Seizures among young adults consuming kratom beverages in Malaysia: A case series

Halim, Sanihah Abdul; Low, Jen Hou; Chee, Yong Chuan; Alias, Muhamad Ridzuan

doi:10.1016/j.yebeh.2021.108057

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…Four additional cases describing kratominduced seizures have also been reported. 112,[114][115][116] In many of these case reports, kratom was coingested with other compounds (illicit or prescription drugs), suggesting that recurrent seizures with kratom were more prevalent in cases of polysubstance abuse.…”

Section: Safetymentioning

confidence: 99%

Clinical Pharmacology of the Dietary Supplement Kratom (Mitragyna speciosa)

Hartley

Bulloch

Penzak

2022

The Journal of Clinical Pharma

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Kratom (Mitragyna speciosa) consists of over 40 alkaloids, with 2 of them, mitragynine and 7-OH-mitragynine (7-OH-MG) being the main psychoactive compounds. Mitragynine and 7-OH-mitragynine each target opioid receptors and have been referred to as atypical opioids. They exert their pharmacologic effects on the mu, delta, and kappa opioid receptors. In addition, they affect adrenergic, serotonergic, and dopaminergic pathways. Kratom has been touted as an inexpensive, legal alternative to standard opioid replacement therapy such as methadone and buprenorphine. Other uses for kratom include chronic pain, attaining a "legal high," and numerous central nervous system disorders, including anxiety, depression, and posttraumatic stress disorder. Kratom induces analgesia and mild euphoria, with a lower risk of respiratory depression or adverse central nervous system effects compared to traditional opioid medications. Nonetheless, kratom has been associated with both physical and psychological dependence, with some individuals experiencing classic opioid withdrawal symptoms upon abrupt cessation. Kratom use has been linked to serious adverse effects, including liver toxicity, seizures, and death. These risks are often compounded by polysubstance abuse. Further, kratom may potentiate the toxicity of coadministered medications through modulation of cytochrome P450, P-glycoprotein, and uridine diphosphate glucuronosyltransferase enzymes. In 2016, the US Drug Enforcement Administration took steps to classify kratom as a federal schedule 1 medication; however, due to public resistance, this plan was set aside. Until studies are conducted that define kratom's role in treating opioid withdrawal and/or other central nervous system conditions, kratom will likely remain available as a dietary supplement for the foreseeable future.

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Section: Safetymentioning

confidence: 99%

Clinical Pharmacology of the Dietary Supplement Kratom (Mitragyna speciosa)

Hartley

Bulloch

Penzak

2022

The Journal of Clinical Pharma

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“…In addition to the ionization method, appropriate sampling techniques are also crucial in drug detection due to the diverse forms of samples [ 20 , 21 , 22 ] to be analyzed, including liquid samples such as beverages, sewage, blood, and urine, as well as solid samples such as capsules, tablets, and hair. Thermal desorption (TD) [ 23 ] is a sampling technique that can be used to separate and vaporize organic substances from matrices by heating.…”

Section: Introductionmentioning

confidence: 99%

Rapid Separation and Detection of Drugs in Complex Biological Matrix Using TD-CDI Mass Spectrometer

Shi,

Ye,

Yang

et al. 2024

Biosensors

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The drug detection technology plays a pivotal role in the domains of pharmaceutical regulation and law enforcement. In this study, we introduce a method that combines thermal desorption corona discharge ionization (TD-CDI) with mass spectrometry for efficient drug detection. The TD-CDI module, characterized by its compact and simple design, enables the separation of analytes within seconds and real-time presentation of one or two analyte peaks on the mass spectrum most of the time, which reduces matrix interference and improves detection performance. Through experimental investigation, we studied the characteristics of TD-CDI for analyte separation and detection, even with the same mass number, and optimized the TD-CDI approach. TD-CDI-MS was employed for the rapid detection of drugs in various traditional medicine, food products, and human samples. Additionally, by utilizing TD-CDI for segmented hair direct analysis, it becomes possible to trace the drug usage cycle of individuals. This underscores the feasibility of the proposed analytical method within the realm of drug detection.

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“… 13 Nevertheless, there are safety concerns related to the use of kratom. 14 Large doses have been reported to cause acute serious adverse effects (e.g., seizures and cardiovascular effects) 15 , 16 and long‐term use severe liver injury. 17 , 18 Deaths attributed to kratom alone, or as a contributing cause, have been reported.…”

Section: Introductionmentioning

confidence: 99%

Drug testing for mitragynine and kratom: Analytical challenges and medico‐legal considerations

Helander

Rylski

2022

Drug Testing and Analysis

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Mitragyna speciosa, known as kratom, is a tropical tree native to Southeast Asia that has long been used to increase energy and in traditional medicine. Kratom leaves contain several indole alkaloids including mitragynine, mitraciliatine, speciogynine, and speciociliatine, which have the same molecular formula and connectivity, but different spatial arrangements (i.e., diastereomers). A routine liquid-chromatographichigh-resolution mass-spectrometric (LC-HRMS) multi-analyte method for addictive and herbal drugs in urine did not separate mitragynine from speciogynine and speciociliatine. Separation and individual measurement of the four diastereomers was possible with an improved LC method. All diastereomers were detected in 29 patient urine samples who tested positive for mitragynine with the routine method, albeit at variable absolute amounts and relative proportions. The presence of all diastereomers rather than individual substances indicated that they originated from the intake of kratom (i.e., plant material). Speciociliatine dominated in most samples (66%), whereas mitragynine and mitraciliatine were the highest in 17% each. A kratom product (powdered plant material) marketed in Sweden contained all diastereomers with mitragynine showing the highest level. In Sweden, there are signs of an increasing use of kratom in society, based on the results from drug testing, the number of poisons center consultations on intoxications, and customs seizure statistics. Because there may be health risks associated with kratom use, including dependence, serious adverse reactions, and death, analytical methods should be able to identify and quantify all diastereomers. In Sweden, this is important from a legal perspective, as only mitragynine is classified, whereas the other three diastereomers, and kratom (plant material), are not.

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Seizures among young adults consuming kratom beverages in Malaysia: A case series

Cited by 7 publications

References 22 publications

Clinical Pharmacology of the Dietary Supplement Kratom (Mitragyna speciosa)

Clinical Pharmacology of the Dietary Supplement Kratom (Mitragyna speciosa)

Rapid Separation and Detection of Drugs in Complex Biological Matrix Using TD-CDI Mass Spectrometer

Drug testing for mitragynine and kratom: Analytical challenges and medico‐legal considerations

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