Applied Chemical Engineering

Profile and consequences of intentional plant intoxication in Morocco: a retrospective study over a 13-year period

Mina Talib

Laboratory of plant, animal and agro-industry production, Faculty of Sciences, Ibn Tofail University, B.P 242, Kenitra 14000, Morocco

Hind Hami

Biologie and health laboratory, Faculty of Sciences, Ibn Tofail University, B.P 242, Kenitra 14000, Morocco

Abdelghani Asraoui

Biologie and health laboratory, Faculty of Sciences, Ibn Tofail University, B.P 242, Kenitra 14000, Morocco ; Moroccan Poison Control and Pharmacovigilance Centre, Rue Lamfedel Cherkaoui, Rabat Institutes, Madinate Al Irfane, P.O. Box 6671, Rabat 10100, Morocco

Naima Rhalem

Moroccan Poison Control and Pharmacovigilance Centre, Rue Lamfedel Cherkaoui, Rabat Institutes, Madinate Al Irfane, P.O. Box 6671, Rabat 10100, Morocco

Abdelmajid Soulaymani

Biologie and health laboratory, Faculty of Sciences, Ibn Tofail University, B.P 242, Kenitra 14000, Morocco

Rachida Soulaymani –Bencheikh

Moroccan Poison Control and Pharmacovigilance Centre, Rue Lamfedel Cherkaoui, Rabat Institutes, Madinate Al Irfane, P.O. Box 6671, Rabat 10100, Morocco

Houda Sefiani

Moroccan Poison Control and Pharmacovigilance Centre, Rue Lamfedel Cherkaoui, Rabat Institutes, Madinate Al Irfane, P.O. Box 6671, Rabat 10100, Morocco

Jamal Mabrouki

Laboratory of spectroscopy, molecular modeling, materials, nanomaterials, water and environment, Faculty of Sciences. University Mohammed V .4 avenue ibn Batouta BP1014 RP, in Rabat - Morocco

Souad Skalli

Microbiology and Molecular Biology Team, Center of Plant and Microbial Biotechnology, Biodiversity and Environment, Faculty of Sciences. University Mohammed V .4 avenue ibn Batouta BP1014 RP, in Rabat - Morocco

Jamila Dahmani

Laboratory of plant, animal and agro-industry production, Faculty of Sciences, Ibn Tofail University, B.P 242, Kenitra 14000, Morocco

DOI: https://doi.org/10.59429/ace.v8i4.5724

Keywords: intentional poisoning; toxic plants; inappropriate use; public health; Morocco

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Abstract

Inappropriate use of plants represents a significant public health risk that is often underestimated. This study aims to determine the profile and consequences of intentional plant intoxication in Morocco over a 13-year period. This study was based on a retrospective analysis of cases of intentional plant intoxication reported to the Moroccan Poison Control and Pharmacovigilance Centre (MPCPC) between 1 January 2010 and 31 December 2022. The significance level was set at 5%. During the study period, the MPCPC recorded 189 cases of intentional herbal intoxication, representing 9.37% of all herbal intoxications occurring during this period (2016 cases). The average age of the patients was 29.77 years, with the majority being young adults (68.25%), adolescents (14.28%) and children under 15 (7.93%). The sex ratio (M/F) was 0.41 (71.04% female). Suicide attempts were the main cause of poisoning (87 cases), with Atractylis gummifera being the most commonly implicated plant (17 cases). Twenty-two cases were related to abortions, mainly caused by Peganum harmala (45.45%), drug addiction (16 cases), of which Datura stramonium was the most incriminated plant (5 cases), and plant mixtures (63.63%) were the most commonly used in criminal activities (11 cases). The route of administration was mainly oral (162 cases). Digestive, neurological and cardiac disorders, renal failure, rhabdomyolysis and liver damage were reported. The outcome was favourable in 103 cases, fatal in 4, including a 9-year-old girl who ingested Rumex divers, with sequelae in 2 cases and unknown in 80 cases. Calculation of the p-value revealed that several variables were highly significant. Inappropriate use of plants poses a significant risk to public health. It is essential to raise awareness of the dangers associated with these plants and to emphasise the importance of appropriate psychiatric support in cases of intentional intoxication.

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References

[1]. Barnes J. 2020.Special Interest Group on Herbal and Traditional Medicines: Towards Progress in Pharmacovigilance for Herbal and Traditional Medicines and Other “Natural Health” Products. The International Society of Pharmacovigilance (ISoP) 43(7):619–622 https://doi.org/10.1007/s40264-020-00937-0

[2]. Ekor M. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Front Pharmacol. 2014 Jan 10;4:177. doi: 10.3389/fphar.2013.00177. PMID: 24454289; PMCID: PMC3887317.

