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An accidental poisoning with mitragynine.

Ritva Karinen1, Jan Toralf Fosen1, Sidsel Rogde2

  • 1Norwegian Institute of Public Health, Division of Forensic Sciences, Box 4404, Nydalen, 0403 Oslo, Norway.

Forensic Science International
|December 3, 2014
PubMed
Summary

Kratom, containing mitragynine and 7-hydroxymitragynine, is increasingly sold online. This case report details a fatal intoxication from these compounds, highlighting the need for their analysis in suspected Kratom poisoning cases.

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Area of Science:

  • Forensic Toxicology
  • Pharmacology
  • Clinical Chemistry

Background:

  • The internet facilitates the global distribution of novel psychoactive substances, often marketed as safe alternatives like "legal highs."
  • Mitragyna speciosa (Kratom) contains mitragynine and the more potent 7-hydroxymitragynine, with significant opioid receptor activity.
  • Previous reports on Kratom poisoning exist, but established toxic or lethal concentration ranges, especially for 7-hydroxymitragynine, remain undetermined.

Observation:

  • A middle-aged male with a history of drug abuse and mental illness was found deceased.
  • Autopsy revealed no significant pathological findings, with therapeutic levels of other prescribed medications detected.
  • Post-mortem blood analysis identified mitragynine (1.06 mg/L) and 7-hydroxymitragynine (0.15 mg/L), also present in urine.
Keywords:
7-HydroxymitragynineBlood drug concentrationDrug fatalityForensic toxicologyMitragynineUPLC–MS/MS

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Findings:

  • The detected concentrations of mitragynine and 7-hydroxymitragynine were deemed indicative of intoxication.
  • The case suggests a potential for fatal outcomes due to Kratom use, even in the presence of other therapeutic drugs.
  • This is the first reported case quantifying 7-hydroxymitragynine in a fatal Kratom intoxication.

Implications:

  • Forensic toxicologists should include mitragynine and 7-hydroxymitragynine in routine drug screens for suspected Kratom-related fatalities.
  • The findings underscore the potential dangers of unregulated substances sold online and the need for greater awareness of Kratom's toxicity.
  • Further research is warranted to establish definitive toxic and lethal concentration ranges for these Kratom alkaloids.