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1.
BMJ Case Rep ; 12(7)2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31326902

RESUMO

Kratom is a psychoactive herb that has stimulant properties at low doses and has opioid-like properties at higher doses. It has been used for centuries in southeast Asia as a stimulant but has gained increasing popularity as a substitute for opioids in western countries as it is easily available. As most cases of kratom use involve other drugs too, the Food and Drug Administration (FDA) has stopped short of restricting kratom due to difficulty in assessing the adverse effects of kratom alone. We present the case of a young healthy 35-year-old man who suffered a cardiac arrest due to kratom use with no other coingestants. He was subsequently intubated and found to have systolic dysfunction and small brain infarcts. Fortunately, he made a successful recovery and was discharged after a stay at thebehavioural health centre. Our case highlights the potential adverse effects of kratom and the need to regulate its use.


Assuntos
Infarto Encefálico/induzido quimicamente , Parada Cardíaca/induzido quimicamente , Mitragyna/envenenamento , Psicotrópicos/efeitos adversos , Adulto , Infarto Encefálico/terapia , Diagnóstico Diferencial , Parada Cardíaca/terapia , Humanos , Hipotermia Induzida , Masculino , Síndrome de Abstinência a Substâncias
2.
J Forensic Sci ; 64(6): 1933-1935, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31121058

RESUMO

Kratom is an herbal product commonly used for its effects which are similar to opioids and stimulants. Few studies demonstrate the dangers and lethality of Kratom, and most fatalities from Kratom involve other abused substances. In the current case report, a 33-year-old white man with a known history of opioid abuse and mental illnesses was found unresponsive in his basement with no obvious signs of trauma. After resuscitative efforts, he was pronounced dead and taken for autopsy evaluation. Blood from the inferior vena cava was analyzed for common abused substances. The laboratory toxicology work-up revealed positive findings of caffeine, cotinine, and naloxone with low levels of Δ-9 tetrahydrocannabinol. However, a marked level of mitragynine at 1.9 mg/L was observed, the highest reported to date. Given the facts and evidence, the medical examiner certified the cause of death as "mitragynine toxicity" and the manner of death was classified as an "accident."


Assuntos
Mitragyna/envenenamento , Alcaloides de Triptamina e Secologanina/sangue , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Humanos , Masculino , Detecção do Abuso de Substâncias
6.
J Psychoactive Drugs ; 50(2): 114-120, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28937941

RESUMO

Kratom is a traditional drug from Southeast Asia that has been an emerging new substance in the United States. On August 30, 2016, the DEA announced the intention to emergency schedule kratom into Schedule I. To support this decision, the DEA cited an increase in drug seizures of kratom and an increase in calls to poison control concerning kratom. However, a short time later, on October 12, 2016, the DEA withdrew the intent to schedule kratom after public and congressional backlash. The withdrawal by the DEA was somewhat unprecedented. To better understand both decisions, the current article examines the evidence the DEA cited to support their decision to emergency schedule kratom and the degree and type of media coverage of kratom to determine if a media-driven drug panic occurred.


Assuntos
Substâncias Controladas/classificação , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Mitragyna/classificação , Tomada de Decisões , Órgãos Governamentais , Humanos , Meios de Comunicação de Massa , Medicina Tradicional do Leste Asiático , Mitragyna/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Estados Unidos
7.
MMWR Morb Mortal Wkly Rep ; 65(29): 748-9, 2016 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-27466822

RESUMO

Kratom (Mitragyna speciosa) is a plant consumed throughout the world for its stimulant effects and as an opioid substitute (1). It is typically brewed into a tea, chewed, smoked, or ingested in capsules (2). It is also known as Thang, Kakuam, Thom, Ketum, and Biak (3). The Drug Enforcement Administration includes kratom on its Drugs of Concern list (substances that are not currently regulated by the Controlled Substances Act, but that pose risks to persons who abuse them), and the National Institute of Drug Abuse has identified kratom as an emerging drug of abuse (3,4). Published case reports have associated kratom exposure with psychosis, seizures, and deaths (5,6). Because deaths have been attributed to kratom in the United States (7), some jurisdictions have passed or are considering legislation to make kratom use a felony (8). CDC characterized kratom exposures that were reported to poison centers and uploaded to the National Poison Data System (NPDS) during January 2010-December 2015. The NPDS is a national database of information logged by the country's regional poison centers serving all 50 United States, the District of Columbia, and Puerto Rico and is maintained by the American Association of Poison Control Centers. NPDS case records are the result of call reports made by the public and health care providers.