[3]. Oztekin-Mat. A., Les intoxications d'origine végétale en Turquie. Ann. Pharm. Françaises. 1994; 52: 260-265.

[4]. Hostege D.M., Seiber J.N., Galey ED., Rapid multiresidue screen for alkaloids in plant material and biological samples. J. Agrie. Food Chem. 1995; 43: 691-699.

[5]. https://pathexo.societe-mtsi.fr/documents/articles-bull/sprexot000091.pdf https://www.sciencedirect.com/science/article/pii/S0003450921000638

[6]. CHEZE M, GAILLARD Y, PÉPIN G. 2000. Réponses analytiques aux intoxications par substances végétales. Annales de Toxicologie Analytique, vol. XII, n° 4, 2000

[7]. James H. Diaz. 2016. Poisoning by Herbsand Plants: Rapid Toxidromic Classification and Diagnosis. Wilderness & Environmental Medicine 2016 ; 27, 136–152

[8]. Fournier P. Les Plantes médicinales. Collection Agronomie, Médecine. Paris (Réédition). 1999

[9]. Fournier P. Les quatres flores de France. Lachevalier. Paris. 2001. Vol II.2.

[10]. Aubry P, Gaüzère B A.2024. Intoxications par les plantes toxiques dans les zones tropicales et inter tropicales Actualités 2024. Centre René Labusquière, Institut de Médecine Tropicale, Université de Bordeaux, 33076 Bordeaux (France). http://medecinetropicale.free.fr/cours/intoxplante.pdf

[11]. Gaudreault P. 2005. La toxicologie d’urgence. 2ème édition. Maloine 2005

[12]. Singh SP, Aggarwal AD, Oberoi SS, Aggarwal KK, Thind AS, Bhullar DS, et al. 2013. Study of poisoning trends in north India-a perspective in relation to world statistics. J Forensic Leg Med 2013;20:148.

[13]. Mew EJ, Padmanathan P, Konradsen F, Eddleston M, Chang S-S, Phillips MR, et al. 2017. The global burden of fatal self-poisoning with pesticides 2006-15: Systematic review. J Affect Disord 2017;219:93104.

[14]. Wang L, Wu Y, Yin P, Cheng P, Liu Y, Schwebel DC, et al. Poisoning deaths in China, 2006–2016. Bull World Health Organ 2018;96:314-326A.

[15]. Soulaymani-Bencheikh R. Un appel à la réglementation et au contrôle de l’usage des plantes Toxicologie Maroc - N° 54 - 3ème trimestre p-2. 2022. https://www.capm-sante.ma/uploads/documents/95.pdf

[16]. Bellakhdar J. La pharmacopée marocaine traditionnelle: médecine arabe ancienne et savoirs populaires. Ibis Press ed, Paris, 1997, p. 764.

[17]. Zidane, L., Salhi, S., Fadli, M., El Antri, M., Taleb, A., &Douira, A. (2010). Etude des groupements d'adventices dans le Maroc occidental. BASE.

[18]. Jahandiez, E., Maire, R., 1931/1934. Catalogue des plantes du Maroc. 3 vols. Minera, Le Chevalier, Alger.

[19]. Hmamouchi, M. (1997). Plantes alimentaires, aromatiques, condimentaires, médicinales et toxiques au Maroc. Identification of wild food and non-food plants of the Mediterranean region. Chania: CIHEAM-IAMC, 89-108.

[20]. Scherrer, A. M., Motti, R., &Weckerle, C. S. (2005). Traditional plant use in the areas of monte vesole and ascea, cilento national park (Campania, Southern Italy). Journal of ethnopharmacology, 97(1), 129-143.

[21]. Hami H, Soulaymani A, Skalli S, Mokhtari A, Sefiani H, Soulaymani Bencheikh R. 2011. Intoxication par Atractylis gummifera L. Données du Centre Antipoison et de Pharmacovigilance du Maroc. Bull Société Pathol Exot. 2011 ;104 (1):5357 https://doi.org/10.1007/s13149-010-0102-8

[22]. Rhalem N, Khattabi Asmae, Soulaymani Abdelmjid, Ouammi Lahcen, Soulaymani-Bencheich Rachida. Etude rétrospective des intoxications par les plantes au Maroc: Expérience du Centre Anti Poison et de Pharmacovigilance du Maroc (1980-2008). Toxicologie Maroc 2010 ; 5 : 5-8), Disponible sur l’URL : https://www.capm-sante.ma/uploads/ documents/8.pd

[23]. Ouammi L, Rhalem N, Aghandous R, Semllali I, Badri M, Jalal G, Benlarabi S, Mokhtari A, Soulaymani A, Soulaymani-Bencheikh R. 2009. Profil épidémiologique des intoxications au Maroc de 1980 à 2007. Toxicologie Maroc 1 :8-13. (consulté le 14 Juin 2024).

