A Drug Fatality Involving Kratom

Abstract

A 17-year-old white man who showed no obvious signs of trauma was found unresponsive in bed and was pronounced dead at the scene. The decedent had a documented history of heroin abuse and chronic back pain and reportedly self-medicated with Kratom (mitragynine). The autopsy was remarkable only for pulmonary congestion and edema and a distended bladder, both of which are consistent with, though not diagnostic of, opiate use. A laboratory work-up revealed therapeutic levels of over-the-counter cold medications and benzodiazepines. However, of interest was a level of mitragynine at 0.60 mg/L. Given the facts of the case, the Medical Examiner certified the cause of death as "possible Kratom toxicity" and the manner of death was classified as "accident."

Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine

“…Infrequent findings associated with chronic Kratom use include seizure or coma [10,24,47,48], acute respiratory distress syndrome [49], hypothyroidism [50], intrahepatic cholestasis or toxic hepatitis [38,48,51], cardiotoxicity or dysrhythmia [52], and hypertension or nephrotoxicity [38]. Fatalities have been reported in the setting of therapeutic or supratherapeutic levels of coingestants such as sympathomimetics [53,54], benzodiazepines and over the counter cold medications [55], antidepressants [56], muscle relaxers, and opioids [57,58].…”

Notes from the Field: Kratom (Mitragyna speciosa) Exposures Reported to Poison Centers — United States, 2010–2015

“…Kratom (Mitragyna speciosa) is a plant consumed throughout the world for its stimulant effects and as an opioid substitute (1). It is typically brewed into a tea, chewed, smoked, or ingested in capsules (2).…”

Panorama actual en el uso de drogas emergentes

“…En este sentido se explica que, desde 2007 que se publicó el primer caso de intoxicación clínica por piperazinas en Reino Unido (Wood et al, 2007), los casos vayan apareciendo en los registros de literatura médica cada vez con más frecuencia. De hecho, se han notificado en la presente década casos de muerte relacionadas con el consumo de nuevas drogas, como el 5-IT, (Seetohul, Maskell, De Paoli y Pounder, 2012), la metoxetamina, (Wikström et al, 2013), el kratom (Neerman et al, 2013) o el bromoDragonFLY, (Corazza et al, 2011), así como datos clínicos, diagnósticos y epidemiológicos de diferentes sustancias emergentes, tanto naturales con usos novedosos como sintéticas (Gaire y Subedi, 2013;Prosser y Nelson, 2012).…”

“…Así, hemos podido ver la asociación de los cannabinoides sintéticos con síntomas psicóticos mantenidos (Durand et al, 2013;Gunderson, Haughey, Ait-Daoud, Joshi y Hart, 2012; Van der Veer y Friday, 2011), la relación del kratom con un trastorno de dependencia similar al que producen los opiáceos (Boyer et al, 2007;Neerman et al, 2013) En conclusión, existen nuevos retos que abordar a la hora de pensar en el consumo de drogas y sus consecuencias. Formas hasta ahora desconocidas en el acceso, la venta y la distribución de tóxicos ponen en cuestión los métodos de vigilancia y prevención actuales.…”