Critique of “Kratom Use and Toxicities in the United States”

Grundmann, Oliver; Brown, Paula N.; Boyer, Edward W.; Swogger, Marc T.; Walsh, Zachary; Prozialeck, Walter C.; Kruegel, Andrew C.; Veltri, Charles A.; Dudley, Steven

doi:10.1002/phar.2336

Cited by 3 publications

(9 citation statements)

References 5 publications

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“…The literature review revealed a wide range of mitragynine concentrations, 10 to 4800 ng/mL, 9–18 which is comparable to the slightly narrower range reported in this study, 8.7 to 1800 ng/mL. Our case where mitragynine was the sole intoxicant, 950 ng/mL, was in the middle of the concentrations found in other reported cases of sole mitragynine toxicity, 260 to 1900 ng/mL 11,15 . This wide range demonstrates why our P value (>0.201) was not statistically significant for the comparison of the 2 study groups (mitragynine-related fatalities and cases with incidental detection of mitragynine and an unrelated cause of death).…”

Section: Discussionsupporting

confidence: 74%

“…Our case where mitragynine was the sole intoxicant, 950 ng/mL, was in the middle of the concentrations found in other reported cases of sole mitragynine toxicity, 260 to 1900 ng/mL. 11,15 This wide range demonstrates why our P value (>0.201) was not statistically significant for the comparison of the 2 study groups (mitragynine-related fatalities and cases with incidental detection of mitragynine and an unrelated cause of death). The concentration at which mitragynine is found to be lethal varies widely because of the potential effects of agonal metabolism, additional cointoxicants, variations in individual metabolism, and opioid tolerance.…”

Section: Discussioncontrasting

confidence: 52%

“…For the cases with fatalities due to combined drug toxicity, the blood levels of mitragynine ranged from 10 to 4800 ng/mL as seen in Table 3. 9,10,[12][13][14][16][17][18] Of the 10 fatalities due to mitragynine, only 3 had quantified values reported: 260, 1400, 11 and 1900 ng/mL, respectively, in blood. 15 Numerical data were the only information provided for the majority of these cases, but the case with the greatest value recorded, 1900 ng/mL, was also the most descriptive.…”

Section: Literature Reviewmentioning

confidence: 99%

“…A total of 127 fatalities due to kratom toxicity were found in the medical literature, within 11 publications. [9][10][11][12][13][14][15][16][17][18][19] Of these 127 cases, 10 were fatalities in which kratom was the sole intoxicant, whereas the other 117 cases were due to combined drug toxicity. For the cases with fatalities due to combined drug toxicity, the blood levels of mitragynine ranged from 10 to 4800 ng/mL as seen in Table 3.…”

Section: Literature Reviewmentioning

confidence: 99%

“…A total of 127 fatalities due to kratom toxicity were found in the medical literature, within 11 publications 9–19 . Of these 127 cases, 10 were fatalities in which kratom was the sole intoxicant, whereas the other 117 cases were due to combined drug toxicity.…”

Section: Literature Reviewmentioning

confidence: 99%

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Kratom-Associated Fatalities in Northern Nevada—What Mitragynine Level Is Fatal?

Schmitt

Bingham

Knight

2021

Am J Forensic Med Pathol

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Mitragyna speciosa, commonly known as the kratom tree, has been utilized in Southeast Asia for centuries for its opioid-like effects. Kratom has been available in the United States for the past decade and has grown increasingly popular despite a lack of clinical research to determine its safety. With its widespread use, there have been an increasing number of fatalities. This study aims to establish a potential lethal range for mitragynine, the active compound in kratom, by investigating the toxicology reports of 35 deaths in Northern Nevada between 2015 and 2020. Mitragynine concentrations ranged from 8.7 to 1800 ng/mL (n = 27) in cases with drug toxicity as the cause of death; in 1 case, the sole intoxicant was mitragynine with a blood concentration of 950 ng/mL. In cases with nonmitragynine causes of death, the concentration was 110 to 980 ng/mL (n = 8). There was no statistically significant difference in blood concentrations between cases where mitragynine was not listed as a cause of death (mean, 315 ± 297.2 ng/mL) and cases in which mitragynine contributed to death (mean, 269.4 ± 382.5 ng/mL; P < 0.201). A literature review is also presented.

