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Abstract
Over the past decade, emerging drugs of abuse and synthetic derivatives of more traditional agents have flooded the market. While Europe was the first to experience a surge in the use of drugs such as synthetic cathinones and cannabinoids, poison centers throughout the United States have seen a dramatic rise in calls related to these new designer drugs of abuse. In the majority of cases, care is largely supportive but significant medical and traumatic complications may occur. Providers must be aware of the ever-changing trends in abuse, so that they may optimally care for poisoned patients.
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Affiliation(s)
- A Pourmand
- Department of Emergency Medicine, Medical Center, George Washington University, Washington, DC, USA
| | - P Armstrong
- Department of Emergency Medicine, Medical Center, George Washington University, Washington, DC, USA
| | - M Mazer-Amirshahi
- Department of Emergency Medicine, Medical Center, George Washington University, Washington, DC, USA
| | - H Shokoohi
- Department of Emergency Medicine, Medical Center, George Washington University, Washington, DC, USA
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102
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103
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Sakaran R, Othman F, Jantan I, Thent ZC, Das S. Effect of Subacute Dose of Mitragyna Speciosa Korth Crude Extract in Female Sprague Dawley Rats. ACTA ACUST UNITED AC 2014. [DOI: 10.12720/jomb.3.2.98-101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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104
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Trakulsrichai S, Tongpo A, Sriapha C, Wongvisawakorn S, Rittilert P, Kaojarern S, Wananukul W. Kratom Abuse in Ramathibodi Poison Center, Thailand: A Five-Year Experience. J Psychoactive Drugs 2013; 45:404-8. [DOI: 10.1080/02791072.2013.844532] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Satariya Trakulsrichai
- a aRamathibodi Poison Center, Ramathibodi Hospital, Faculty of Medicine , Mahidol University , Bangkok , Thailand
| | - Achara Tongpo
- a aRamathibodi Poison Center, Ramathibodi Hospital, Faculty of Medicine , Mahidol University , Bangkok , Thailand
| | - Charuwan Sriapha
- a aRamathibodi Poison Center, Ramathibodi Hospital, Faculty of Medicine , Mahidol University , Bangkok , Thailand
| | - Sunun Wongvisawakorn
- a aRamathibodi Poison Center, Ramathibodi Hospital, Faculty of Medicine , Mahidol University , Bangkok , Thailand
| | - Panee Rittilert
- a aRamathibodi Poison Center, Ramathibodi Hospital, Faculty of Medicine , Mahidol University , Bangkok , Thailand
| | - Sming Kaojarern
- a aRamathibodi Poison Center, Ramathibodi Hospital, Faculty of Medicine , Mahidol University , Bangkok , Thailand
| | - Winai Wananukul
- a aRamathibodi Poison Center, Ramathibodi Hospital, Faculty of Medicine , Mahidol University , Bangkok , Thailand
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105
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Kowalczuk AP, Łozak A, Zjawiony JK. Comprehensive methodology for identification of Kratom in police laboratories. Forensic Sci Int 2013; 233:238-43. [PMID: 24314525 DOI: 10.1016/j.forsciint.2013.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/11/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Abstract
Leaves of Mitragyna speciosa Korth (Rubiaceae), commonly known as Kratom, are a popular narcotic product among recreational users all over the world. This product is widely distributed on the Internet and via smart-shops and is often a subject of examination in police laboratories. A major psychoactive component of Kratom is mitragynine which occurs exclusively in this species. The variety of combinations among M. speciosa products, cases of plant or chemical composition adulteration, give rise to a need to develop an universal methodology for identification of both, plant material and its active metabolite, mitragynine. Herein we propose a comprehensive authentication procedure which involves the microscopic analysis of plant material and inexpensive mitragynine detection using thin layer chromatography (TLC) and high performance liquid chromatography (HPLC). The developed methodology was successfully applied for the plant material investigation. Five samples of dried, shredded or powdered Kratom leaves, purchased via the Internet and one sample delivered by police have been identified.
