is within 3-8 minutes, duration is 30-60 minutes, and elimination half-life is 15-40 minutes. Atropine (0.5 mg/1 mg physostigmine given in the last dose) should be available for reversal of symptoms of cholinergic excess from the physostigmine: bradycardia, heart block, or excessive secretions.
Shenoy described the use of physostigmine as a diagnostic tool with a hallucinating patient who became worse on haloperidol. He was given 2 mg of physostigmine as a challenge, and became lucid enough to give the history of the ingestion, then was treated with lorazepam. Guharoy suggested its use in treating mild symptoms in three teens, who were discharged without problems in 24 hours. Rodgers proposed conservative treatment after reviewing 29 cases over 7 years that received no physostigimine. He felt that charcoal, sedatives and monitoring were adequate and that the majority of ingestions pose little threat.
Alternatives or adjuncts to using physostigmine to treat tachyarrhythmias, are alkalization of the blood to pH 7.5 and propranolol. The dosing of propranolol is for an adult:2 mg IV over 1 minute, repeating every 2-5 minutes to a maximum of 5mg total. For children 0.01-0.1 mg/kg/dose over 10 minutes, maximum 1 mg/dose.10 For patients that require sedation for extreme agitation, benzodiazepines or hydroxyzine should be used instead of phenobarbitol, phenothiazines, or haloperidol secondary to their additive anticholinergic effects.(2) A patient should be admitted if physostgmine is needed or until CNS symptoms resolve.
Prevention
Defoliation programs are one way to decrease access to Jimson Weed. It is important to educate health care providers about the hazards and symptoms involved with contact with Datura stramonium. However information to the public should stress hazards and avoid explicit descriptions and locations of the plant which might encourage some to purposefully seek out Jimson Weed for its use as a recreational drug.
Pipeline (page 5)
Race Bias, Judge Tosses Evidence
By: Bill Dedman, (Boston Globe)
A Latino man caught with 2 pounds of cocaine in the trunk of his car may go free, after a judge found that the State Police troopers who arrested him had routinely searched more cars driven by minority motorists than whites.
Worcester Superior Court Judge John S. McCann threw out the evidence of the cocaine and the man's admission he planned to sell it. Legal observers called it extremely rare for a judge to exclude evidence in a criminal case solely because of a statistical pattern suggesting racial bias.
If upheld on appeal, the decision could jeopardize other drug arrests, and force police departments to monitor the patterns of stops and searches by their officers.
"This is an unusual and perhaps pathbreaking decision," said law professor Samuel R. Gross of the University of Michigan, who has written about racial profiling.
The Worcester district attorney's office plans to appeal Friday's ruling from McCann, who will decide today whether to release Andres Lora of New York City while the appeal is heard. The charges against Lora have not been dismissed, and he could still face a minimum sentence of 15 years if convicted of cocaine trafficking. But the case against him rests entirely on evidence that has now been thrown out, the cocaine found by troopers in the trunk and his admissions to them that he planned to sell it.
According to court records, at about 9 p.m. on Dec. 21, 2001, Trooper Brendan Shugrue stopped the Pontiac Grand Am that Lora was a passenger in, on Interstate 290 in Auburn, just south of Worcester. Shugrue, who had been parked on an offramp, followed the Pontiac, which stayed within the speed limit, made no erratic movements, and showed no equipment problems. The Pontiac, however, stayed in the left lane, which is illegal in Massachusetts except when passing or preparing for a left turn. The little-known law does not specify how long a driver may remain in the left lane, but after a mile and a half, Shugrue pulled over the car.
The trooper testified that he had seen that the men in the car were dark-skinned, but that that was not the reason for the stop.
"You put the cruiser lights on a few seconds after you observed the color of their skin," defense attorney Michael H. Erlich asked Shugrue, according to the records. "Is that what you just testified to?"
"To twist my words, yes," Shugrue replied.
Neither of the men in the car spoke much English, but the driver, who is not named in the court record, volunteered to Shugrue that his license was suspended, and that the passenger, Lora, owned the car. The trooper testified that he took the driver to his patrol car, intending to let the men leave with Lora driving. Then he saw Lora, still in the Pontiac, talking on a cellphone, and then opening the car door, as though he might be planning to get out of the car. The trooper approached the car again, and Lora closed the door.
The trooper shined his flashlight into the car and saw a sealed plastic bag on the driver-side floor, containing what he thought was cocaine. He called for backup, and when Trooper William Pinkes arrived, they searched the trunk, finding a larger package wrapped in cellophane, next to the spare tire. It contained about 1,000 grams, or 2.2 pounds, of cocaine.
Lora, 53, who is a Dominican immigrant, was arrested and taken to the State Police barracks. The officers said he admitted that he had bought the cocaine in the Bronx for $26,000, and intended to sell it in Worcester for $30,000.
In asking the judge to exclude the cocaine and Lora's statements as evidence, Erlich obtained copies of all tickets written by Shugrue during a six-month period, and Pinkes for two months. According to the records, Shugrue had searched the cars of 5.1 percent of the white motorists he ticketed for moving violations in Auburn and Worcester, but 33.2 percent of minorities' cars. Pinkes had searched 1.6 percent of the white motorists, but 69.7 percent of minorities. Those disparities are far greater than for state troopers generally, according to a series of Boston Globe articles that the defense submitted as evidence.
In his ruling, Judge McCann found, first, that Shugrue was within his discretion to stop the car, because the driver was violating the left-lane prohibition.
But regarding the search, McCann agreed with the defense argument that the troopers' pattern in previous traffic stops was relevant. He was applying to criminal law the US Constitution's Equal Protection Clause, which is usually restricted to civil law. It is routine in civil cases alleging employment discrimination, for example, for judges to allow statistical evidence of discrimination.
The unrebutted evidence of the trooper's pattern of stops and searches, McCann wrote, "leaves no reasonable conclusion but that Shugrue stopped the motor vehicle in which the defendant was a passenger because of the race of the operator and the race of the defendant." After excluding the search as evidence, McCann also threw out the statements that resulted from it. A State Police spokeswoman declined to comment on the ruling. The assistant district attorney, James R. Lemire, did not return a telephone call from the Globe, nor did the Worcester district attorney, John J. Conte.
John Reinstein, legal director for the ACLU of Massachusetts, praised the decision: "We applaud Judge McCann for his willingness to enforce the constitutional guarantee of equal protection."
Erlich, the defense attorney, acknowleged that the decision might be hard for some people to stomach. His client did have 1,000 grams of cocaine in his trunk.
"But the Equal Protection Clause does not focus on what was found, or how much was found, but on the process in which it was found," Erlich said.
The case appears to break significant ground. Professor Gross, who has researched racial profiling, said he knew of only one similar case, in New Jersey. Judge McCann, in his ruling, said the issue has not been addressed by any appeals court in Massachusetts.
Gross said that courts generally are increasingly skeptical of any use of race by police in deciding whom to stop and search.
"It's going to be a very brave attorney for the government who would say to a judge, `We stopped this person in part because he's an African-American in a white neighborhood and that's suspicious,' " Gross said. "I don't think those words will ever be said again in court, but 20 years ago that was common."
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