Presence of kratom in opioid overdose deaths: findings from coroner postmortem toxicological report
Tyler Torrico,
Kajal Patel,
Nicole Nikolov
et al.
Abstract:BackgroundKratom (Mitragyna speciosa) use in the United States is becoming increasingly popular and its legal status varies widely from state to state. Multiple reports of adverse events associated with kratom use have ranged from liver injury, seizures, psychiatric disturbance, and rarely death.MethodsThis study investigated coroner autopsy reports from Kern County in California for the year 2020 which included qualitative data on substances from blood toxicological reports. Of the 214 opioid-associated accid… Show more
“…Torrico et al. incorrectly state that the lethal dose of mitragynine was 0.398 mg/L based on three cases ( 1 ). The mitragynine concentration quoted by Torrico et al.…”
“…A recent publication in Frontiers in Psychiatry, Addictive Disorders described the forensic analysis of four polydrug fatalities involving kratom in a California county ( 1 ). Kratom products derived from the botanical kratom ( Mitragyna speciosa Korth.)…”
Section: Introductionmentioning
confidence: 99%
“…Torrico and colleagues described the forensic analysis of four kratom-related fatal polydrug exposures in a California county ( 1 ). Their report, while correct in mentioning some of the context surrounding kratom consumption, incorrectly reported a blood concentration as a lethal dose, neither of which have been established, and lacked details critical to appropriately interpreting the causal contribution of kratom to toxicity or a fatal outcome.…”
“…Torrico et al. incorrectly state that the lethal dose of mitragynine was 0.398 mg/L based on three cases ( 1 ). The mitragynine concentration quoted by Torrico et al.…”
“…A recent publication in Frontiers in Psychiatry, Addictive Disorders described the forensic analysis of four polydrug fatalities involving kratom in a California county ( 1 ). Kratom products derived from the botanical kratom ( Mitragyna speciosa Korth.)…”
Section: Introductionmentioning
confidence: 99%
“…Torrico and colleagues described the forensic analysis of four kratom-related fatal polydrug exposures in a California county ( 1 ). Their report, while correct in mentioning some of the context surrounding kratom consumption, incorrectly reported a blood concentration as a lethal dose, neither of which have been established, and lacked details critical to appropriately interpreting the causal contribution of kratom to toxicity or a fatal outcome.…”
Purpose of Review
We apply the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria for substance use disorders (SUDs) to the herbal product kratom. Similarities and differences between kratom use disorder (KUD) and other SUDs are explored, along with assessment, diagnostic, and therapeutic recommendations for KUD.
Recent Findings
Literature reports of “kratom addiction” or KUD rarely specify the criteria by which patients were diagnosed. Individuals meeting DSM-5 KUD criteria typically do so via tolerance and withdrawal, using more than intended, and craving, not functional or psychosocial disruption, which occur rarely. Most clinicians who use medication to treat patients with isolated KUD select buprenorphine formulations, although there are no controlled studies showing that buprenorphine is safe or efficacious in this patient population.
Summary
Diagnosis and treatment decisions for KUD should be systematic. We propose an algorithm that takes into consideration whether KUD occurs with comorbid opioid use disorder.
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