IN BRIEF

What Pediatric Care Providers Need to Know About Kratom

April 4, 2019
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The herbal supplement is increasingly the source of toxic exposures and health care facility admissions.

In recent years, kratom has become popular as a treatment for chronic or acute pain as well as mood conditions such as depression and anxiety. It is also sometimes used to help with opioid withdrawal. While there is a perception that kratom is safe because it is classified as an herbal supplement, a variety of serious medical outcomes including 11 deaths have occurred following kratom use.

A new study conducted by the Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children’s Hospital found that there were more than 1,800 calls to U.S. Poison Control Centers regarding exposures to kratom from January 2011 through December 2017. The annual number of calls increased dramatically, going from 13 calls in 2011 to 682 calls in 2017. That is the equivalent of going from about one call a month to two calls a day. Almost two-thirds (65 percent) of these exposures occurred from 2016 through 2017 – the two most recent years of the study.

The study, published online in the journal Clinical Toxicology, found that most exposures occurred among males (71 percent), age 20 years and older (89 percent), at a residence (86 percent), and were intentional abuse or misuse (60 percent), suspected suicide (9 percent) or adverse reaction (8 percent). Exposure rates were highest in Idaho and Oregon and lowest in Delaware and Wisconsin.

Overall, nearly one third (32 percent) of the calls resulted in admission to a health care facility and more than half (52 percent) resulted in serious medical outcomes, especially among teenagers and adults. Taking kratom with another substance increased the odds of admission to a health care facility (OR 2.80) and of having a serious medical outcome (OR 2.25). The medical effects noted in this study ranged from tachycardia, agitation/irritability and hypertension to seizures, coma, increased bilirubin, renal failure and death.

Among the 48 kratom exposures that involved children age 12 years and younger, 69 percent were children younger than two years, including seven newborns, five of whom were experiencing withdrawal.

“As physicians, we need to educate pregnant women on the risks of kratom use during pregnancy and while breastfeeding. Kratom can cause neonatal abstinence syndrome, also known as NAS, in which newborns suffer withdrawal from drugs they were exposed to in utero,” says Henry Spiller, MS, DABAT, co-author of the study and director of the Central Ohio Poison Center at Nationwide Children’s Hospital. “Individuals who choose to use kratom need to be aware of the potential risks. Just because it is currently classified as an herbal supplement does not mean it is regulated or that it is safe.”

The study authors suggest that primary care providers ask patients about all medications they’re taking, including herbal supplements. Some patients may not think to mention herbal supplements like kratom unless prompted. Additionally, some specific patient populations might be more likely to use kratom. Asking about kratom directly can help start a conversation and create awareness about potential risks.

“Kratom is sometimes used to help with opioid withdrawal and chronic pain, so it would be prudent to ask patients who are or recently have been prescribed opioids or have recently been through treatment for opioid use disorder if they use kratom,” says Spiller. “Individuals with mood conditions such as depression or anxiety may also be more likely to use kratom.”

Multiple-substance exposures are associated with greater odds of admission to a health care facility and having a serious medical outcome, he adds.

Kratom is listed by the Drug Enforcement Administration (DEA) as a “drug of concern” and has not been approved for any medical use by the Food and Drug Administration (FDA). Because it is not currently regulated, product quality, purity and concentration vary dramatically. The researchers are calling for FDA regulation to ensure product uniformity.

Data for this study were obtained from the National Poison Data System, which is maintained by the American Association of Poison Control Centers (AAPCC). The AAPCC receives data about calls to poison control centers that serve the U.S. and its territories. Poison control centers receive phone calls through the Poison Help Line and document information about the product, route of exposure, individual exposed, exposure scenario and other data.

Citation

Post, S, Spiller, HA, Chounthirath, T, and Smith, GA. Kratom exposures reported to United State poison control centers: 2011-2017. Clinical Toxicology. 2019 Feb 18.

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