Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA.
Am J Drug Alcohol Abuse. 2021 Jan 2;47(1):74-83. doi: 10.1080/00952990.2020.1836185. Epub 2020 Nov 24.
Interest in the Southeast Asian natural remedy kratom has increased in Western countries recently, along with increasing concern over its potential toxic effects. To describe and compare demographics, common co-exposure substances, clinical effects, treatments, and medical outcomes of kratom "abuse" exposures in the United States (US) and Thailand. This is a retrospective analysis of kratom "abuse" exposures, defined as use when attempting to gain a psychotropic effect, reported to the National Poison Data System (NPDS) in the US and the Ramathibodi Poison Center (RPC) in Thailand from 2010 to 2017. Multivariate analysis identified risk factors for severe medical outcomes, defined as both ICU admissions and death. Nine-hundred-twenty-eight cases were included (760 from NPDS and 168 from RPC). A greater proportion of cases involved co-exposures in Thailand (64.8% versus 37.4%; odds ratio [OR] = 3.10, 95% confidence interval [CI] = 2.15-4.47, < .01). Both countries had a similar prevalence of opioid and benzodiazepine co-ingestions, but the US had more co-ingestions with other sedatives (4.6% versus 0%, OR = 0, 95% CI = 0-0.47, < .01). Common clinical effects included tachycardia (30.4%), agitation/irritability (26.2%), and drowsiness/lethargy (21.1%). Six deaths occurred, including one single-substance exposure in the US, three multiple-substance exposures in the US, and two multiple-substance exposures in Thailand. Severe medical outcomes were reported more frequently in the US (OR = 18.82, 95% CI = 5.85-60.56, p < .01). Despite lower frequencies of co-ingestants overall, US kratom abuse exposures yielded greater clinical severity. This disparity may be attributable to differences in the products labeled "kratom," greater sedative co-exposures in the US, and/or differences in population genetics or use patterns.
最近，西方国家对东南亚天然药物 kratom 的兴趣日益增加，同时对其潜在的毒性作用也越来越关注。本研究旨在描述和比较美国和泰国的 kratom“滥用”暴露病例的人口统计学特征、共同暴露物质、临床效应、治疗方法和医疗结局。这是一项对 kratom“滥用”暴露病例的回顾性分析，这些病例被定义为为了获得精神活性作用而使用 kratom 的情况，病例报告来自美国国家毒物数据系统（NPDS）和泰国 Ramathibodi 中毒中心（RPC），时间跨度为 2010 年至 2017 年。多变量分析确定了严重医疗结局的危险因素，严重医疗结局定义为 ICU 入院和死亡。共纳入 928 例病例（NPDS 760 例，RPC 168 例）。泰国的病例中共同暴露的比例更高（64.8%对 37.4%；比值比 [OR] = 3.10，95%置信区间 [CI] = 2.15-4.47，<0.01）。两国的阿片类药物和苯二氮䓬类药物共同摄入的比例相似，但美国的其他镇静剂共同摄入的比例更高（4.6%对 0%，OR = 0，95%CI = 0-0.47，<0.01）。常见的临床效应包括心动过速（30.4%）、激惹/烦躁（26.2%）和嗜睡/昏睡（21.1%）。共发生 6 例死亡，包括美国 1 例单一物质暴露，美国 3 例多种物质暴露，泰国 2 例多种物质暴露。美国报告的严重医疗结局更为常见（OR = 18.82，95%CI = 5.85-60.56，p < 0.01）。尽管总体来看共同摄入的物质频率较低，但美国的 kratom 滥用暴露导致了更大的临床严重程度。这种差异可能归因于标签为“kratom”的产品的差异、美国镇静剂共同摄入的差异，以及/或者人口遗传学或使用模式的差异。
