Herbal sup­ple­ment kratom linked to new­born ill­ness

The Washington Times Weekly - - National - BY LAURA KELLY

Doc­tors be­lieve the herbal sup­ple­ment kratom caused new­borns to ex­hibit with­drawal symp­toms, as fed­eral of­fi­cials seek to clas­sify the South­east Asian plant as a dan­ger­ous opi­oid and ac­tivists de­fend it as a harm­less pain re­liever.

The Food and Drug Ad­min­is­tra­tion has doc­u­mented at least five cases of ba­bies born with neona­tal ab­sti­nence syn­drome, which doc­tors be­lieve is linked to kratom.

The lat­est case re­port was pub­lished last week in the jour­nal Pe­di­atrics. In it, kratom use was con­firmed by the fa­ther, who said the mother drank it daily as a tea to man­age opi­oid crav­ings and help her sleep dur­ing the preg­nancy.

The mother told doc­tors she had been ad­dicted to oxy­codone for seven years but had been sober for two years prior to be­com­ing preg­nant.

Mar­keted as an herbal sup­ple­ment in the U.S., kratom does not fall un­der Food and Drug Ad­min­is­tra­tion reg­u­la­tions. Its two main ac­tive in­gre­di­ents — mi­trag­y­nine and 7-hy­drox­ymi­trag­y­nine — are known to ac­ti­vate opi­oid re­cep­tors in the brain. But kratom isn’t known to cause res­pi­ra­tory de­pres­sion like mor­phine or heroin, the main causes of over­dose fa­tal­i­ties.

An es­ti­mated 2.1 mil­lion Amer­i­cans have an opi­oid ad­dic­tion. More than 60,000 peo­ple died from opi­oids in 2017.

The FDA has doc­u­mented at least 44 deaths linked to kratom, but crit­ics say nearly all of those cases in­volved other sub­stances.

Sup­port­ers of the plant say it boosts en­ergy, re­lives pain and curbs opi­oid with­drawal symp­toms. It is con­sumed in dry pow­der form or mixed with wa­ter as a tea.

In the Pe­di­atrics re­port, doc­tors wrote that the child was ex­hibit­ing clas­sic symp­toms of neona­tal ab­sti­nence syn­drome, in­clud­ing a high-pitched cry, sneez­ing, jit­ter­i­ness, ex­ces­sive suck­ing, abra­sions to the face, ir­ri­tabil­ity and stiff mus­cles.

But drug tests for both mother and baby came back neg­a­tive for known sub­stances. That’s when a fam­ily his­tory was un­der­taken, and the fa­ther re­ported that the mother had been drink­ing kratom as a tea.

“It was not a sub­stance I was fa­mil­iar with, as well as most of my col­leagues,” Dr. Whit­ney B. Eldridge, lead author of the re­port and a neona­tol­o­gist for BayCare Health Sys­tem in Tampa, Florida, told The Wash­ing­ton Times. “The les­son I took home for my­self from this case is that I need to specif­i­cally ask about herbal sup­ple­ments or other nat­u­ral aids that moth­ers may use to help with opi­oid with­drawal.”

The child was treated with mor­phine and was weaned off, and was able to go home with the par­ents on its eighth day of life.

The FDA has cited five cases of neona­tal ab­sti­nence syn­drome linked to kratom, at least two in Canada and two in the U.S. — in­clud­ing Dr. Eldridge’s case.

The fifth case, how­ever, was a ret­ro­spec­tive study of 15 hos­pi­tal vis­its linked to kratom be­tween 2002 and 2016. It in­cluded the case of a 1-day-old with neona­tal ab­sti­nence syn­drome, but it’s un­clear if the case is in ad­di­tion to the cited cases or is one of them.

It’s also un­clear how many peo­ple use kratom. The Amer­i­can Kratom As­so­ci­a­tion, which ad­vo­cates for nor­mal­iza­tion of the plant’s use, says the num­ber of users range be­tween 3 mil­lion and 5 mil­lion peo­ple.

Re­spond­ing to the Pe­di­atric case re­port, FDA Com­mis­sioner Dr. Scott Got­tlieb tweeted that “Kratom is an opi­oid. There are no proven med­i­cal uses for kratom.”

Kratom is not fed­er­ally il­le­gal al­though a hand­ful of states, ci­ties and some coun­ties ban the plant.

The FDA has placed the plant on im­port alert, seiz­ing it at the bor­der or ports of en­try when it can, but the sub­stance is eas­ily bought on­line and shipped into the U.S.

AS­SO­CI­ATED PRESS

The FDA has doc­u­mented sev­eral cases of ba­bies be­ing born with neona­tal ab­sti­nence syn­drome, which doc­tors be­lieve is linked to kratom.

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