Kratom and neonatal abstinence syndrome.
Published in Pediatrics and Child Health , a Canadian Pediatrics Journal is this case report of a newborn requiring 2 months of morphine withdrawal. I have not heard of kratom from the tropical Mitragena speciosa tree, mitragynine the likely active ingredient. In low doseage it produces a stimulant effect and at higher doses sedation and nausea. Respiratory depression is not a feature.
It is a regulated Herbal Product in the USA, but illegal to sell in Canada. There is easy internet availability however.
The combination of Kratom and analgesics like tramadol is known as Krypton, a party drug, associated with several deaths. Conventional urine testing does not pick it up.
Is kraton widely known?
It is well-known on internet forums and for users of novel psychoactive substances. I've had several patients who use it. There are some good review articles on it too, but the data informing the literature is relatively poor quality. Also, even though it is illegal to sell in Canada as a food product, it is still sold online for dubious reasons (e.g. incense, seed propagation) and warnings not to eat it ("not for human consumption").
Mild opiate agonism is the intended effect from use, but intense nausea limits dosing to some extent. Despite minimal evidence, it is often promoted as a way of getting off of opioids (i.e. as harm reductions) similar to other natural products like ibogaine. Novel psychoactive substances are generally not going to show up on your urine drug screens and can have unpredictable side effects.
As Jonathon Gregory says "Mild opiate agonism is the intended effect from use" and it is often promoted as a way of getting off of opioids (i.e. as harm reductions).
I have two patients who tried it when they ran out of Opioid. (They made it into a cold drink) . It is very easy obtainable in Canada (online) and yes it is sold for "seeding ". However the websites that sell it are very sophisticated and extol it's virtues but don't say exactly how much of the chemical is in it. This was my concern with one patient (who I eventually got on 1mg of Bup/0.125 of Nlx instead.
My concern was that he was going by some recipes he found (but the dose and the way to make it are not standardized .
5 to 15 g of raw leaves is high dose and the incidence of death is rising as more people try these doses (One of the most recent "headliner" was a young Pennsylvania Police Sergeant. (I used to work there so follow their Opioid and Opioid Like Death Rates -morbid I know but keeps me informed
Mitragynine (Kratom) is easily confused with 7-Hydroxymitragynine
7-Hydroxymitragynine is an agonist at the μ-opioid receptor[3] with a potency, calculated using pD (2) values, that is 30-fold higher than that of mitragynine and 17-fold higher than that of morphine, respectively.
This similarity between the two was enough to make my patient think twice and start on Bup/Nlx (He had accepted already he had Opioid Use Disorder and we worked through the stages of change ) He still craves the Kratom but not as severely as the Oxycodone .
Hope this helps Stan.
Regards
Patrick