Kratom toxicity

Background

Kratom flowers and foliage.

Typical powdered Kratom for commercial use.

• Derived from Mitragyna speciosa, a plant native to Southeast Asia
• Contains numerous chemicals acting on mu opioid, adrenergic, serotonin, and GABA receptors
• Increasingly popular in US for attempted self-treatment of pain, opioid addiction/withdrawal, and depression
  • Patients often perceive incorrectly as a "safe" alternative to opioids

Clinical Features

• Effects are dose dependent and may mimic those of both opioid and stimulant toxicity
• Stimulant effects typically predominate at low doses (<5 g) with sedating effects more prevalent at higher doses

Differential Diagnosis

• Opioid overdose
• Opioid withdrawal
• Sympathomimetic overdose
• Anticholinergic toxicity

Evaluation

• Clinical diagnosis
• Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis

Management

• Management should be tailored to primary symptoms
  • Naloxone for respiratory depression
  • Benzodiazepines for hyperarousal, tachycardia, hypertension, and seizures
  • NSAIDs, antiemetics, fluids, etc. for opioid withdrawal symptoms
    • Medication-assisted treatment with buprenorphine or methadone

Disposition

• Discharge unless presenting with severe/intractable symptoms

See Also

• Opioids

References

• Swogger M, Walsh D. Kratom use and mental health: A systematic review. Drug and Alcohol Dependence. 2017;183:134-140.
• Vestal C. Kratom Concerns. State Legislatures Magazine. 2018; 44(4)
• Killelea E. Kratom: Why Did the FDA Declare the Herbal Supplement an Opiate? Rolling Stone Magazine. March 2018.
• Gottlieb, S. Statement from FDA Commissioner Scott Gottlieb, M.D., on new warning letters FDA is issuing to companies marketing kratom with unproven medical claims; and the agency’s ongoing concerns about kratom [press release]. Sep 11, 2018.