Facts on Overdosing on Kratom: A Tropical Psychotropic Drug

Kratom (Mitragyna speciosa) is an evergreen tree in the coffee family. Some people use it for its stimulant, sedative, or pain-relieving effects. However, it can lead to an overdose, physical dependence, and unpleasant side effects.

Treatment

Poison control centers statewide are seeing more people suffer from overdose-like symptoms of popular drug products, and federal health officials are pressing for restrictions on how they are made. Federal health regulators recently announced plans to control a highly potent kratom byproduct called 7-hydroxymitragynine (7-OH). The FDA clarified, “We’re not targeting the kratom leaf or ground-up kratom,” but rather “the concentrated synthetic byproduct that is an opioid”1.

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• Her score on the Glasgow Coma Scale was 3, and point-of-care glucose was 203 milligrams/deciliter.
• The signs may not be as recognizable or obvious as alcohol or opioid overdose signs, but it is a dangerous situation.
• Medical and regulatory experts agree that kratom acts like an opioid, carrying real risks of addiction, withdrawal, and even fatal overdose.
• Shulman said the poison center has had several calls about 7-OH since August.
• However, to our surprise, the patient’s urine toxicology was negative for opioid or fentanyl use.
• The average amount of the active compound (mitragynine) in one serving of “kratom juice” is 79 milligrams, and the average daily intake recommendation from brands is 276.5 milligrams 2.

Though kratom is seen as a safe herbal remedy, it has risks and side effects. In the US, kratom is available on the market as a natural remedy and recreational drug. It’s not a controlled substance listed in the Controlled Substances Act, but its safety and risks are under review.

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The Drug Enforcement Administration lists kratom as a Drug and Chemical of Concern 6. There is limited literature on kratom toxicity and its clinical presentation, and thus, it is easily missed in the emergency department (ED) differential diagnosis. Due to its opioid-like properties, patients who overdose on kratom do respond to naloxone administration 7. Because reports of kratom overdose are infrequent (682 reports in 2017), proven treatments for kratom overdose have yet to be determined. Most reports of kratom overdose involve other substances, so signs and symptoms of kratom overdose can vary and are dependent on the types and amounts of drugs used.

Other health risks and side effects

Unlike opioid toxicity, kratom toxicity presents a continued risk for rebound symptoms and hypoxia hours after the initial ingestion. For many other patients, misdiagnosis of kratom overdose as an opioid overdose could result in failure to recognize the risk of delayed rebound symptoms and hypoxia. While can you overdose on kratom some adverse effects of this herb have been reported, the data is limited to case reports. Adverse effects include respiratory depression, seizures, and opioid-like withdrawal symptoms when a user stops kratom use abruptly 5.

Addiction treatment is individualized, but inpatient and outpatient treatment with behavioral therapies and traditional therapies like individual and group counseling can be effective. Like any form of addiction, Kratom addiction requires medical assistance. In most cases, you’ll need a medical detox to flush the drug out of your system with minimal withdrawal symptoms and complications.

The effects of the substance can vary based on dose, the potency of the active ingredients, and whether the source is contaminated. There are individual differences in how the drug is metabolized as well. Kratom is an herb tree known to have opium-like medicinal properties, and it’s possible to overdose it. Its leaves have been used as an herbal supplement to treat health issues like cough, muscle pain, intestinal problems, and diarrhea. The patient was placed back on supplemental oxygen at 3 liters per minute via nasal cannula.

“7-OH is more potent than products that contain mitragynine in general, so it makes sense as we’re seeing more of these products in the area; we’re getting more calls about it,” Shulman said. PMP is a regional news service that focuses on government and enterprise reporting in southwestern Pennsylvania. Some states, including Arizona, Minnesota and Texas, prohibit the sale of products with 7-OH to minors. “Consumers who use 7-OH products are exposing themselves to products that have not been proven safe or effective for any use,” the FDA stated. The department urges residents to look out for products with labels such as “plant alkaloids” or simply “alkaloid,” as they may contain 7-OH. Recovery is an ongoing process that helps people maintain their sobriety.

We understand that there are no shortcuts on the path to recovery, and our compassionate team offers unwavering support and intensive care throughout your healing journey. Products are often sold without dosing instructions, ingredient lists, or accurate labeling, leaving consumers to guess at potency and safety. Vendors frequently advertise their kratom as “powerful,” “most potent,” or “long-lasting,” yet independent testing has shown that many of these products fail to disclose their true strength.

If dependence has occurred, medical detox can help you overcome withdrawal. A medical team monitors your health 24/7 and provides medications or support as needed to reduce the severity of symptoms and prevent complications. In cases of leaving AMA with full decision-making capacity, the patient and companions should be given naloxone and instructions upon signing out of the department. Laboratory work including complete blood count (CBC), comprehensive metabolic panel (CMP), and venous blood gas (VBG) were ordered, and the results are shown in Table 1. Additionally, creatine kinase, magnesium, acetaminophen level, salicylate level, ethanol level, and urine toxicology were negative or normal.

The Orange County Board of Supervisors also recently passed a ban on the sale or possession of synthetic kratom products. Similar restrictions are in place in Newport Beach, San Diego and Oceanside. Orange County is the latest community to ban synthetic kratom products that are not yet federally regulated. Rehabilitation programs help to address the underlying causes of addiction and teach people how to live drug-free. There are behavioral and cognitive therapies, as well as other types, that can help in addiction treatment.

• Her urine toxicology was noted to be negative for opioids or any other substance use.
• It’s important to get help as early as possible to avoid adverse effects, including possible fatal overdoses.
• She was immediately placed on a bag valve mask with supplemental oxygen.

Alcohol Rehab

The FDA recommended classifying 7-OH as an illicit substance due to its high potency and addictive potential, with FDA Commissioner Marty Makary stating, “7-OH is an opioid that can be more potent than morphine”1. At the more severe end, individuals have been found extremely drowsy, unresponsive or in states resembling opioid overdose3. These effects highlight the unpredictable nature of kratom, especially when consumed in high doses or in concentrated forms. Kratom products are sold in powders, gummies and energy-style drinks, all derived from a plant native to Southeast Asia. They are widely available online, in smoke shops and even at gas stations, often promoted as natural remedies for fatigue, pain relief and opioid withdrawal.

Described as “legal morphine,” 7-OH is much more addictive and problematic than traditional kratom. Many consumers are unaware of the difference between kratom and its concentrated byproducts, increasing the risk of unintended overdoses15. It is possible to overdose on kratom, and in some cases, it can be fatal. A Tampa Bay Times investigation revealed that more than 580 people died from kratom-involved overdoses in Florida over the last decade. While most of these deaths involved other substances, 46 were attributed to kratom alone5. At low doses, kratom produces stimulant-like effects such as high energy, alertness, talkativeness, and sociability.

Generally, if there are no signs of opioid withdrawal, there is no current maximum safe dose of naloxone. However, if the patient does not clinically improve after 5-10 milligrams, the diagnosis of opioid withdrawal should be reconsidered 7. The Pennsylvania Department of Health says poison control centers continue to see a rise in calls involving kratom and its derivative, 7-hydroxymitragynine (7-OH). From 2022 through June, Allegheny County reported the most cases with 18. The department issued a health advisory this month warning that reports of exposure remain elevated; it also issued an advisory in August. Due to the patient’s responsiveness to naloxone, high on our differential was opioid use disorder with overdose.