A Case Report of Inpatient Detoxification after Kratom &lt;i&gt;(Mitragyna speciosa)&lt;/i&gt; Dependence

McWhirter, Laura; Morris, S.

doi:10.1159/000320288

Cited by 85 publications

(48 citation statements)

References 14 publications

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“…This alkaloid is the major contributing factor for Kratom's analgesic properties, demonstrating opioid receptor affinity up to 17 times that of morphine [20][21][22]. It may also contribute to problematic Kratom use, which has been reported numerous times in the literature [10,[23][24][25][26]. 7-Hydroxymitragynine's role in Kratom abuse is supported by Matsumoto et al's findings (2005), which demonstrate development of tolerance, cross-tolerance to morphine, and physical dependence in 7-hydroxymitragynine treated mice [27].…”

Section: Introductionmentioning

confidence: 99%

Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine

et al. 2016

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Introduction Kratom (Mitragyna speciosa), a plant native to Southeast Asia, has been used for centuries for its stimulant and opium-like effects. Mitragynine and 7-hydroxymitragynine, exclusive to M. speciosa, are the alkaloids primary responsible for Kratom's biologic and psychoactive profile, and likely contribute to its problematic use. We purchased several commercially available Kratom analogs for analysis and through our results, present evidence of probable adulteration with the highly potent and addictive plant alkaloid, 7-hydroxymitragynine. Methods A simple and sensitive LC-MS/MS method was developed for simultaneous quantification of mitragynine and 7-hydroxymitragynine in methanol extract of marketed Kratom supplements. Results We found multiple commercial Kratom products to have concentrations of 7-hydroxymitragynine that are substantially higher than those found in raw M. speciosa leaves. Conclusions We have found multiple packaged commercial Kratom products likely to contain artificially elevated concentrations of 7-hydroxymitragynine, the alkaloid responsible for M. speciosa's concerning mechanistic and side effect profile. This study describes a unique form of product adulteration, which stresses the importance of increased dietary supplement oversight of Kratom-containing supplements.

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Section: Introductionmentioning

confidence: 99%

Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine

et al. 2016

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“…M. speciosa is also frequently used by drug addicts seeking for relief during opioid withdrawal stage [10]. While the use of M. speciosa is illegal in Thailand, Malaysia, South Korea and Australia, it is as source of unregulated ‘legal high’ in the UK and USA [11]. Among contributing factors are the lower cost of the plant material as compared to buprenorphine and the widespread availability of Kratom vendors [12].…”

Section: Introductionmentioning

confidence: 99%

Mitragynine Attenuates Withdrawal Syndrome in Morphine-Withdrawn Zebrafish

et al. 2011

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A major obstacle in treating drug addiction is the severity of opiate withdrawal syndrome, which can lead to unwanted relapse. Mitragynine is the major alkaloid compound found in leaves of Mitragyna speciosa, a plant widely used by opiate addicts to mitigate the harshness of drug withdrawal. A series of experiments was conducted to investigate the effect of mitragynine on anxiety behavior, cortisol level and expression of stress pathway related genes in zebrafish undergoing morphine withdrawal phase. Adult zebrafish were subjected to two weeks chronic morphine exposure at 1.5 mg/L, followed by withdrawal for 24 hours prior to tests. Using the novel tank diving tests, we first showed that morphine-withdrawn zebrafish display anxiety-related swimming behaviors such as decreased exploratory behavior and increased erratic movement. Morphine withdrawal also elevated whole-body cortisol levels, which confirms the phenotypic stress-like behaviors. Exposing morphine-withdrawn fish to mitragynine however attenuates majority of the stress-related swimming behaviors and concomitantly lower whole-body cortisol level. Using real-time PCR gene expression analysis, we also showed that mitragynine reduces the mRNA expression of corticotropin releasing factor receptors and prodynorphin in zebrafish brain during morphine withdrawal phase, revealing for the first time a possible link between mitragynine's ability to attenuate anxiety during opiate withdrawal with the stress-related corticotropin pathway.

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“…A withdrawal syndrome has also been described in chronic Kratom users reporting irritability, yawning, rhinorrhea, and diarrhea [138]. One contemporary case report describes a 44-year-old patient who manifested the following signs of withdrawal from Kratom: "anxiety, restlessness, tremor, sweating, and cravings for the substance" [142]. He also had a history of alcohol abuse and anxiety, and he was reportedly successfully treated for his withdrawal with a regimen of dihydrocodeine and lofexidine [142].…”

Section: Clinical Effects/toxicitymentioning

confidence: 99%

Here Today, Gone Tomorrow…and Back Again? A Review of Herbal Marijuana Alternatives (K2, Spice), Synthetic Cathinones (Bath Salts), Kratom, Salvia divinorum, Methoxetamine, and Piperazines

2012

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Despite their widespread Internet availability and use, many of the new drugs of abuse remain unfamiliar to health care providers. The herbal marijuana alternatives, like K2 or Spice, are a group of herbal blends that contain a mixture of plant matter in addition to chemical grade synthetic cannabinoids. The synthetic cathinones, commonly called "bath salts," have resulted in nationwide emergency department visits for severe agitation, sympathomimetic toxicity, and death. Kratom, a plant product derived from Mitragyna speciosa Korth, has opioid-like effects, and has been used for the treatment of chronic pain and amelioration of opioid-withdrawal symptoms. Salvia divinorum is a hallucinogen with unique pharmacology that has therapeutic potential but has been banned in many states due to concerns regarding its psychiatric effects. Methoxetamine has recently become available via the Internet and is marked as "legal ketamine." Moreover, the piperazine derivatives, a class of amphetamine-like compounds that includes BZP and TMFPP, are making a resurgence as "legal Ecstasy." These psychoactives are available via the Internet, frequently legal, and often perceived as safe by the public. Unfortunately, these drugs often have adverse effects, which range from minimal to life-threatening. Health care providers must be familiar with these important new classes of drugs. This paper discusses the background, pharmacology, clinical effects, detection, and management of synthetic cannabinoid, synthetic cathinone, methoxetamine, and piperazine exposures.

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A Case Report of Inpatient Detoxification after Kratom <i>(Mitragyna speciosa)</i> Dependence

Cited by 85 publications

References 14 publications

Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine

Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine

Mitragynine Attenuates Withdrawal Syndrome in Morphine-Withdrawn Zebrafish

Here Today, Gone Tomorrow…and Back Again? A Review of Herbal Marijuana Alternatives (K2, Spice), Synthetic Cathinones (Bath Salts), Kratom, Salvia divinorum, Methoxetamine, and Piperazines

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