The plant pictured is used as a tea, powder, or capsule by individuals looking to self-treat pain or opioid use disorder. Patients may develop nausea, vomiting, hallucinations, or other serious clinical effects after ingestion. What compound is contained in this plant?
3 – Mitragynine from Mitragyna speciosa also known as Kratom
What is Kratom? [1-6]
Kratom is an herbal product that derives from the tree Mitragyna speciosa, native to Southeast Asia, where it has been historically used as a stimulant.
Recently it has grown in popularity in western countries for its opioid activity, primarily used to self-treat opioid withdrawal and chronic pain.
It is sold in several forms including leaves, powder, capsules, gum, and extract.
The active compound, mitragynine, may cause nausea, vomiting, hallucinations, and opioid-like Deaths have been reported.
There are currently no FDA-approved uses for kratom and its legal status is evolving, most recently classified by the DEA as a Drug and Chemical of Concern. The FDA continues to warn consumers not to use any products labeled as containing the botanical substance kratom or its psychoactive compounds, mitragynine, and 7-hydroxymitragynine.
What is the clinical presentation of kratom toxicity? [1,3,5,7]
Kratom contains over 40 alkaloids, including mitragynine. Mitragynine is primarily a mu-opioid receptor agonist but also has activity at postsynaptic α-2, serotonin, dopamine, adenosine, and additional opioid receptors.
Kratom’s neuropsychiatric effects occur rapidly after ingestion and may last 4-6 hours after the exposure.
At lower ingestions (approximately 2-6 grams) kratom acts as a stimulant, while larger ingestions predominantly result in sedation and other opioid effects.
The dose-dependent effects of kratom are thought to be due to the dual binding of α adrenergic receptors leading to stimulation and μ opioid receptors causing sedation.
Gastrointestinal symptoms including nausea, vomiting, and constipation
Cardiovascular symptoms such as tachycardia and hypertension
Neurologic symptoms including seizures, hallucinations, agitation, psychosis, and coma
Respiratory depression can occur
Substance use disorder and withdrawal are reported with symptoms similar to other opioids.
How do you manage kratom toxicity? [1, 3]
Minor symptoms generally require only supportive care
Naloxone can reverse opioid effects
Benzodiazepines can be used to treat patients with seizures, tachycardia, hypertension, and agitation.
Withdrawal and substance use disorder may be managed similarly to other opioids.
Kratom use is increasingly popular in the United States, often for self-treatment of chronic pain or opioid use disorder.
Kratom acts on many different receptors, including the μ, κ, and δ opioid receptors, which contributes to potential withdrawal symptoms and substance use disorders
Toxicity can lead to life-threatening symptoms such as respiratory depression, seizure, and coma
Withdrawal presents similarly to opioid withdrawal and should be managed similarly
This post has been peer-reviewed on behalf of ACMT by William Eggleston, Bryan Judge, and Louise Kao