UMEM Educational Pearls

Title: Kratom: is it a safe herbal alternative to opioids?

Keywords: kratom, adverse effects, poison center data (PubMed Search)

Posted: 3/14/2019 by Hong Kim, MD
Click here to contact Hong Kim, MD

Kratom (Mitragyna speciosa) has been used for centuries in Southeast Asia to manage pain and opium withdrawal. It is increasingly being used in the U.S. for similar purpose. The U.S. DEA lists Kratom as a “drug of concern”.

Effects of Kratom leaves

1 – 5 gm: mild stimulatory effects
5 – 15 gm: opioid-like effects
>15 gm: sedative effects

A study reviewed National Poison Data System (2011 to 2017) to evaluate the clinical effects/outcomes of Kratom exposure.

Finding: (N=1807; single-substance: 1174; multiple-substance: 633])

2/3 of all exposure occurred in 2016 – 2017 via oral route (83.0%)
88.9% were adults (> 20 years old)
86.1% of the exposures occurred in private residence
Fatality: 11 (2 deaths occurred after an isolated exposure to Kratom)

Common symptoms

Agitation: 22.9%
Tachycardia: 21.4%
Drowsiness/lethargy: 14.3%
Nausea/vomiting: 13.2% - 14.6%
Confusion: 10.6%
Hypertension: 10.1%
Seizure (single/multiple): 9.6%
Respiratory depression: 3.6%

Disposition

Admitted to a health care facility: 31.8% (n=498)
- Critical care unit: 14.0%
- Non-critical care: 13.1%
- Psychiatric facility: 4.7%

Bottom line:

Kratom use is associated with a wide spectrum of clinical signs/symptoms.
Death from isolated exposure to Kratom is rare.

References

Sara Post, Henry A. Spiller, Thitphalak Chounthirath & Gary A. Smith (2019): Kratom exposures reported to United States poison control centers: 2011–2017, Clinical Toxicology, DOI: 10.1080/15563650.2019.1569236