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Affiliation(s)
- Anna Paulina Kowalczuk
- National Institute of Medicines, Chelmska 30/34, 00-725 Warsaw, Poland; Department of Pharmacognosy and Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS 38677, USA.
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106
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Sabetghadam A, Ramanathan S, Sasidharan S, Mansor SM. Subchronic exposure to mitragynine, the principal alkaloid of Mitragyna speciosa, in rats. JOURNAL OF ETHNOPHARMACOLOGY 2013; 146:815-823. [PMID: 23422336 DOI: 10.1016/j.jep.2013.02.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 02/06/2013] [Accepted: 02/08/2013] [Indexed: 06/01/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Mitragyna speciosa is a popular medicinal plant in Southeast Asia which is commonly used for its morphine-like effects. Although the analgesic properties of Mitragyna speciosa and its ability to ameliorate withdrawal signs after abrupt cessation of opioid abuse are well known, information about the long-term safety of the plant's active compounds is lacking. In this work, we evaluated the effects of sub-chronic exposure to mitragynine, the principal alkaloid of Mitragyna speciosa leaves in rats. MATERIALS AND METHODS Male and female Sprague-Dawley rats received three doses of mitragynine (1, 10, 100mg/kg, p.o) for 28 days respectively. Food intake and relative body weight were measured during the experiment. After completion of drug treatment biochemical, hematological, and histological analyses were performed. RESULTS No mortality was observed in any of the treatment groups. The groups of rats treated with the lower and intermediate doses showed no toxic effects during the study. However, the relative body weight of the group of female rats treated with the 100mg/kg dose was decreased significantly. Food intake also tended to decrease in the same group. Only relative liver weight increased after treatment with the high dose of mitragynine (100mg/ kg) in both the male and female treatment groups of rats. Biochemical and hematological parameters were also altered especially in high dose treatment group which corresponds to the histopathological changes. CONCLUSIONS The study demonstrated that mitragynine is relatively safe at lower sub-chronic doses (1-10mg/kg) but exhibited toxicity at a highest dose (sub-chronic 28 days: 100mg/kg). This was confirmed by liver, kidney, and brain histopathological changes, as well as hematological and biochemical changes.
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Affiliation(s)
- Azadeh Sabetghadam
- Centre for Drug Research, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
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107
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Affiliation(s)
- Savithiri Ratnapalan
- Departments of Paediatrics and Dalla Lana School of Public Health, University of Toronto Divisions of Emergency Medicine, Clinical Pharmacology and Toxicology, The Hospital for Sick Children, 555 University Avenue, Toronto
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108
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Lim EL, Seah TC, Koe XF, Wahab HA, Adenan MI, Jamil MFA, Majid MIA, Tan ML. In vitro evaluation of cytochrome P450 induction and the inhibition potential of mitragynine, a stimulant alkaloid. Toxicol In Vitro 2012; 27:812-24. [PMID: 23274770 DOI: 10.1016/j.tiv.2012.12.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 12/04/2012] [Accepted: 12/13/2012] [Indexed: 12/17/2022]
Abstract
CYP450 enzymes are key determinants in drug toxicities, reduced pharmacological effect and adverse drug reactions. Mitragynine, an euphoric compound was evaluated for its effects on the expression of mRNAs encoding CYP1A2, CYP2D6 and CYP3A4 and protein expression and resultant enzymatic activity. The mRNA and protein expression of CYP450 isoforms were carried out using an optimized multiplex qRT-PCR assay and Western blot analysis. CYP1A2 and CYP3A4 enzyme activities were evaluated using P450-Glo™ assays. The effects of mitragynine on human CYP3A4 protein expression were determined using an optimized hCYP3A4-HepG2 cell-based assay. An in silico computational method to predict the binding conformation of mitragynine to the active site of the CYP3A4 enzyme was performed and further validated using in vitro CYP3A4 inhibition assays. Mitragynine was found to induce mRNA and protein expression of CYP1A2. For the highest concentration of 25 μM, induction of mRNA was approximately 70% that of the positive control and was consistent with the increased CYP1A2 enzymatic activity. Thus, mitragynine is a significant in vitro CYP1A2 inducer. However, it appeared to be a weak CYP3A4 inducer at the transcriptional level and a weak CYP3A4 enzyme inhibitor. It is therefore, unlikely to have any significant clinical effects on CYP3A4 activity.
