Kratom

Abstract

1 Kratom (Mitragyna speciosa Korth.) is a herbal product from Southeast Asia with opioid agonist properties Kratom is a herbal product that is most commonly obtained as a powder and consumed as a beverage. 1-3 Kratom contains the indole alkaloid compounds mitragynine and 7-hydroxymitragynine, which are opioid receptors agonists. 2,3 They reduce pain, cause dose-dependent stimulant and sedative effects, and have an adverse effect profile consistent with opioid activity. 2 Kratom is not detected on conventional urine drugscreening tests. 2 2 Kratom use is increasing Avoidance of drug withdrawal, treatment of chronic pain and recreation are common reasons for kratom use. 1,2 American poison centres saw an increase in kratom-related calls, from 18 exposures in 2011 to 357 in the first 7 months of 2018. 4 The US Centers for Disease Control and Prevention identified 91 cases in which kratom was identified as a potential cause of death from July 2016 to December 2017. 5 3 Effects of kratom use appear to be dose dependent Kratom use is associated with stimulant effects at low doses (1-5 g), and sedative effects at higher doses (5-15 g). 2 Negative adverse effects most commonly include gastrointestinal symptoms and agitation, and are reported to be dose dependent. 1,4 4 Kratom users may experience withdrawal with cessation Moderate to heavy daily users of kratom (≥ 3 doses/d) commonly have cravings and withdrawal symptoms similar to those of opioid withdrawal with cessation. 2,5 Of kratom users, 43% reported negative adverse events if they abstained for more than 48 hours. 1 5 Management of kratom ingestion is supportive Doses in excess of 15 g may mimic an opioid toxidrome. Naloxone should be given for drowsiness and respiratory depression. 3 Severe adverse events, including death, have been reported with kratom use in conjunction with opioids, benzodiazepines, modafinil and other medications. 2,5 Supportive management and toxicology consultation are indicated for cases of overdose or intoxication.

A case of a mixed overdose involving kratom (Mitragyna speciosa) leading to serotonin syndrome

“…Traditionally kratom was brewed into a tea and used by day laborers to increase productivity. In low dosages, it appears to act as a stimulant (1-5 g per day); in higher concentrations, it has opioid and sedative effects (5-15 g) (3,4,5). Thus, depending on dosing, kratom can act as a stimulant, anxiolytic, analgesic, or antidepressant.…”

Kratom exposures managed by the British Columbia poison centre, 2012–2019: a descriptive analysis

“…Despite the publication of articles about kratom in the BC Medical Journal 33 and the CMAJ , 36 as well as local press coverage, 37 the DPIC continues to receive requests for patient management support from clinicians. Most (72%) of the DPIC case calls were from health care workers, similar to proportions seen in US poison centre studies.…”

A Case of Severe Kratom Addiction Contributing to a Suicide Attempt

“…She typically drank a mixture of between two to three tablespoons of kratom powder and apple juice twice a day. Sanderson and Rowe found that doses over 15 g may mimic an opioid toxidrome [ 14 ]. Clearly, Mrs. K developed tolerance after months of consistent use and increasing dosages, as she did not report any recent history of opioid toxicity symptoms.…”