[24]. Khattabi A, Soulaymani R. 36 Intoxications with traditional pharmacopoeia products in Morocco. Human and Experimental Toxicology. 2000 Aug;19 : 473 - 483Hélène LEHMANN. Op.cit. p 21. 33.

[25]. Rebgui, H., Soulaymani-Bencheikh, R., Hami, H., Ouammi, L., Hadrya, F., Soulaymani, A., Mokhtari, A., 2013. Les déterminants des intoxications par les plantes. Cas de la région de Fès-Boulemane, Maroc. Antropo, 30, 71-78. www.didac.ehu.es/antropo

[26]. Benabdellah, FZ, Soulaymani, A., Mokhtari, A. et al. Évaluation économique du coût direct résultant des intoxications infantiles au Maroc : analyse micro-costing. Arch Public Santé 78, 59 (2020). https://doi.org/10.1186/s13690-020-00440-z

[27]. Lefebvre L, Mathieu M, Nantel A, RambourgSchepens M. Definition INTOX. 2000 Mars. http://www.who.int/ipcs/ poisons/ en/definitions_fr.pdf

[28]. OMS, World Health Organization. Programme-t-on Traditional Medicine. (‎1998)‎. Réglementation des médicaments à base de plantes : la situation dans le monde. Organisation mondiale de la Santé. https://iris.who.int/handle/10665/67060

[29]. OMS. ART. 2000. The uppsala monitoring centre. Adverse Reaction Terminology. Uppsala : OMS ; 2000

[30]. Charline D. 2018. Intoxications. Santé de la vie quotidienne (Dernière mise à jour : 9 janvier 2025) https://www.sante-sur-le-net.com/sante-quotidien/vie-courante/intoxications/ (consulté 2 février 2025)

[31]. Combe, C.Guitton, J.Daudé, A.Le Bricon, T.Guibert, N.Bosset, C. Girardot, T. 2022. Prise en charge multidisciplinaire d’une intoxication volontaire au laurier rose: comment estimer les quantités ingérées ? Annales Pharmaceutiques Françaises, SN-0003-4509, VL-80, DO - https://doi.org/10.1016/j.pharma.2021.04.003 https://www.sciencedirect.com/science/article/pii/S0003450921000638

[32]. Ait el cadi M, Khabbal Y, Mahnine N, Idrissi L. 2007. Les décès toxiques au Maroc: bilan de 5 ans d'étude (1999-2003) 2007. Annales de Toxicologie AnalytiqueArticle available at http://www.ata-journal.org or http://dx.doi.org/10.1051/ata:2007027

[33]. Achour S., Rhalem N., Khattabi A. 2012a Peganum harmala L. poisoning in Morocco: about 200 cases. Aim of the study. Therapie. 2012;67(1):53–58. doi: 10.2515/therapie/2012003. Article ID th121989. [DOI] [PubMed] [Google Scholar]

[34]. Abderrahmane A, Kharbach A, Azzine H, Lkoul A, Bouchriti Y, Cherrat Z, Ezzahir N, Boukrim M, Sine H. Suicide attempts in Morocco: A systematic review. Rev Epidemiol Sante Publique. 2022 Oct;70(5):243-251. doi: 10.1016/j.respe.2022.05.006. Epub 2022 Aug 1. PMID: 35927118.

[35]. Holbrook TC, Gilliam LL, Stein FP, Morgan SE, Avery AL, Confer AW, Panciera RJ. Lathyrus hirsutus (Caley Pea) intoxication in a herd of horses. J Vet Intern Med. 2015 Jan;29(1):294-8. doi: 10.1111/jvim.12515. Epub 2015 Jan 16. PMID: 25594329; PMCID: PMC4858080.

