Kratom case report

I thank Drs Mackay and Abrahams for the rare and very good case report of maternal and neonatal kratom dependence and withdrawal in the February 2018 issue of Canadian Family Physician.¹ Kratom, also known as ketum or herbal speedball, is crushed or pulverized leaves of the kratom tree (Mitragyna speciosa) that grows in Thailand, Malaysia, Indonesia, Philippines, Myanmar, and Papua New Guinea, and is mainly offered via the Internet. This past year, Health Canada and the US Food and Drug Administration repeatedly warned against the use of kratom-containing products.^2,3

Mackay and Abrahams mention that apart from their new case report, kratom withdrawal in neonates has so far only been reported in Thailand¹; however, this is not entirely correct. I would like to point out that such cases have also recently been documented in the United States.^4,5 Interestingly, a case report on neonatal abstinence syndrome after maternal regular use of kratom tea has also been published recently in the official journal of the Canadian Paediatric Society.⁶

I fully agree with the authors¹ that the increasing prevalence of kratom use with serious health risks should not be underestimated, and further case reports will certainly follow. Yes, it is extremely important that primary care physicians or practitioners, as well as other front-line health care professionals, generally determine the use of dietary and herbal supplements in their anamnesis.⁷

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