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Affiliation(s)
- Ee Lin Lim
- Malaysian Institute of Pharmaceuticals & Nutraceuticals, Ministry of Science, Technology & Innovation (MOSTI), Pulau Pinang, Malaysia
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109
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Hassan Z, Muzaimi M, Navaratnam V, Yusoff NHM, Suhaimi FW, Vadivelu R, Vicknasingam BK, Amato D, von Hörsten S, Ismail NIW, Jayabalan N, Hazim AI, Mansor SM, Müller CP. From Kratom to mitragynine and its derivatives: physiological and behavioural effects related to use, abuse, and addiction. Neurosci Biobehav Rev 2012. [PMID: 23206666 DOI: 10.1016/j.neubiorev.2012.11.012] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Kratom (or Ketum) is a psychoactive plant preparation used in Southeast Asia. It is derived from the plant Mitragyna speciosa Korth. Kratom as well as its main alkaloid, mitragynine, currently spreads around the world. Thus, addiction potential and adverse health consequences are becoming an important issue for health authorities. Here we reviewed the available evidence and identified future research needs. It was found that mitragynine and M. speciosa preparations are systematically consumed with rather well defined instrumentalization goals, e.g. to enhance tolerance for hard work or as a substitute in the self-treatment of opiate addiction. There is also evidence from experimental animal models supporting analgesic, muscle relaxant, anti-inflammatory as well as strong anorectic effects. In humans, regular consumption may escalate, lead to tolerance and may yield aversive withdrawal effects. Mitragynine and its derivatives actions in the central nervous system involve μ-opioid receptors, neuronal Ca²⁺ channels and descending monoaminergic projections. Altogether, available data currently suggest both, a therapeutic as well as an abuse potential.
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Affiliation(s)
- Zurina Hassan
- Centre for Drug Research, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
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110
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Sabetghadam A, Navaratnam V, Mansor SM. Dose-Response Relationship, Acute Toxicity, and Therapeutic Index between the Alkaloid Extract ofMitragyna speciosaand Its Main Active Compound Mitragynine in Mice. Drug Dev Res 2012. [DOI: 10.1002/ddr.21052] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Azadeh Sabetghadam
- Centre for Drug Research; Universiti Sains Malaysia; P. Pinang; 11800; Malaysia
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111
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Neerman MF, Frost RE, Deking J. A drug fatality involving Kratom. J Forensic Sci 2012; 58 Suppl 1:S278-9. [PMID: 23082895 DOI: 10.1111/1556-4029.12009] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/20/2011] [Accepted: 01/07/2012] [Indexed: 12/17/2022]
Abstract
A 17-year-old white man who showed no obvious signs of trauma was found unresponsive in bed and was pronounced dead at the scene. The decedent had a documented history of heroin abuse and chronic back pain and reportedly self-medicated with Kratom (mitragynine). The autopsy was remarkable only for pulmonary congestion and edema and a distended bladder, both of which are consistent with, though not diagnostic of, opiate use. A laboratory work-up revealed therapeutic levels of over-the-counter cold medications and benzodiazepines. However, of interest was a level of mitragynine at 0.60 mg/L. Given the facts of the case, the Medical Examiner certified the cause of death as "possible Kratom toxicity" and the manner of death was classified as "accident."
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Affiliation(s)
- Michael F Neerman
- Bexar County Medical Examiner's Office, 7337 Louis Pasteur Drive, San Antonio, TX 78229, USA.
