Kratom and Anesthesia

Main Article Content

Somchai Amornyotin

Abstract

Kratom, known as Mitragyna speciosa (Korth), is a native plant in Thailand and Southeast Asia. It is used as a drug of abuse, opioid alternative, or pain killer. The pharmacokinetics of this plant has been studied only in animals, and there are no such studies in humans. Kratom contains pharmacologically active ingredients, most particularly mitragynine and 7-hydroxy- mitragynine. Kratom leaves contain multiple psychoactive chemicals that stimulate opioid, alpha-2, and serotonergic receptors. It produces complex stimulant and opioid-like analgesic effects. Therefore, it is used to treat pain and to alleviate opioid withdrawal or as an opioid replacement among people with opioid use disorder. Kratom is one of abuse drugs including tobacco and cannabis.1,2 It is illegal in many countries. Conventionally, kratom could be smoked, vaporized, or consumed as a powder. Several patients who consume kratom require medical intervention and care by anesthesiologists. Importantly, kratom users are of direct concerns to periprocedural management. To date, anesthetic personnel need to understand the pharmacodynamics and pharmacokinetics of the use of kratom and its chemical compounds.

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References

Amornyotin S, Prakanrattana U, Chalayonnawin W, Kongphlay S. Brief advice offered by anesthetic personnel to encourage smoking cessation in ambulatory gastrointestinal endoscopic patients in a developing country. Int J Life Sci Med Res. 2012;2:37-42.

Amornyotin S. Cannabis: what anesthesiologists need to know? Thai J Anesthesiol. 2022;48:177-9.

White CM. Pharmacologic and clinical assessment of kratom. Am J Health Syst Pharm. 2018;75:261-7.

Swogger MT, Smith KE, Garcia-Romeu A, et al. Understanding kratom use: a guide for healthcare providers. Front Pharmacol. 2022;13:801855.

Scott TM, Yeakel JK, Logan BK. Identification of mitragynine and O-desmethyltramadol in kratom and legal high products sold online. Drug Test Anal. 2014;6:959-63.

Hanapi NA, Ismail S, Mansor SM. Inhibitory effect of mitragynine on human cytochrome P450 enzyme activities. Pharmacognosy Res. 2013;5:241-6.

Grundmann O. Patterns of kratom use and health impact in the US-results from an online survey. Drug Alcohol Depend. 2017;176:63-70.

Coea MA, Pillitterib JL, Sembowerb MA, Gerlachb KK, Henningfield JE. Kratom as a substitute for opioids: results from an online survey. Drug Alcohol Depend. 2019;202:24-32.

Lund E, Low AB, Allan JD, Puentes JA, Flynn DN. Anesthetic challenges posed by heavy kratom users. Cureus. 2022;14:e22864.

Vermaire DJ, Skaer D, Tippets W. Kratom and general anesthesia: a case report and review of the literature.

A & A PRACTICE. 2019;12:103-5.

Nelsen JL, Lapoint J, Hodgman MJ, et al. Seizure and coma following kratom (Mitragyna speciosa korth) exposure. J Med Toxicol. 2010;6:424-6.

Osborne CS, Overstreet AN, Rockey DC, Schreiner AD. Drug-induced liver injury caused by kratom use as an alternative pain treatment amid an ongoing opioid epidemic. J Investig Med High Impact Case Rep. 2019;7:2324709619826167.

Ulbricht C, Costa D, Dao J, et al. An evidence-based systematic review of kratom (Mitragyna speciosa) by the Natural Standard Research Collaboration. J Diet suppl. 2013;10:152-70.

Swogger MT, Hart E, Erowid F, et al. Experiences of kratom users: a qualitative analysis. J Psychoactive Drugs. 2015;47:360-7.

Vicknasingam B, Narayanan S, Beng GT, et al. The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy. Int J Drug Policy. 2010;21:283-8.

Brown PN, Jensen A, Lund S, Murch J. A botanical, phytochemical and ethnomedicinal review of the genus Mitragyna korth: implications for products sold as kratom. J Ethnopharmacol. 2017;202:302-25.

Stanciu CN, Gnanasegaram SA, Ahmed S, et al. Kratom withdrawal: a systematic review with case series. J Psychoactive Drugs. 2019;51:12-8.

Khazaeli A, Jerry JM, Vazirian M. Treatment of kratom withdrawal and addiction with buprenorphine. J Addict Med. 2018;12:493-5.

Galbis-Reig D. A case report of kratom addiction and withdrawal. WMJ. 2016;115:49-53.

Striley CW, Hoeflich CC, Viegas AT, et al. Health effects associated with kratom (Mitragyna speciosa) and polysubstance use: a narrative review. Subst Abuse. 2022;16:11782218221095873