[36]. Wangny S, Ouattara V, Emmanuel Joël A, N’guessan K.2019. Etude Ethnobotanique des Plantes Utilisées en Médecine Traditionnelle dans le Traitement de l’Hypertension Artérielle chez les Peuples du Département de Divo, (Centre-ouest, Côted’Ivoire). European Scientific Journal ESJ, VL - 15. DO - 10.19044/esj.2019.v15n24p384

[37]. Kamel N, El Boullani R, Cherrah Y. 2022. Use of Medicinal Plants during Pregnancy, Childbirth and Postpartum in Southern Morocco. Healthcare (Basel). 2022 Nov 21;10(11):2327. doi: 10.3390/healthcare10112327. PMID: 36421651; PMCID: PMC9690511.

[38]. Rhalem N, Hamzaoui H, Hmimou R, Chebat A, Soulaymani-Bencheikh R. 2022. INTOXICATIONS PAR LES PLANTES ET LES PRODUITS DE LA PHARMACOPÉE TRADITIONNELLE DONNÉES DU CENTRE ANTIPOISON ET DE PHARMACOVIGILANCE DU MAROC. Toxicologie Maroc - N° 54 - 3ème trimestre, 3-7. Disponible sur l’URL https://www.capm-sante.ma/uploads/documents/95.pdf

[39]. Kamel N, El Boullani R, Cherrah Y. 2025. Epidemiological, clinical, and obstetrical profile of women who used medicinal plants during labor and delivery: a retrospective survey in the Guelmim-Oued Noun region, Morocco. February 2025 Brazilian Journal of Biology 84(2)DOI:10.1590/1519-6984.286538LicenseCC BY 4.0

[40]. Asraoui A, Rhalem N, Chaoui H, Soulaymani-Bencheikh R. 2023. Rapport général 2022 de toxicovigilance.Toxicologie Maroc - N° 55- 4ème trimestre 2022.Disponible via l’URL : https://www.capm-sante.ma/uploads/documents/97.pdf

[41]. Achour S. et al.P49: collective poisoning by Atractylis gummifera L., MoroccoToxicol Anal Clin (2014).

[42]. Rhalem Naima, Chebat Abderrahim: Intoxication par le chardon à glu: Addad. Toxicologie Maroc - N° 46 - 3ème trimestre 2020 – 15.

[43]. Skalli S, Alaoui I, Pineau A, Zaid A, Soulaymani R. 2002. L’intoxication par le chardon à glu (Atractylis gummifera L.); à propos d’un cas clinique. Manuscrit n°2395.”Santé publique”. https://pathexo.societe-mtsi.fr/documents/articles-bull/T95-4-2395.pdf

[44]. Larrey D.2017. Hepatotoxicity of herbal remedies. Consultable via l’ URL : https://www.soshepatites.org/plateforme/wp-content/uploads/2017/04/hepatotoxicite-de-la-physiotherapie.pdf

[45]. Sincich F. Bedouin Traditional Medicine in the Syrian Steppe. FAO ed, 2002, p. 146.

[46]. Massoud M, Jalilpour H, Salehian P. Toxicity of Peganum harmala: Review and a Case Report. Iran J Pharmacol Ther 2002; 1: 1-4.

[47]. Achour S., Saadi H., Turcant A. 2012b.Intoxication au Peganum harmala L. et grossesse: deux observations marocaines. Medecine et Sante Tropicales. 2012;22:84–86. doi: 10.1684/mst.2012.0013.

[48]. Berdai M A, Labib S, and Harandou M. 2014. Peganum harmala L. Intoxication in a Pregnant Woman. Hindawi Publishing Corporation Case Reports in Emergency Medicine Volume 2014, Article ID 783236, 3 pages. http://dx.doi.org/10.1155/2014/783236

[49]. El Aidouni G, Merbouh M , Haddad A I , Diyas S , Lezreg M , Bkiyar H , Housni B. 2021. Fatal poisoning of pregnant women by peganum harmala L.: A case reports. Ann Med Surg (Lond). 2021 Jul 29;68:102649. doi: 10.1016/j.amsu.2021.102649. PMID: 34401132; PMCID: PMC8350184

[50]. Soni P, Siddiqui AA, Dwivedi J, Soni V. Pharmacological properties of Datura stramonium L. as a potential medicinal tree: an overview. Asian Pac J Trop Biomed 2012;2(12):1002-8.

[51]. Djibo A, Bouzou SB. Intoxication aiguë au "sobi-lobi" (Datura). A propos de quatre cas au Niger [Acute intoxication with "sobi-lobi" (Datura). Four cases in Niger]. Bull Soc Pathol Exot. 2000 Nov;93(4):294-7. French. PMID: 11204734.)

