Novel case of maternal and neonatal kratom dependence and withdrawal

Dear Editor,

I would like to thank Dr Mackay and Dr Abrahams for the rare and very good case report of maternal and neonatal kratom dependence and withdrawal in the February 2018 issue of the Canadian Family Physician [1]. Kratom, also known as ketum or herbal speedball, are crushed or pulverized leaves of the kratom tree (Mitragyna speciose) growing in Thailand, Malaysia, Indonesia, Philippines, Myanmar, and Papua New Guinea and are mainly offered via the internet. The U.S. Food and Drug Administration and Health Canada repeatedly warned against the use of kratom-containing products in 2018.
The authors mentioned that apart from their new case report, kratom withdrawal in neonates has so far only been reported in Thailand [1]. That is not entirely correct; I would like to point out that such cases have also been documented in the United States recently [2, 3]. Interestingly, a case report on neonatal abstinence syndrome after maternal regular use of kratom tea has just been published in the journal of the Canadian Paediatric Society [4].
I fully agree with the authors, the increasing prevalence of kratom use with serious health risks should not be underestimated, further case reports will certainly follow. Yes, it is extremely important that primary care physicians/practitioner and other front-line health care professionals generally determine the use of dietary and herbal supplements in their anamnesis [5].

Sincerely,

Dr. Martin Hofmeister, Consumer Centre of the German Federal State of Bavaria, Department Food and Nutrition, Germany

References

1. Mackay L, Abrahams R. Novel case of maternal and neonatal kratom dependence and withdrawal. Can Fam Physician 2018;64(2):121-22.

2. Pizarro-Osilla C. Introducing… Kratom. J Emerg Nurs 2017;43(4):373-74.

3. Cumpston KL, Carter M, Wills BK. Clinical outcomes after Kratom exposures: A poison center case series. Am J Emerg Med 2018;36(1):166-68.

4. Murthy P, Clark D. An unusual cause for neonatal abstinence syndrome. Paediatrics & Child Health 2018 June 29:pxy084. doi: 10.1093/pch/pxy084. [Epub ahead of print].

5. Levy I, Attias S, Ben-Arye E, Schiff E. Use and safety of dietary and herbal supplements among hospitalized patients: what have we learned and what can be learned? – A narrative review. Eur J Integr Med 2017;16:39-45.