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; Joseph A Odin; Paul H Hayashi; Robert J Fontana; Hari Conjeevaram; Bharathi Avula; Ikhlas A Khan; Huiman Barnhart; Raj Vuppalanchi; Victor J Navarro; Drug-Induced Liver Injury Network

doi:10.1016/j.drugalcdep.2020.108426

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

Drug Alcohol Depend. 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.

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.

Publication types

Research Support, N.I.H., Extramural
Review

MeSH terms

Adult
Analgesics, Opioid / adverse effects
Chemical and Drug Induced Liver Injury / epidemiology*
Female
Humans
Male
Mitragyna / adverse effects*
Prospective Studies
United States / epidemiology

Substances

Analgesics, Opioid

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

Authors

Affiliations

Abstract

Publication types

MeSH terms

Substances

Grants and funding