My take: Beware of drug interactions. Don't mix powerful natural substances (Kratom, Rue) with artificial pharmaceuticals (venlafaxine, SSRIs). Such pharmaceuticals did not exist during the thousands of years of safe traditional use of natural drugs, so beware of the unknowns and toxicity of modern medicine.

Also, I admit I may be biassed towards nature in my comment above. I also think that trained researchers in the western science environment may be (sometimes subconsciously?) biassed in favor of the synthetics their craft creates. The truth is probably somewhere in between.

To the credit of the folks who published the report above, they did frame the issue as additive toxicity. On the other hand they refer to venlafaxine as "therapeutic" and seem to give it a positive spin, while they seem to frame Kratom in more negative terms throughout the text. Or maybe I'm reading too much into it...

I'm with you on the bias. I had initially thought this was, in fact, the first report in the scientific literature to document a fatal OD attributed solely to unadulterated Kratom consumption which didn't involve the concomitant use of other CNS depressants. Upon reading further into the results, I saw that it was nothing more than another misleading label. Reading further into the discussion/conclusion of the article, I noticed that the authors blatantly stated that mitragynine was the main culprit without providing any concrete proof whatsoever to back their claim up. Just because mitragynine was found in a post-mortem autopsy of a polydrug-induced OD doesn't inherently mean that mitragynine/kratom was the main agent responsible for the death. To add further insult to this misleading article, the authors stated that they had no conflict of interest...

My feeling is, that one has to be careful mixing kratom with anything. I myself had had uncomfortable effects with caapi the day after taking kratom even. I also wonder if dimenhydrinate is so safe to take or if it can lead to respiratory depression. I know people take small amounts to combat kratom induced nausea with no ill effects but this is purely anecdotal.

My opinion is people shouldnt downplay the power of natural compounds.

Afterall you dont see many people going around heavy dosing datura and burmansia.
So why would you do the same for Kratom and Iboga? Just because they are plants doesnt mean they are safe.

Kratom has been used for a long time yes. But that doesnt mean its safe.
Asbestos was used forever too. People used lead to sweeten their vine for hundreds of years.
Just because ppl have been doing it the same way doesnt mean its safe.


They wrote this because on its own that combo would have never killed the person.
They meant that kratom was the key here that lead to the death.

The thing is...how common is the combo?

People who suffer from depression and anxiety are drawn to taking kratom.

What else do they take?

- SSRIs
- Benzos
- Dimenhydrinate against nausea

Not too wild...

Mirtazipine will cause heavy sedation. I could see the 2 of them being more sedating than is safe.

The only thing that stands out to me is that kratom isn't sold by big pharm and the carelessness of mixing chemicals... on my side of the fence I've taken naseauting doses of kratom causing heavy sedation, though relatively not to sedative compared with typical full agonist mu opiate receptor agonists, on multiple occasions and didn't see much of a risk other than the effects on my body from physicall consumption of close to an ounce of plant material.

There are random chemicals in kratom that haven't been well researched and it does have a strange effect different from typical opiods. But my money would be on combination of dimenhydrinate, mirtazipi e and kratom combining to cause to much respiratory depression.

In this case, ethanol was thrown into the equation. The patient had a history of ethanol abuse, and post-mortem concentrations indicated the presence of this fatal CNS depressant and emetic as well. Unfortunately, due to the lag in tissue sample collection post mortem, the serum levels of some of the others, including ethanol, may have decreased over that period (it should be noted that I'm not familiar how ethanol is excreted/metabolised by the body post-mortem, but would hypothesize that the BAC may have declined due to lag in acquiring samples).

Although benzos were present in other fatalities in polydrug OD's involving Kratom, they were not found in the post-mortem analysis in this case report. The concomitant administration of ethanol, diphenhydramine and mirtazepine shortly before he went to sleep may have been enough to cause such a fatal OD on their own, let alone with or without Kratom (which the article didn't state when it was consumed prior to the deceased going to sleep). Given the moderate stimulant properties of mitragynine, I may be hesitant to jump the shark and state that kratom was the straw which sapped the life out of this fellow.

Some SSRIs and SNRIs (IIRC) exert mild stimulant properties, as well, so I would likely rule out this option as a respiratory depressant (buuuuut it may have made him more prone to emesis, so who knows?)

Alcohol results in the death of 2.5 million people annually each year. Cigarette smoking is responsible for 1,300 deaths every day. kratom has like 36 deaths but these people had other drugs in their system. Compared to other substances i would say kratom is safe.

you think 0.2 permilles is enough to kill him?
Thats so low he could have gotten it from eating bread /drinking apple juice

Kratom is a plant near and dear to my heart and my fondness for it has reached a level of where I need to look at taking a break.

I can't seem to find the link for this article - but am sceptical about these reported deaths from Mitragynine and it would stand to reason that any fatality attribute to Kratom alone (i.e. absence of any other drug interactions) could only be the result of highly concentrated extract or some rare af idiosyncratic reaction.

I have seen the idiosyncratic response to Kratom play out with ayahuasca interactions. Several times I have sat ceremony having had half of my normal dose in the morning before the night of drinking and been fine... for the first few times. These were all with traditional 9-plant ayahuasca. The next time I drank ayahuasca with Kratom in my system (a regular dose that afternoon) was an vine-acacia brew and I also encountered no ill-effects.

