Complicated postoperative course secondary to kratom withdrawal: a case report

Kucharik, Michael P.; Gupta, Anupam; Averkiou, Peter; Luck, George; Ross, Andrew Slavin

doi:10.1093/jscr/rjz309

Cited by 10 publications

(12 citation statements)

References 7 publications

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“…Physical exam findings include mydriasis, hypothermia, tremors, and diaphoresis. Additionally, a significant number of patients report psychiatric symptoms, most commonly nervousness, anxiety, and depression [33,127]. Patients in acute withdrawal are managed conservatively, although there is some evidence to suggest that the combination of buprenorphine and naloxone can alleviate both the physical and mental symptoms associated with kratom withdrawal [128].…”

Section: Considerations For Treatment and Managementmentioning

confidence: 99%

Kratom—Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review

2020

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Kratom, or Mitragyna, is a tropical plant indigenous to Southeast Asia, with unique pharmacological properties. It is commonly consumed by preparing the leaves into decoction or tea, or by grinding them into a powder. Recent evidence has revealed that kratom has physiological effects similar to opioids, including pain relief and euphoria, as well as stimulant properties, which together raise potential concern for dependence and addiction. Moreover, growing evidence suggests that the prevalence of kratom use is increasing in many parts of the world, raising important considerations for healthcare providers. This manuscript will discuss the most current epidemiology, pharmacology, toxicity, and management related to kratom, while seeking to provide a contemporary perspective on the issue and its role in the greater context of the opioid epidemic.

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Section: Considerations For Treatment and Managementmentioning

confidence: 99%

Kratom—Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review

2020

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“…Clinical reports detailed patients who presented with kratom-associated, adverse cardiovascular effects, such as cardiac arrest, cardiac palpitations, elevated blood pressure, prolonged QT interval, or tachycardia. 25 - 35 Abdullah et al 25 described a patient who experienced cardiac arrest and had a history of ingesting kratom tea several times per day to self-treat opioid dependency. Further, Nacca et al 28 presented a case of intracerebral hemorrhage when a kratom-based product was adulterated with phenylethylamine.…”

Section: Reviewmentioning

confidence: 99%

“… 39 Vomiting and/or nausea associated with kratom use or withdrawal were also documented in clinical reports. 26 , 27 , 30 , 31 , 33 , 40 - 42 Some patients with a history of kratom use were observed to have symptoms of liver 31 , 34 , 42 - 48 or kidney 47 , 49 injury.…”

Section: Reviewmentioning

confidence: 99%

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Health Effects Associated With Kratom (Mitragyna speciosa) and Polysubstance Use: A Narrative Review

et al. 2022

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Background: Kratom ( Mitragyna speciosa) consumption and associated health effects have raised debates in the United States. Although most people using this herb do not experience adverse health effects associated with kratom use, medical providers should be knowledgeable of emerging substances and concurrent, sequential, or simultaneous use of other drugs which may impact healthcare recommendations and prescribing practices. Methods: The objective of this narrative review was to elucidate selected health effects associated with using kratom—either alone or with other substances. Since scientifically controlled human subjects research on kratom use is still limited, relevant case reports were also described. Results: Cardiovascular, gastrointestinal, neurological, and psychiatric effects associated with kratom use were especially notable, and in-utero exposure accompanied concern regarding a neonate’s risk for developing neonatal abstinence syndrome. Our ability to identify and understand the role of this herb in kratom-associated fatalities is complicated since kratom is not routinely screened for in standard forensic toxicology. If a screening is performed, it is usually for the major alkaloid, mitragynine, as a surrogate for kratom use. In addition to lacking a standard practice of screening decedents for kratom alkaloids, the association between mortality and kratom use may be confounded by polysubstance use, adulteration of kratom products, and drug-herb interactions. Conclusions: Increasing medical awareness of this herb is vital to ensuring prompt administration of best-practice medical advice or treatment for people seeking information related to kratom use or for patients experiencing an adverse health effect that may be associated with using or withdrawing from kratom. Knowledge gained from continued surveillance and study of kratom and its associated health effects may assist in guiding clinical decision-making and preventing development of adverse health effects among people using kratom.

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“…While several surveys from Southeast Asia have reported addiction and withdrawal, reports of severe withdrawal in an unsuspecting population are becoming more frequent in the United States (Galbis‐Reig, 2016; Stanciu et al, 2019). Kucharik described post‐operative complications caused by the cessation of kratom use and advised physicians to be aware of the physiological symptoms of kratom use and withdrawal (Kucharik, Gupta, Averkiou, Luck, & Ross, 2019), a sentiment expressed by many health‐care professionals (Eastlack et al, 2020; Goldin, Salani, & McKay, 2019; Han et al, 2019; White, 2019). There have also been several case studies involving neonatal abstinence syndrome among infants whose mothers consumed kratom frequently during pregnancy (Davidson, Rawat, Stojanovski, & Chandrasekharan, 2019; Eldridge, Foster, & Wyble, 2018; Mackay & Abrahams, 2018; Murthy & Clark, 2018).…”

Section: Pharmacology and Effectsmentioning

confidence: 99%

Kratom: A systematic review of toxicological issues

Kerrigan

Basiliere

2021

WIREs Forensic Science

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Kratom is a botanical substance derived from the leaves of Mitragyna speciosa. Although kratom has been used traditionally in Southeast Asia for over a century, recreational use and non‐medically supervised use of the drug in the West has escalated considerably over the past decade. Viewed as a legal, “safe” or “natural” alternative to opioids, kratom has gained widespread use for the non‐medically supervised treatment of chronic pain, anxiety, and opioid withdrawal. Kratom consists of a complex mixture of more than 50 alkaloids, of which mitragynine and 7‐hydroxymitragynine are the principal compounds of interest due to their abundance and heightened affinity for the mu opioid receptor, respectively. Mitragynine, which is structurally and pharmacologically distinct from traditional opioids, exhibits a multimodal mechanism of action which accounts for its complex adrenergic, serotonergic, and opioid‐like effects. Adverse effects including fatalities have been associated with kratom's use, often in combination with other drugs. While users report numerous benefits associated with its use, lack of regulatory control and escalating use among individuals with opioid use disorder has attracted widespread concern. In this review the origins, pharmacology, uses, effects, and analysis of the drug are reviewed from a toxicological standpoint. This article is categorized under: Toxicology > New Psychoactive Substances Toxicology > Opioids Toxicology > Plants and Poisons

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Complicated postoperative course secondary to kratom withdrawal: a case report

Cited by 10 publications

References 7 publications

Kratom—Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review

Kratom—Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review

Health Effects Associated With Kratom (Mitragyna speciosa) and Polysubstance Use: A Narrative Review

Kratom: A systematic review of toxicological issues

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