Abstract
Multiorgan toxicities have been extensively reported in kratom (Mitragyna speciosa Korth) users in Western countries but not in Southeast Asia. Existing literature argued that this discrepancy may be due to underreporting of kratom-related toxicity cases in Southeast Asia. Hence, this case series filled the research gap by clinically assessing the cardiovascular functioning and serum mitragynine level of regular kratom users in its traditional settings in Malaysia. Nine regular kratom users without history of polysubstance use were recruited from the same community via snowball sampling and were subjected to electrocardiogram (ECG) and echocardiogram assessments. Serum mitragynine analysis was also performed by solid-phase extraction and liquid chromatography-tandem mass spectrometry. The mean serum mitragynine level was 10.3 mg/L (SD = 6.9) and ranged from 2.5 mg/L to 22.4 mg/L. Those who consumed an average daily quantity of four or more glasses of brewed kratom juice (p = 0.045) and those who had prolonged QTc intervals (p = 0.017) had significantly higher serum mitragynine level. Echocardiographic findings of all the respondents were normal except one reported left ventricular hypertrophy and another had trivial tricuspid regurgitation with pulmonary artery systolic pressure (PASP) of 10 + 5 mmHg. Regular kratom use without concomitant use of other illicit substances may not provoke any risk of cardiovascular impairment or toxicity except for prolonged QTc interval, which appeared to be dose dependent. However, as this study was limited by a small sample size, future studies with larger sample size are warranted to confirm our findings.
Highlights
The leaves of Mitragyna speciosa (Korth) or better known as kratom, a subtropical plant native to the region of Southeast Asia, exhibits psychotropic properties and has been used as a traditional remedy for symptomatic relief of various illnesses
All the nine regular kratom users were recruited from a targeted community located in the state of Penang in Peninsular Malaysia which has a high prevalence of kratom use
Snowball sampling was employed in which an informant who was a regular kratom user who resided in the targeted community was briefed on the purpose and procedures of the case series and assisted in the recruitment drive
Summary
The leaves of Mitragyna speciosa (Korth) or better known as kratom, a subtropical plant native to the region of Southeast Asia, exhibits psychotropic properties and has been used as a traditional remedy for symptomatic relief of various illnesses. It has been used in Thailand and Malaysia for centuries but for the past decade, its use in Western countries, such as United States and European nations, as a self-prescribe medication for depression, anxiety disorders, chronic pain and as a substitute to illicit and prescription opioids soared exponentially (Grundmann, 2017). Despite various toxidrome reported in the West, toxicity related to kratom use has not been documented in Southeast Asia (Singh et al, 2016)
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