Nicholas Nacca1,2, Rachel F Schult3,4,5, Lingyun Li6, David C Spink6,7, Gary Ginsberg8, Kristen Navarette8,9, Jeanna Marraffa4,10. 1. Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655, Rochester, NY, 14642, USA. Nicholas_Nacca@urmc.rochester.edu. 2. Upstate New York Poison Center, Syracuse, NY, USA. Nicholas_Nacca@urmc.rochester.edu. 3. Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655, Rochester, NY, 14642, USA. 4. Upstate New York Poison Center, Syracuse, NY, USA. 5. Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA. 6. New York State Department of Health, Wadsworth Center, Albany, NY, USA. 7. State University of New York, University at Albany, School of Public Health, Albany, NY, USA. 8. Center for Environmental Health, New York State Department of Health, Albany, NY, USA. 9. Albany Medical Center Department of Pediatrics, Albany, NY, USA. 10. Department of Emergency Medicine, Upstate Medical University, Syracuse, NY, USA.
Abstract
INTRODUCTION: Kratom is derived from the plant Mitragyna speciosa which is indigenous to Southeast Asia. Active compounds, mitragynine and 7-hydroxymitragynine, cause mild stimulant and opioid agonist effects. Although reported to have potential benefits in the treatment of opioid use disorder, efficacy remains uncertain while adverse health effects have been reported. A compounding concern is the presence of adulterants given that this is an unregulated product. CASE DETAILS: A 54-year-old fitness instructor who used an online purchased kratom product regularly for one year developed stimulatory effects and suffered a large hemorrhagic stroke with a close temporal relationship to ingestion of a different kratom product from the one he regularly used. A collaborative investigation by medical toxicologists, a regional poison center, the state public health laboratory, and public health officials determined that his new kratom product was adulterated with phenylethylamine (PEA). DISCUSSION: We report a case of PEA adulterated kratom purchased and used with resultant adverse effects. PEA is structurally similar to amphetamine and is known to produce sympathomimetic effects. It is possible the stimulatory effect of PEA resulted in a marked and transient increase in blood pressure resulting in hemorrhagic stroke. CONCLUSION: Medical toxicologists should form working relationships with laboratories and public health officials to aid in early identification of adulterated products that carry risk to the general population.
INTRODUCTION:Kratom is derived from the plant Mitragyna speciosa which is indigenous to Southeast Asia. Active compounds, mitragynine and 7-hydroxymitragynine, cause mild stimulant and opioid agonist effects. Although reported to have potential benefits in the treatment of opioid use disorder, efficacy remains uncertain while adverse health effects have been reported. A compounding concern is the presence of adulterants given that this is an unregulated product. CASE DETAILS: A 54-year-old fitness instructor who used an online purchased kratom product regularly for one year developed stimulatory effects and suffered a large hemorrhagic stroke with a close temporal relationship to ingestion of a different kratom product from the one he regularly used. A collaborative investigation by medical toxicologists, a regional poison center, the state public health laboratory, and public health officials determined that his new kratom product was adulterated with phenylethylamine (PEA). DISCUSSION: We report a case of PEA adulterated kratom purchased and used with resultant adverse effects. PEA is structurally similar to amphetamine and is known to produce sympathomimetic effects. It is possible the stimulatory effect of PEA resulted in a marked and transient increase in blood pressure resulting in hemorrhagic stroke. CONCLUSION: Medical toxicologists should form working relationships with laboratories and public health officials to aid in early identification of adulterated products that carry risk to the general population.
Authors: C H W Wijers; M C Visser; R T H van Litsenburg; R J M Niesink; R B Willemse; Esther A Croes Journal: J Neurol Date: 2018-05-08 Impact factor: 4.849
Authors: Pieter A Cohen; Rickard Zeijlon; Rachel Nardin; Peter H J Keizers; Bastiaan Venhuis Journal: Ann Intern Med Date: 2015-06-16 Impact factor: 25.391
Authors: Catherine W Striley; Carolin C Hoeflich; Andrew T Viegas; Lindsey A Berkowitz; Emily G Matthews; Leyla P Akin; Chidinma Iheanyi-Okeahialam; Urmeen Mansoor; Christopher R McCurdy Journal: Subst Abuse Date: 2022-05-20
Authors: Alessandro E Vento; Simone de Persis; Sergio De Filippis; Fabrizio Schifano; Flavia Napoletano; John M Corkery; Georgios D Kotzalidis Journal: Front Psychiatry Date: 2021-03-31 Impact factor: 4.157