Assuntos
Mitragyna/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Envenenamento/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
8.
J Addict Dis ; 32(4): 396-400, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24325774

RESUMO

Kratom use is a growing problem in the United States. Kratom exposures reported to Texas poison centers between January 1998 and September 2013 were identified. No kratom exposures were reported from 1998 to 2008 and 14 exposures were reported from 2009 to September 2013. Eleven patients were male, and 11 patients were in their 20s. The kratom was ingested in 12 patients, inhaled in 1, and both ingested and inhaled in 1. Twelve patients were managed at a healthcare facility and the remaining 2 were managed at home.


Assuntos
Mitragyna/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Psicotrópicos/envenenamento , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Bases de Dados como Assunto , Alcaloides Diterpenos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Alcaloides de Triptamina e Secologanina/farmacologia , Texas , Estados Unidos/epidemiologia , Adulto Jovem
9.
J Forensic Sci ; 58 Suppl 1: S278-9, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23082895

RESUMO

A 17-year-old white man who showed no obvious signs of trauma was found unresponsive in bed and was pronounced dead at the scene. The decedent had a documented history of heroin abuse and chronic back pain and reportedly self-medicated with Kratom (mitragynine). The autopsy was remarkable only for pulmonary congestion and edema and a distended bladder, both of which are consistent with, though not diagnostic of, opiate use. A laboratory work-up revealed therapeutic levels of over-the-counter cold medications and benzodiazepines. However, of interest was a level of mitragynine at 0.60 mg/L. Given the facts of the case, the Medical Examiner certified the cause of death as "possible Kratom toxicity" and the manner of death was classified as "accident."


Assuntos
Mitragyna/envenenamento , Psicotrópicos/envenenamento , Alcaloides de Triptamina e Secologanina/envenenamento , Adolescente , Cromatografia Líquida , Overdose de Drogas , Toxicologia Forense , Humanos , Masculino , Psicotrópicos/sangue , Edema Pulmonar/patologia , Alcaloides de Triptamina e Secologanina/sangue , Espectrometria de Massas em Tandem
10.
J Psychoactive Drugs ; 45(5): 404-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24592666

RESUMO

Kratom (Mitragyna speciosa Korth), a native tree in Southeast Asia, is misused as an abuse drug and becomes legally widespread to several countries. Currently, it is available through the online market or by some shops. The clinical manifestations of Kratom's effects are not well-defined and the clinical studies are limited. This study was designed to identify the characteristics of Kratom poisoning and withdrawal cases from Kratom exposure cases in Ramathibodi Poison Center (RPC), Thailand, during a five-year period. We used a retrospective review of Kratom exposure cases from the RPC toxic surveillance system. A total of 52 Kratom exposure cases were identified. The trend of case consultations has been increasing. There were Kratom poisoning cases (76.9%) and withdrawal cases (23.1%). Common presenting symptoms in the poisoning group were palpitation (22.5%), followed by seizure (17.5%). For the withdrawal group, the common presenting symptoms were myalgia (33.3%), insomnia (16.67%), fatigue (16.67%), and chest discomfort (16.67%). There was a baby with withdrawal symptoms who was delivered from a chronic Kratom-abusing mother, suggesting possible exposure via the transplacental route. There were no deaths in either group. Kratom abuse can cause either poisoning or withdrawal. Most cases in both groups had good prognostic outcome.


Assuntos
Mitragyna/envenenamento , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome de Abstinência a Substâncias/etiologia , Tailândia , Fatores de Tempo
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