Two Single-Drug Fatal Intoxications by Mitragynine

Area of Science:

• Forensic Toxicology
• Pharmacology

Background:

• Mitragyna speciosa, native to Southeast Asia, contains psychoactive alkaloids mitragynine and 7-hydroxymitragynine.
• These alkaloids exhibit biphasic effects, acting as stimulants at low doses and sedatives at high doses.
• Recreational and medicinal use of M. speciosa has been linked to intoxications and fatalities.

Observation:

• This case report details two instances of young males experiencing fatal intoxications.
• Both decedents presented with single-substance mitragynine poisoning, with no other toxicological findings.
• The fatalities occurred in outdoor settings, involving a vehicle and a bicycle.

Findings:

• Postmortem blood mitragynine concentrations were 2,325 ng/mL and 3,809 ng/mL.
• The medical examiner certified acute mitragynine intoxication as the cause of death in both cases.
• These findings establish mitragynine as the sole agent in these lethal intoxications.

Implications:

• Toxicology results are crucial for identifying mitragynine as the cause of death in single-drug fatalities.
• This information is vital for medical examiners, forensic pathologists, and toxicologists.
• Emergency department personnel can utilize this data for evaluating potential mitragynine poisoning cases.