- 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
- 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
- Bath salts
- Gamma hydroxybutyrate (GHB)
- Inhalant abuse
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
- Chloral hydrate
- Body packing
- Clinical diagnosis
- Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis
- Consider EKG
- Some patients may present with tachycardia and there is theoretical possibility QT prolongation
- Management should be tailored to primary symptoms
- Discharge unless presenting with severe/intractable symptoms
- 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.