However, things soon started to change when I drank a strong acacia brew which becoming intensely physically uncomfortable after the second cup and and I suspected that this was due to Kratom (as the other Kratom users in the room had the same experience). The next incident was with a unique - orally active acacia species that is served here in Australia in a ceremonial context inline with traditional Indigenous practices. This night was particularly intense and again it was the second cup that bought me to this state. A deep discomfort (akin to heroin withdrawals) in which everything resonated with a pervasive disharmony, a dis-equilibrium that manifested physically as painful muscle tension and a contortion of the nervous system, mentally as utter confusion and metaphysically as 'blockage to spirit' - the message from this medicine was loudly and clearly "This is Kratom". I got the impression that the acacia did not know how to counter the Kratom due to it being simultaneously both an agonist and antagonist.

Interested to hear form any others encountering such contraindications of ill-effects with Kratom and ayahuasca as this seems to be an under-represented or under-reported phenomenon. Some have suggested that Kratom is serotonergic, hence the state of emotional well-being.

thoughts most welcome,

Flux

Imo its probably not serotonergic at all.
The well being is the same you get from heroin. Just opiod endorphine activity.

Opiates do a affect serotonin release, one of the reasons opiates relieve depression. The activation of opiod recepters and serotonin release are well documented by scientist, though a cascading effect.

" Because opioid agonists also stimulate both PRL release and serotonin (5-HT) turnover, "

Effects of opiate antagonists on serotonin turnover and on luteinizing hormone and prolactin secretion in estrogen- or morphine-treated rats.
https://www.ncbi.nlm.nih.gov/pubmed/6328344

There is more to this death than just kratom, a lot of questions arise after reading. I get the feeling it is spun by anti kratom people. The American Kratom Association has addressed these type of reports on deaths, more than a few DR.'s have stated that these death reports are not honest.

Kratom seems to be the go-to "OTC" replacement for many trying to kick opiates. Loperimide (lope) runs a close second and is what I personally used to taper off the psychoactive opiates and finally quit completely (with the help of a big dose of LSA and DMT).

I don't know a lot about kratom but I did some research on loperimide before committing to it as a morphine and heroin cessation aid. Consider this. There are around 300 documented cases of lope related toxicity, always in combination with other meds, primarily antidepressants and always at much higher than therapeutic doses. In 2016 there were 2 deaths. Lope hit the shelves in 1976. Despite there only being 2 confirmed deaths from lope in 40 years a request was made to the FDA to limit availability of lope based on these deaths.

Running Bear says something like 36 deaths for kratom and I'll take his word for it. Now let's look at NSAIDs:
A statement from a July 1998 issue of The American Journal of Medicine states the following:
“Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone.  The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.” 

The USFDA considers these to be acceptable numbers from a cost/benefit perspective apparently. Things get interesting when we compare nsaid hospitalizations to hospitalizations from prescribed opiates but I'm veering off point.

So I gotta ask; why all the hub-bub about opiate analogues(?) like kratom and how in the H*LL is a non-psychoactive opiate like loperimide being ignored as a tool against opiate addiction?

Well, it's methadone, isn't it? And the "war on drugs" and all the subsidiary industries it has spawned from law enforcement to medical to "recovery programs" and on and on. At least where I live.

This subject needs a lot more exposure IMO. Especially in light of the huge increase in poppy production in Afghanistan following our incursions which coincidentally correspond with the rise in the "opioid epidemic".

Until addiction ceases to be an income generating mechanism for the state WE are the cutting edge of addiction treatment.

A yes, the imaginary monetary system that only exists in our human monkey brains. Corrupting human monkeys against their best interest for a few thousand years now.

Some enlightened folks are trying to grow out of the monetary system. Jobless economies through technology, universal income, etc. It is going to be very interesting to see where all that goes. For anyone not familiar with the subject but interested here is an interesting point of view.

Anyone who uses kratom knows this statement is false, a lie.

"Moreover, when they are given to animals for 5 days or longer, both compounds produce a state of physical dependence, with withdrawal symptoms that resemble those of opioid withdrawal"
Pharmacology of Kratom: An Emerging Botanical Agent With Stimulant, Analgesic and Opioid-Like Effects
http://jaoa.org/article.aspx?articleid=2094342

This thread is like the discussions about cannabis 70 or so years ago , smoke weed, kill people, go crazy, spend life in mental hospital.

I really expected more from this community, I expected the truth.I know better from personel experience.

I am wondering who you are? The first thought is ................. my second is you have no experiential knowledge, which seems to confirm my first thought of who you are. Be-aware

"Seem"
Yes just seems not does

Theres is nothing really that says anything striking that Kratom acts on the brain 5HT in that paper.

Also that aricle is better but did you read the full thing?
[Redacted: Courtesy Pitubo] DOI :10.1159/000123911

I completely agree. I believe that none on these 30 something death's were caused by kratom. This kratom ban has nothing to go with people dying. If they actually cared about are health they would be going after things like mcdonalds or marlboro reds. Lots of things effect the opioid receptors, even chocolate. They're losing money because of kratom and thats what it comes down to. Most humans live under a corrupt government...