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Section: Discussionsupporting

confidence: 74%

Section: Discussioncontrasting

confidence: 52%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

See 3 more Smart Citations

Kratom-Associated Fatalities in Northern Nevada—What Mitragynine Level Is Fatal?

Schmitt

Bingham

Knight

2021

Am J Forensic Med Pathol

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Kratom safety and toxicology in the public health context: research needs to better inform regulation

Henningfield,

Grundmann,

Huestis

et al. 2024

Front. Pharmacol.

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Although kratom use has been part of life for centuries in Southeast Asia, the availability and use of kratom in the United States (US) increased substantially since the early 2000s when there was little information on kratom pharmacology, use patterns, and effects, all critical to guiding regulation and policy. Here we provide a synthesis of research with several hundred English-language papers published in the past 5 years drawing from basic research, epidemiological and surveillance data, and recent clinical research. This review of available literature aims to provide an integrated update regarding our current understanding of kratom’s benefits, risks, pharmacology, and epidemiology, which may inform United States-based kratom regulation. Recent surveillance indicates there are likely several million past-year kratom consumers, though estimates vary widely. Even without precise prevalence data, kratom use is no longer a niche, with millions of United States adults using it for myriad reasons. Despite its botanical origins in the coffee tree family and its polypharmacy, kratom is popularly characterized as an opioid with presumed opioid-system-based risks for addiction or overdose. Neuropharmacology, toxicology, and epidemiology studies show that kratom is more accurately characterized as a substance with diverse and complex pharmacology. Taken together the work reviewed here provides a foundation for future scientific studies, as well as a guide for ongoing efforts to regulate kratom. This work also informs much-needed federal oversight, including by the United States Food and Drug Administration. We conclude with recommendations for kratom regulation and research priorities needed to address current policy and knowledge gaps around this increasingly used botanical product.

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Effectiveness of positive deviance, a behavior change approach, to improve knowledge, attitude and practices on dengue prevention and control in selected slums in Islamabad, Pakistan : a mixed-method study

Shafique

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This is the first practical application of positive deviance on dengue in the two selected low-income slums of Islamabad which was conducted during June-October 2020. A total of 112 participants (56 for intervention and 56 for the control group) participated in the study. The intervention arm received the positive deviance intervention through the identified positive deviance role models during the regular PD sessions, role plays, illustration competitions, and songs for two months. Three surveys were conducted, before the intervention, after two months, and after four months to assess the changes in knowledge, attitude, and practices. At the baseline, no statistically significant differences in dengue knowledge were found between control (M=8.93, SD=3.107) and intervention (M=10.09, SD=3.549) groups (p=0.071). After two months, the intervention group demonstrated statistically significant improvements in dengue knowledge (M=19.00, SD=6.093) compared to the control group (M=13.13, SD=4.953) (p<0.001). After another two months at the end-line, dengue knowledge not only persisted but continued to improve with a statistically significant difference between control (M=14.30, SD=4.944) and intervention group (M=25.00, SD=9.607) (p<0.001). After two months, there were no statistically significant differences in dengue attitudes and practice between control and intervention groups. However, after four months, attitude towards dengue disease improved significantly in the intervention group (M=28.34, SD=3.604) compared to the control group (M=26.52, SD=4.343) (p=0.018). Similarly, after four months, at the end-line, practice regarding dengue disease improved significantly in the intervention group (M=13.77, SD=2.216) compared to the control group (M=11.37, SD=1.629) (p<0.001). The study revealed that positive deviance intervention had a significant impact on dengue knowledge, attitudes, and practices in the target communities.

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Critique of “Kratom Use and Toxicities in the United States”

Cited by 3 publications

References 5 publications

Kratom-Associated Fatalities in Northern Nevada—What Mitragynine Level Is Fatal?

Kratom-Associated Fatalities in Northern Nevada—What Mitragynine Level Is Fatal?

Kratom safety and toxicology in the public health context: research needs to better inform regulation

Effectiveness of positive deviance, a behavior change approach, to improve knowledge, attitude and practices on dengue prevention and control in selected slums in Islamabad, Pakistan : a mixed-method study

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