Kratom Overview and Toxicity

Kratom Overview

• Kratom (Mitragyna speciosa) is a tropical evergreen tree native to Southeast Asia.
• It is gaining popularity in the U.S. as an herbal supplement for its stimulating properties and analgesic effect.
• Estimated 2.1 million US residents used kratom in 2020 for pain, opioid withdrawal, and other conditions.

Kratom Toxicity and Deaths

• Severe toxicity and death have been reported from Kratom use.
• More than 90 deaths have been caused by Kratom between July 2016 and December 2017 according to CDC.
• Kratom abuse is an emerging public health emergency.

Kratom Exposures

• From 2011 through 2017, 1807 kratom exposures were reported to United States Poison Control Centers.
• Most exposures occurred in adults over 20 years of age (88.9%) and males (70.8%).
• Almost two-thirds (65.0%) of these exposures occurred during 2016–2017 and most exposures were intentional (74.3%).
• After Kratom use, 51.9% of subjects had adverse effects.

Active Ingredients and Pharmacological Effects

• Active ingredients of Kratom are indole-based alkaloids with no similarity to opiates.
• They bind with mu-opiate receptor, resulting in pharmacological effects.
• Urine drug screen is negative in a suspected Kratom overdose patient.

Case Report

• A 56-year-old patient with a past medical history of hypertension, hypothyroidism, nephrolithiasis, and biliary stricture causing hepatic dysfunction presented to the emergency department with acute liver injury and jaundice.
• The patient was using Kratom on a regular basis for almost one year for pain relief.

Treatment and Outcome

• Treatment of Kratom overdose is mostly conservative as symptoms resolve after supportive therapy in most cases.
• However, severe overdose may not respond to supportive therapy, causing fatality.
• Plasma exchange was used to reverse Kratom overdose, and the patient was discharged on day 5 at stable condition with a total bilirubin value of 21.3 mg/dL.