FEATURE
KRATOM PART II:
Updates for the ED Provider on a Substance Skyrocketing in Use By Nicholas Titelbaum, MD, PGY-2
By Vir Singh, MD, MBS, PGY-3
UCF/HCA Emergency Medicine Residency at Ocala
UCF/HCA Emergency Medicine Residency at Ocala
A patient presents to your ED with a chief complaint of non-stop vomiting over the last day. She says she was sore from working in the yard all day and tried a pain reliever her relative swears by. Is this liver failure from acetaminophen overdose? Cyclic vomiting syndrome from marijuana? The substance is revealed to be… kratom. Kratom is an emerging substance that patients are turning to for relief from opioid addiction. It is 44
becoming apparent that emergency physicians need to learn more about this substance before it shows up in your ED, so we are continuing the kratom discussion from the last issue of EMpulse. Kratom refers to derivatives of Mitragyna speciosa, a tree native to southeast Asia. Leaves of this tree can be chewed or prepared in several ways for ingestion: ground into an extract, dried and crushed into powder, or drank as tea.1 Its use traces back to EMpulse Summer 2020
the 1800s by indigenous peoples in Malaysia and Thailand as an opium substitute.2 Since the 1960s, biochemical studies have isolated more than 25 alkaloid compounds from Mitragyna leaves, the major component (66%) being mitragynine, with paynantheine (9%) and speciogynine (7%) also being significant components.2 Mitragynine has μ-, κ-, and δ-opioid receptor agonism.3 Therefore, kratom is considered to be within the class of opioid substances. Uniquely, kratom
