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THURSDAY, Feb. 21, 2019 (Pharmacist's Briefing) -- Calls to U.S. poison control centers related to the herbal drug kratom have skyrocketed, increasing more than 50-fold in a matter of six years, a new study shows.
Back in 2011, poison centers received about one call a month regarding someone who'd taken too much kratom, a plant that is purported to produce mild opioid-like effects.
These days, nearly two calls a day are received concerning kratom exposures, researchers report in the Feb. 21 issue of the journal Clinical Toxicology.
"We're now getting literally hundreds of cases a year versus 10 or 20," said researcher Henry Spiller, director of the Central Ohio Poison Center at Nationwide Children's Hospital in Columbus. He noted that kratom reports underwent a "relatively big spike" sometime between 2015 and 2016.
The researchers identified 11 deaths associated with kratom use, including two in which kratom was used by itself and nine where kratom was used with other drugs.
Unfortunately, kratom is being promoted as a safe alternative to opioid painkillers for people with chronic pain, Spiller said.
"Because it's a plant and it's natural, at this point it's unregulated," Spiller said. "A lot of people have been Google-searching it for use in chronic pain and other things, and we've started to see a really significantly increased use and, in many cases, abuse of it."
But taking too much kratom can cause some unintended health problems, including agitation, seizures, rapid heart rate and high blood pressure, Spiller said. In extreme cases, kratom overdose can put a person into a coma, stop their breathing or cause kidney failure.
"Just because it's natural doesn't mean it's harmless," Spiller said.
The U.S. Food and Drug Administration has issued a warning to consumers against using kratom, and the U.S. Drug Enforcement Agency has listed it as a "drug of concern." Kratom has not been approved for any medical use by the FDA.
For this study, researchers analyzed calls to U.S. Poison Control Centers between 2011 and 2017, finding more than 1,800 reports related to kratom use.
The annual number of calls increased dramatically, going from 13 calls in 2011 to 682 calls in 2017, researchers found.
About two of every three of these calls occurred recently, in either 2016 or 2017.
About a third of the calls resulted in a person needing hospitalization, and more than half resulted in serious medical outcomes, the researchers said.
"The belief that kratom is harmless because it is classified as an herbal supplement is directly challenged by the findings in this report, and policy efforts needs to address this knowledge gap," said Dr. Harshal Kirane, director of addiction services at Staten Island University Hospital.
Most dangerous kratom exposures occurred among males (71 percent), adults aged 20 and older (89 percent), in a home (86 percent) and involving intentional abuse or misuse (60 percent), findings show.
Although kratom appears confined to adult use for now, children and teenagers could be exposed to the herb if its popularity keeps increasing, said Kirane, who wasn't involved with the study.
"The dramatic increase in the rate of reported kratom exposures in recent years suggests a growing demand for this substance," Kirane said. "Increasing prevalence of kratom use may place young children in dangerous situations, particularly if regulatory measures are not in place to ensure childproof packaging and consistency in quality of kratom."
Idaho and Oregon are the states with the most reported kratom poisonings, while Delaware and Wisconsin had the lowest rates.
Using kratom with another substance significantly raised a person's chances of poisoning, nearly tripling the odds that they'd land in a hospital and more than doubling the risk of having a serious medical outcome.
Of the nine deaths involving a mixture of kratom with another substance, kratom was the first-ranked substance in seven, researchers said. The deaths involved kratom used alongside antihistamines, alcohol, benzodiazepines (such as Valium or Xanax), caffeine, fentanyl or cocaine.
"Though the drug claims to cure anxiety and depression, there are very few 'cure-alls' in the medical world, and anything that claims to alter an individual's mental state should be taken with the utmost seriousness," said Dr. Teresa Amato. She is chair of emergency medicine at Northwell Health's Long Island Jewish Forest Hills in New York City.
"We, as doctors, are unable to tell patients how this 'medication' might affect them and cannot in good conscience advise the use of this medicine without a thorough FDA investigation," said Amato, who had no part in the study.
People should be aware that kratom can interact with medications or illicit drugs in harmful ways, and could exacerbate existing health problems, Spiller said.
There's also a concern that because it's unregulated, people may be getting kratom that either varies in potency or is mixed with other substances, he added.
"I'd be cautious," Spiller said. "At this point, we're not sure of everything kratom does."
Pregnant women in particular should be careful with kratom.
The researchers identified seven babies who had been exposed to kratom in the womb, three of whom required admission to a critical care unit after birth.
Five of the babies experienced withdrawal symptoms from their mothers' kratom use, and four of those had been exposed to kratom alone.
"I would very much caution pregnant women," Spiller said. "You can have a real impact on your child."
The U.S. Food and Drug Administration has more about kratom.
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