Introducing… Kratom

      A 1-day-old, term infant presented to the emergency department with signs of opioid withdrawal. The baby had breathing difficulties, irritability, jitteriness, muscle hypertonicity, and a high-pitched, inconsolable cry. The baby received intravenous glucose for hypoglycemia and was started on methadone for presumptive opioid withdrawal syndrome. However, the mother denied using any opioids. The only prescription medication she used was fluoxetine to treat her anxiety. During her pregnancy, the mother admitted to taking 2 herbal supplements to help her relax. The frequency and amount she usually took were undetermined. She reported taking them “occasionally.” The supplements were kava-kava and kratom. Research regarding these substances is limited, and no documented studies or anecdotal literature show kava-kava or fluoxetine causing opioid-like withdrawal. However, studies and case reports have been published regarding abuse, addiction, and opiate-like withdrawal symptoms associated with kratom.
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      References

        • Adkins JE
        • Boyer EW
        • McCurdy CR
        Mitragyna speciosa, a psychoactive tree from southeast Asia with opioid activity.
        Curr Top Med Chem. 2011; 11: 1165-1179
        • Truven Health Analytics
        Poisindex management.
        in: Plants—Mitragyna. Micromedex Healthcare Series. vol. 169. Truven Health Analytics, Ann Arbor, MI2016
        • Cinosi E
        • Martinotti G
        • Simonato P
        • et al.
        Following “the roots” of kratom (Mitragyna speciosa): the evolution of an enhancer from a traditional use to increase work and productivity in Southeast Asia to a recreational psychoactive drug in Western countries.
        Biomed Res Int. 2015; 2015: 1-11
        • Babu KM
        • McCurdy CR
        • Boyer EW
        Opioid receptors and legal highs: salvia divinorum and kratom.
        Clin Toxicol (Phila). 2008; 46: 146-152
        • Gruley B
        Is kratom a deadly drug or a life-saving medicine?.
        (Published December 12, 2016. Accessed April 3, 2017)
        • Bergen-Cico D
        • MacClurg K
        Kratom (Mitragyna speciosa) use, addiction potential, and legal status.
        in: Preely VR Neuropathology of Drug Addictions and Substance Misuse. vol. 3. Academic Press, Cambridge, MA2016: 903-911
        • Galbis-Reig D
        A case report of kratom addition and withdrawal.
        WMJ. 2016; 115: 49-52
        • Anway M
        • Law R
        • Schier J
        Notes from the field. Kratom (Mitragyna speciosa) exposure reported to poison centers—United States, 2010-2015.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 748-749
        • Drug Enforcement Administration
        DEA announces intent to schedule kratom.
        (Published August 30, 2016. Accessed April 3, 2017)

      Biography

      Charisse Pizarro-Osilla is Clinical Nurse Manager, Oregon Poison Center, Oregon Health and Science University, Portland, OR.

      Linked Article

      • Pizarro-Osilla JEN Article
        Journal of Emergency NursingVol. 43Issue 6
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          We wanted to let you know how much we appreciated the article about kratom by Charisse Pizarro-Osilla, MS, RN, CSPI1. Our emergency department reviewed the article in our weekly education, and a few days later a patient checked into triage stating that he had taken kratom for anxiety. The triage nurse and primary nurse remembered the article and were able to provide patient and family education based on what they had read.
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