Risk of respiratory and neurologic effects in children ingesting kratom and related alkaloids

Kratom products are increasingly misused in the United States (US). Potent semi-synthetic kratom alkaloids like 7-hydroxymitragynine (7-OH) and mitragynine pseudoindoxyl (MP) may pose higher risks, but little is reported about pediatric exposures. We evaluated the risk of serious respiratory and neurologic effects in children <12 years of age following ingestion of 7-OH or MP compared to mitragynine.

A retrospective analysis was performed on National Poison Data System (NPDS) data. Pediatric (<12 years) single-substance kratom ingestions with known medical outcomes and product codes were included. Descriptive statistics were used for general characteristics. Composite groups for serious respiratory and neurologic effects were created and age-adjusted logistic regression performed to evaluate for differences in 7-OH or MP vs mitragynine exposures, reported as odds ratios (ORs) with 95% confidence intervals (CIs).

Of 169 cases that met inclusion, 60% were male with a median age of 2 years. Most ingestions (97%) were unintentional. Naloxone use was nearly twice as likely among children exposed to 7-OH or MP. 7-OH or MP exposures had higher odds of serious respiratory and neurologic effects with OR of 2.5 (95% CI 1.1-5.4, p = 0.025) and OR of 2.6 (95% CI 1.2-5.4, p = 0.01), respectively.

This data supports the recent scheduling of 7-OH and MP products. Emergency Physicians should be aware of the potential complications of pediatric kratom alkaloid ingestions.

High potency kratom alkaloids may pose significant respiratory and neurologic risks to pediatric patients when unintentionally exposed.