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The FDA has reported a spike in kratom overdoses. Here are the warning signs.
The use of kratom has exploded in recent years. So, have overdoses.
In the United States, calls from poison control centers against drugs have increased dramatically. About 32% of these cases were admitted to the hospital, more than half of which resulted in serious medical consequences, including 11 deaths.
According to a new study published in the journal Clinical Toxicology, between 2011 and 2017, 1,807 kratom exposures were reported to poison control centers. Two-thirds occurred between 2016 and 2017 alone.
In 2011, only 13 exposures were reported, compared to 682 in 2017, from about one call per month to two calls per day.
In total, an increase of more than 50 times.
"It has become more popular, I guess you would say. When we started, there were dozens of cases and now there are hundreds of them a year, "said Rick Spiller, MS, DABAT, FAACT, co-author of the research and director of the center for combating cancer. Poison in central Ohio at Nationwide Children's Hospital.
Kratom (Mitragyna speciosa) is a Southeast Asian tree. The leaves of the plant consumed raw, in capsules or tea produce stimulating effects light and similar to those of opioids. The plant has traditionally been used for centuries as an badgesic and as a substance that can be misused in places such as Thailand and Myanmar.
Experts have described it as an "atypical opioid" because of the pathways by which it interacts with the brain.
"It's a more complex substance. It's not a unique mechanism, "said Spiller.
Due to its complexity, symptoms of overdose may be more difficult to diagnose, especially compared to traditional opioids. Kratom affects the μ receiver [mu-receptor], like other opiates, but also affects the reuptake inhibition of noradrenaline and serotonin.
"Kratom is a tough toxin for many reasons. First, the doses are not well defined because it is a plant product. Secondly, the toxicity can be manifested in different ways and in very different times, depending on the patient, what else he can take, or his experience / opioid tolerance. There are a lot of variables, "said Dr. Rais Vohra, medical director of the Fresno / Madera division of California's poison control system.
An overdose of opioids usually involves shallow or depressed breathing, slow or weak pulse, and loss of consciousness. An overdose of kratom may involve some of these symptoms, but it is often accompanied by others that are rarely badociated with opioids.
"We clearly saw a respiratory depression. We saw coma. That's what you expect from this μ receptor, from this opioid receptor, but …[we saw] things like convulsions, agitation, tachycardia, hypertension. None of this has anything to do with the μ receptor, but with the inhibition of noradrenaline and serotonin reuptake. "
The study found that the most common effects of the drug also included nausea, vomiting, drowsiness and confusion.
The treatment of these very varied symptoms can not be done with any type of medication. While an overdose of opioids is usually treated with a drug like naloxone (Narcan), often called an "overdose" drug, symptoms such as seizures and agitation are treated with benzodiazepines, a sedative.
"We treat what's coming. Again, because there's not a lot of data before that, you'd go in and say, oh, it's an opiate, and the person takes you from there, and all those who know nothing about opiates know that they do not know it. seize it from. That's not what opiates do, "said Spiller.
The reason of increase in use of kratom and overdose is not clear either. The growing popularity of the drug is often seen as another facet of the ongoing opioid epidemic in the United States. Anecdotally, users report that the drug can be used in the context of maintaining opioid withdrawal, stopping drug use or at least transitioning from painkillers and other misused drugs.
Spiller and his colleagues fear, however, that the reputation of this drug as a natural herbal remedy is misleading.
"It's not trivial because it's a natural plant. There is a real concern about the need for caution, "said Spiller.
This point is reinforced in the study by the fact that kratom begins to appear in infants.
The authors report seven cases of newborns exposed to kratom, all of which occurred during the most recent period, 2016-2017. Five of these cases also had withdrawal symptoms.
This means that pregnant women can pbad the drug across the placenta to their unborn baby.
"We do not know why the mother used it. We do not know if it is for pain relief, discomfort, or opioid cessation, we simply have newborns with neonatal withdrawal symptoms. It's something we want to publicize, "said Spiller.
Kratom is legal throughout the United States and can be purchased on the Internet. The Drug Enforcement Agency (DEA) and the Food and Drug Administration (FDA) have considered a potential action against kratom, but none of them has yet acted. At present, the DEA considers that it is a "drug of concern" and has no medical use approved by the FDA.
"It's really something to watch for," Vohra said.
Despite the increase in overdoses and calls to poison control centers, deaths and hospitalizations related to the use of kratom remain relatively few in number.
Spiller especially wants the public to receive more information about kratom, than it is from those who regularly use it, from doctors or federal agencies.
"Right now, we're seeing hundreds of people in the ER, but it's across the United States. If it starts to turn into thousands, I think action will be taken, "he said.
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