[52]. Marc B, Martis A, Moreau C, et al. [Acute Datura stramonium poisoning in an emergency department]. Presse Med 2007;36(10 Pt 1):1399-403.

[53]. Graziano S, Orsolini L, Rotolo MC, et al. Herbal highs: review on psychoactive effects and neuropharmacology. Curr Neuropharmacol 2017;15(5):750-61.

[54]. Rakotomavo F, Andriamasy C, Rasamoelina N, Raveloson N. Datura Stramonium intoxication in two children. Pediatr Int 2014;56(3):e14-16.

[55]. Bernadet P., Guegan Le Souder A., Dondia D., Titier K., Courtois A., Labadie M. (2015) Intoxication au Datura stramonium : traitement spécifique par physostigmine à partir d’un cas, Journal Européen des Urgences et de Réanimation, Volume 27, Issue 2, Pages 113-116, ISSN 2211-4238, https://doi.org/10.1016/j.jeurea.2015.04.003. (https://www.sciencedirect.com/science/article/pii/S2211423815000577)

[56]. Anses.2020. Intoxication grave dans un jardin potager suite à la consommation de feuilles de datura. https://www.anses.fr/fr/content/intoxication-grave-dans-un-jardin-potager-suite-%C3%A0-la-consommation-de-feuilles-de-datura

[57]. Jaggernauth C, Dalip D, Ewe P, Jaggernauth S. Datura Poisoning in Trinidad: A Case Report. Cureus. 2022; DOI: 10.7759/cureus.29829

[58]. Soulaymani R. Les plantes et la santé publique. Toxicologie Maroc - N°5 - 2ème trimestre p-2. 2010. https://www.capm-sante.ma/uploads/documents/8.pdf

[59]. Durasnel P. Vanhuffel L, Blondé R, Lion F, Galas T, Mousset-Hovaere M, Balaÿ I, Viscardi G et Valyi L. 2014.Intoxications graves lors de traitements traditionnels par les plantes à Mayotte Severe poisoning by plants used for traditional medicine in Mayotte. Bull. Soc. Pathol. Exot. (2014) 107:306-311 DOI 10.1007/s13149-014-0400-7

[60]. WY Ng, LY Hung, YH Lam and all. Poisoning by toxic plants in Hong Kong: a 15-year review. Hong Kong Medical Journal. 2019

[61]. Slaughter Robin J. and al. Poisonous plants in New Zealand: a review of those that are most commonly enquired about to the National Poisons Centre. The New Zealand medical journal. 2012

[62]. Mathieu Nolf M; Rapport annuel 2005. Centre AntiPoison de Lille. https://www.yumpu.com/fr/document/read/48014440/rapport-annuel-2005-centre-antipoison-de-lille

[63]. Mourabiti Hajar, Rhalem Naima, Chebat Abderrahim, Hamzaoui Hind, Asraoui Abdelghani, Achour Sanae, Soulaymani-Bencheikh Rachida. 2022. DÉCÈS PAR LES PLANTES ET LES PRODUITS DE LA PHARMACOPÉE TRADITIONNELLE AU MAROC: ETUDE RETROSPECTIVE DU CENTRE ANTIPOISON ET DE PHARMACOVIGILANCE DU MAROC. Toxicologie Maroc - N° 54 - 3ème trimestre 2022. https://www.capm-sante.ma/uploads/documents/95.pdf

[64]. Benaddi FZ, Ouahbi A, Bellahmar M and Chakir S. THE ACUTE TOXICITY OF THE AQUEOUS EXTRACT OF PEGANUM HARMALA L, « MOROCCO » PREPARED BY THE TRADITIONAL METHOD. World Journal of Pharmaceutical and Life Sciences WJPLS, wjpls, 2019, Vol. 5, Issue 3, 15-19, ISSN 2454-2229, file:///C:/Users/Dell/Downloads/article_1551335168.pdf

[65]. Vasas A,Orbán-Gyapai O, Hohmann J.2015.The Genus Rumex: Review of traditional uses, phytochemistry and pharmacology. Journal of Ethnopharmacology, VL - 175,198-228. DO - https://doi.org/10.1016/j.jep.2015.09.001

[66]. https://www.sciencedirect.com/science/article/pii/S0378874115301264

[67]. Fournier A, Ruel D. 2002. Les plantes toxiques, un danger potentiel pour votre bétail. Agri.réseau. https://www.agrireseau.net/bovinslaitiers/documents/plantes%20toxiques.pdf

[68]. Encyclopédie des plantes. 2024. https://www.picturethisai.com/fr/wiki. (consulté le 19 février 2025)