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Le D, Goggin MM, Janis GC. Analysis of Mitragynine and Metabolites in Human Urine for Detecting the Use of the Psychoactive Plant Kratom. J Anal Toxicol 2012; 36:616-25. [DOI: 10.1093/jat/bks073] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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113
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Logan BK, Reinhold LE, Xu A, Diamond FX. Identification of Synthetic Cannabinoids in Herbal Incense Blends in the United States. J Forensic Sci 2012; 57:1168-80. [DOI: 10.1111/j.1556-4029.2012.02207.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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114
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Rosenbaum CD, Carreiro SP, Babu KM. Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J Med Toxicol 2012; 8:15-32. [PMID: 22271566 DOI: 10.1007/s13181-011-0202-2] [Citation(s) in RCA: 236] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Despite their widespread Internet availability and use, many of the new drugs of abuse remain unfamiliar to health care providers. The herbal marijuana alternatives, like K2 or Spice, are a group of herbal blends that contain a mixture of plant matter in addition to chemical grade synthetic cannabinoids. The synthetic cathinones, commonly called "bath salts," have resulted in nationwide emergency department visits for severe agitation, sympathomimetic toxicity, and death. Kratom, a plant product derived from Mitragyna speciosa Korth, has opioid-like effects, and has been used for the treatment of chronic pain and amelioration of opioid-withdrawal symptoms. Salvia divinorum is a hallucinogen with unique pharmacology that has therapeutic potential but has been banned in many states due to concerns regarding its psychiatric effects. Methoxetamine has recently become available via the Internet and is marked as "legal ketamine." Moreover, the piperazine derivatives, a class of amphetamine-like compounds that includes BZP and TMFPP, are making a resurgence as "legal Ecstasy." These psychoactives are available via the Internet, frequently legal, and often perceived as safe by the public. Unfortunately, these drugs often have adverse effects, which range from minimal to life-threatening. Health care providers must be familiar with these important new classes of drugs. This paper discusses the background, pharmacology, clinical effects, detection, and management of synthetic cannabinoid, synthetic cathinone, methoxetamine, and piperazine exposures.
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Affiliation(s)
- Christopher D Rosenbaum
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts, Worcester, MA, USA
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116
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Ward J, Rosenbaum C, Hernon C, McCurdy CR, Boyer EW. Herbal medicines for the management of opioid addiction: safe and effective alternatives to conventional pharmacotherapy? CNS Drugs 2011; 25:999-1007. [PMID: 22133323 DOI: 10.2165/11596830-000000000-00000] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Striking increases in the abuse of opioids have expanded the need for pharmacotherapeutic interventions. The obstacles that confront effective treatment of opioid addiction - shortage of treatment professionals, stigma associated with treatment and the ability to maintain abstinence - have led to increased interest in alternative treatment strategies among both treatment providers and patients alike. Herbal products for opioid addiction and withdrawal, such as kratom and specific Chinese herbal medications such as WeiniCom, can complement existing treatments. Unfortunately, herbal treatments, while offering some advantages over existing evidence-based pharmacotherapies, have poorly described pharmacokinetics, a lack of supportive data derived from well controlled clinical trials, and severe toxicity, the cause for which remains poorly defined. Herbal products, therefore, require greater additional testing in rigorous clinical trials before they can expect widespread acceptance in the management of opioid addiction.
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Affiliation(s)
- Jeanine Ward
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Kapp FG, Maurer HH, Auwärter V, Winkelmann M, Hermanns-Clausen M. Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa). J Med Toxicol 2011; 7:227-31. [PMID: 21528385 DOI: 10.1007/s13181-011-0155-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Kratom (Mitragyna speciosa) is a common medical plant in Thailand and is known to contain mitragynine as the main alkaloid. According to an increase in published reports and calls at German poison control centers, it has been used more frequently as a drug of abuse in the western hemisphere during the last couple of years. Despite this increase, reports of severe toxicity are rare within the literature. CASE REPORT We describe a case of a young man who presented with jaundice and pruritus after intake of kratom for 2 weeks in the absence of any other causative agent. Alkaloids of M. speciosa were detected in the urine. CONCLUSION While M. speciosa is gaining in popularity among illicit drug users, its adverse effects remain poorly understood. This is the first published case of intrahepatic cholestasis after kratom abuse.
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Affiliation(s)
- Friedrich G Kapp
- Poisons Information Center VIZ-Freiburg, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany.
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