Fatal Mitragynine-Associated Toxicity in Canada

Wang, Carol; Walker, Alfredo E.

doi:10.1177/1925362118782076

Cited by 24 publications

(9 citation statements)

References 21 publications

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“…In comparison to other reported mitragynine death cases, the age and gender, majority being male, were similar to what was previously found (5, 8 -17). For age of decedents in mitragynine-related deaths, Neerman et al (2013) reported the youngest decedent who was a 17-year-old male and the two oldest decedents were both female at 60 and 65 years old from Mata and Andera (2020) and Wang and Walker (2018), respectively.…”

Section: Discussionsupporting

confidence: 90%

Postmortem Mitragynine Distribution in a Single Drug Fatality Case

Mata¹,

Chang²

2023

Academic Forensic Pathology

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A 32-year-old Caucasian male was found unconscious at his sober-living home and pronounced dead after transportation to the emergency room. The decedent had a documented history of substance-use disorder and past suicide attempts, but according to his family, he was sober for the past year. Significant autopsy findings were cardiomegaly, hepatomegaly, congested lungs, cerebral edema, and obesity. The toxicology examination of blood and tissues using liquid chromatography tandem mass spectrometry detected only mitragynine in the central blood (7.5 mg/L), peripheral blood (3.3 mg/L), liver (42.2 mg/kg), and gastric contents (33.1 mg). The qualitative identification of 7-hydroxymitragynine was performed only on the central blood. The pathologist ruled the cause of death acute mitragynine intoxication combined with cardiomegaly with left ventricular hypertrophy, with severe hepatomegaly and obesity listed as other significant conditions. The mode, or manner, of death was determined to be an accidental overdose. To the authors’ knowledge, this is the first reported case where mitragynine was the only drug detected. This case study will contribute to the understanding of mitragynine-only death investigation and provide valuable toxicology information for medical examiners and pathologists.

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Section: Discussionsupporting

confidence: 90%

Postmortem Mitragynine Distribution in a Single Drug Fatality Case

Mata¹,

Chang²

2023

Academic Forensic Pathology

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“…PEA remains an unscheduled substance without restrictions on its inclusion in supplements. The patient had a measurable mitragynine concentration; however, the range of toxicity has not been well established, with deaths having been reported in association with postmortem concentrations of 1060 ng/mL and 2500 ng/mL [13].…”

Section: Discussionmentioning

confidence: 98%

Kratom Adulterated with Phenylethylamine and Associated Intracerebral Hemorrhage: Linking Toxicologists and Public Health Officials to Identify Dangerous Adulterants

Nacca

Schult

et al. 2019

J. Med. Toxicol.

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Introduction Kratom is derived from the plant Mitragyna speciosa which is indigenous to Southeast Asia. Active compounds, mitragynine and 7-hydroxymitragynine, cause mild stimulant and opioid agonist effects. Although reported to have potential benefits in the treatment of opioid use disorder, efficacy remains uncertain while adverse health effects have been reported. A compounding concern is the presence of adulterants given that this is an unregulated product. Case Details A 54-year-old fitness instructor who used an online purchased kratom product regularly for one year developed stimulatory effects and suffered a large hemorrhagic stroke with a close temporal relationship to ingestion of a different kratom product from the one he regularly used. A collaborative investigation by medical toxicologists, a regional poison center, the state public health laboratory, and public health officials determined that his new kratom product was adulterated with phenylethylamine (PEA). Discussion We report a case of PEA adulterated kratom purchased and used with resultant adverse effects. PEA is structurally similar to amphetamine and is known to produce sympathomimetic effects. It is possible the stimulatory effect of PEA resulted in a marked and transient increase in blood pressure resulting in hemorrhagic stroke. Conclusion Medical toxicologists should form working relationships with laboratories and public health officials to aid in early identification of adulterated products that carry risk to the general population.

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“…An emergency case presenting with cardiorespiratory arrest could not be rescued despite the use of intralipid, that nevertheless improved somehow the conditions of a 26-year-old man, but proved ineffective in avoiding exitus, attributed to cardiorespiratory failure and hypoxic brain damage ( 91 ). A Canadian 56-year-old woman with chronic obstructive pulmonary disease, after skipping her medication and consuming kratom purchased from Indonesia, died due to respiratory failure ( 92 ). Her mitragynine levels in the femoral vein were found to be substantial but sublethal (under the reporting laboratory's threshold of fatality, which was 0.21 mg/L).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Treatment of Kratom Use Disorder With a Classical Tricyclic Antidepressant

Vento

Persis²,

Filippis³

et al. 2021

Front. Psychiatry

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Kratom or Mitragyna speciosa (Korth.) is an evergreen tree of the coffee family native to South-East Asia and Australasia. It is used by locals recreationally to induce stimulant and sedative effects and medically to soothe pain and opiate withdrawal. Its leaves are smoked, chewed, or infused, or ground to yield powders or extracts for use as liquids. It contains more than 40 alkaloids; among these, mitragynine and 7-hydroxymitragynine are endowed with variable mu, delta, and kappa opioid stimulating properties (with 7-hydroxymitragynine having a more balanced affinity), rhynchophylline, which is a non-competitive NMDA glutamate receptor antagonist, but is present in negligible quantities, and raubasine, which inhibits α1-adrenceptors preferentially over α2-adrenceptors, while the latter are bound by 7-hydroxymitragynine, while mitragynine counters 5-HT2A receptors. This complexity of neurochemical mechanisms may account for kratom's sedative-analgesic and stimulant effects. It is commonly held that kratom at low doses is stimulant and at higher doses sedative, but no cut-off has been possible to define. Long-term use of kratom may produce physical and psychological effects that are very similar to its withdrawal syndrome, that is, anxiety, irritability, mood, eating, and sleep disorders, other than physical symptoms resembling opiate withdrawal. Kratom's regulatory status varies across countries; in Italy, both mitragynine and the entire tree and its parts are included among regulated substances. We describe the case of a patient who developed anxiety and dysphoric mood and insomnia while using kratom, with these symptoms persisting after withdrawal. He did not respond to a variety of antidepressant combinations and tramadol for various months, and responded after 1 month of clomipramine. Well-being persisted after discontinuing tramadol.

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Fatal Mitragynine-Associated Toxicity in Canada

Cited by 24 publications

References 21 publications

Postmortem Mitragynine Distribution in a Single Drug Fatality Case

Postmortem Mitragynine Distribution in a Single Drug Fatality Case

Kratom Adulterated with Phenylethylamine and Associated Intracerebral Hemorrhage: Linking Toxicologists and Public Health Officials to Identify Dangerous Adulterants

Case Report: Treatment of Kratom Use Disorder With a Classical Tricyclic Antidepressant

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