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

Abstract

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.

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

“…For instance, it has been reported that kratom products may be altered by artificially increasing levels of 7-OH-mitragynine to enhance potency [91]. In addition, multiple instances of deliberate adulteration of kratom have been documented, for instance, by adding synthetic substances such as phenylethylamine (PEA) or O-desmethyltramadol, both of which have resulted in patient deaths [92,93]. Other risks include product contamination (intentional or otherwise).…”

Kratom: A systematic review of toxicological issues

“…Mitragynine has also been identified in other herbal blends sold in retail outlets (Cornara et al, 2013). However, some products are known to contain not only kratom, but several other psychoactive drugs, toxic heavy metals, and dangerous microbes such as Salmonella (Arndt et al, 2011; Kronstrand, Roman, Thelander, & Eriksson, 2011; Nacca et al, 2020; Prozialeck et al, 2020; Rosenbaum et al, 2012). Its unregulated use increases the potential risk associated with exposure to adulterated or contaminated products.…”

Kratom – eine kurze Übersicht für die Schmerzmedizin

“…Unter Krypton beispielsweise wurde ein Kratomprodukt vertrieben, welchem O-Desmethyltramadol beigefügt war, welches dadurch nachweislich für 9 letale Intoxikationen verantwortlich war [14]. Auch wurde in der Literatur über eine intrazerebrale Blutung wegen des Zusatzes eines Phenylethylamins, welches eine sympathomimetische Wirkung hat, berichtet [20].…”