Description of a fatal intoxication due to Kratom, including results of mitragynine quantitative analysis.

A 36-year-old man with a history of heroin, cocaine and drug (oxazepam and bromazepam) use was found dead in his bed. A plastic bag containing 50g of an unidentified green powder was found near the corpse. The results of the autopsy revealed asphyxia with pulmonary edema, pancreatitis and petechial gastritis.

Toxicological screening was performed for ethanol, drugs and drugs of abuse by LC-MS/MS and GC-MS, in biological samples (peripheral blood, urine, gastric fluid, bile) and powder. Furthermore, compounds identified by screening were quantified in blood by LC-MS/MS.

Mitragynine was identified in blood, urine and powder. A lethal concentration of mitragynine and oxazepam was found, associated with cocaine and central nervous system depressants (methadone, morphine, bromazepam). The postmortem peripheral blood concentrations are presented in Table 1.

Kratom (Mitragyna speciosa), a plant traditionally used in Southeast Asia for its medicinal value in treating diarrhoea, fever or pain, is now popular in Western countries as a recreational drug or as a self-treatment for opioid dependence. Mitragynine, the main alkaloid found in Kratom, is an opiate mu receptor agonist and kappa receptor antagonist. It is described to produce stimulant effects at low doses, and sedative and/or euphoric effects at high doses. An increasing number of deaths is reported after Kratom use, especially in association with other central nervous system depressant drugs, with mitragynine concentrations ranging from 16 to 4800ng/mL [1Gershman K., e al. Deaths in Colorado attributed to Kratom N Engl J Med 2019 ;  380 : 97-98 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti]. In this case, mitragynine and oxazepam were found in lethal concentration and were associated with other depressants of the central nervous system (methadone, morphine, bromazepam). Corroborated by the asphyxia syndrome observed at autopsy, all these data were in favor of the causal role of Kratom in the death.