Liver injury associated with kratom, a popular opioid-like product: Experience from the U.S. drug induced liver injury network and a review of the literature

Affiliations

¹ Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 G. Levy Place, Box 1101, New York, NY, 10029, USA.
² Department of Medicine, University of North Carolina, Division of Gastroenterology & Hepatology, 8011 Burnett-Womack Bldg, Room 8011, Chapel Hill, 27599-7584, NC, USA. Electronic address: Paul.hayashi@fda.hhs.gov.
³ Department of Medicine, University of Michigan School of Medicine, Division of Gastroenterology & Hepatology, 1500 E. Medical Center, Dr. Ann Arbor, MI, 48109, USA.
⁴ University of Mississippi, National Center for Natural Products Research, 3012 Thad Cochran, P.O. Box 1848, University, MS, 38677, USA.
⁵ Duke Clinical Research Institute, Duke University, 300 West Morgan St. Durham, NC, 27701, USA.
⁶ Department of Medicine Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA.
⁷ Department of Digestive Disease and Transplantation, Einstein Healthcare Network, Klein 505, 5501 Old York Road, Einstein Medical Center, Philadelphia, PA, 19141, USA. Electronic address: NavarroV@einstein.edu.

PMID: 33257199
PMCID: PMC8113016
DOI: 10.1016/j.drugalcdep.2020.108426

Review

Liver injury associated with kratom, a popular opioid-like product: Experience from the U.S. drug induced liver injury network and a review of the literature

Jawad Ahmad et al. Drug Alcohol Depend. 2021.

. 2021 Jan 1:218:108426.

doi: 10.1016/j.drugalcdep.2020.108426. Epub 2020 Nov 23.

Affiliations

¹ Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 G. Levy Place, Box 1101, New York, NY, 10029, USA.
² Department of Medicine, University of North Carolina, Division of Gastroenterology & Hepatology, 8011 Burnett-Womack Bldg, Room 8011, Chapel Hill, 27599-7584, NC, USA. Electronic address: Paul.hayashi@fda.hhs.gov.
³ Department of Medicine, University of Michigan School of Medicine, Division of Gastroenterology & Hepatology, 1500 E. Medical Center, Dr. Ann Arbor, MI, 48109, USA.
⁴ University of Mississippi, National Center for Natural Products Research, 3012 Thad Cochran, P.O. Box 1848, University, MS, 38677, USA.
⁵ Duke Clinical Research Institute, Duke University, 300 West Morgan St. Durham, NC, 27701, USA.
⁶ Department of Medicine Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA.
⁷ Department of Digestive Disease and Transplantation, Einstein Healthcare Network, Klein 505, 5501 Old York Road, Einstein Medical Center, Philadelphia, PA, 19141, USA. Electronic address: NavarroV@einstein.edu.

PMID: 33257199
PMCID: PMC8113016
DOI: 10.1016/j.drugalcdep.2020.108426

Abstract

Background: Kratom is a botanical product used as an opium substitute with abuse potential.

Methods: Assessment of suspected cases of kratom-induced liver injury in a prospective US cohort.

Results: Eleven cases of liver injury attributed to kratom were identified with a recent increase. The majority were male with median age 40 years. All were symptomatic and developed jaundice with a median latency of 14 days. The liver injury pattern was variable, most required hospitalization and all eventually recovered. Biochemical analysis revealed active kratom ingredients.

Conclusion: Kratom can cause severe liver injury with jaundice.

Keywords: 7-hydroxymitragynine; Hepatotoxicity; Kratom; Mitragynine; Opioid.

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Figures

**Figure 1-**
Temporal trend of Kratom liver injury enrolled in the Drug Induced Liver Injury Network 2004–2019.

See this image and copyright information in PMC

References

1. Hassan Z, Muzaimi M, Navaratnam V, et al. From Kratom to mitragynine and its derivatives: physiological and behavioural effects related to use, abuse, and addiction. Neurosci Biobehav Rev 2013;37:138–51. - PubMed
1. Olsen EO, O’Donnell J, Mattson CL, et al. Notes from the Field: Unintentional Drug Overdose Deaths with Kratom Detected - 27 States, July 2016-December 2017. MMWR Morb Mortal Wkly Rep 2019;68:326–327. - PMC - PubMed
1. Coe MA, Pillitteri JL, Sembower MA, et al. Kratom as a substitute for opioids: Results from an online survey. Drug Alcohol Depend 2019;202:24–32. - PubMed
1. Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers: 2011–2017. Clin Toxicol (Phila) 2019;57:847–854. - PubMed
1. Chalasani N, Bonkovsky HL, Fontana R, et al. Features and Outcomes of 899 Patients With Drug-Induced Liver Injury: The DILIN Prospective Study. Gastroenterology 2015;148:1340–52. - PMC - PubMed

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Liver injury associated with kratom, a popular opioid-like product: Experience from the U.S. drug induced liver injury network and a review of the literature

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Liver injury associated with kratom, a popular opioid-like product: Experience from the U.S. drug induced liver injury network and a review of the literature

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