Characteristics of deaths associated with kratom use

Abstract

Background: Kratom (Mitragyna speciosa) use has increased in Western countries, with a growing number of associated deaths. There is a growing debate about the involvement of kratom in these events. Aims: This study details characteristics of such fatalities and provides a ‘state-of-the-art’ review. Methods: UK cases were identified from mortality registers by searching with the terms: ‘kratom’, ‘mitragynine’, etc. Databases and online media were searched using these terms and ‘death’, ‘fatal*’, ‘overdose’, ‘poisoning’, etc. to identify additional cases; details were obtained from relevant officials. Case characteristics were extracted into an Excel spreadsheet, and analysed employing descriptive statistics and thematic analysis. Results: Typical case characteristics (n=156): male (80%); mean age 32.3 years; White (100%); drug abuse history (95%); reasons for use - self-medication, recreation, relaxation, body-building, avoiding positive drug tests. Mitragynine alone was identified/implicated in 23% of cases. Polysubstance use was common (87%), typically controlled/recreational drugs; therapeutic drugs; alcohol. Death cause(s) included: toxic effects of kratom ± other substances; underlying health issues. Conclusions: These findings add substantially to the knowledge-base on kratom-associated deaths; these need systematic, accurate recording. Kratom’s safety profile remains only partially understood; toxic and fatal levels require quantification.