By Stuart Kurtz, D-ABFT-FT
Axis Forensic Toxicology has previously written on kratom and cases involving kratom fatalities. As a quick recap, Mitragyna speciosa, is a tree or shrub that grows in southeast Asia. It’s part of the Rubiaceae family which includes coffee plants. It can be consumed by chewing leaves, brewing a beverage, or pulverized and smoked or put in a capsule. Fatalities have been reported from kratom use with mitragynine as the primary alkaloid responsible for toxic effects.
7-OH mitragynine is naturally occurring in the kratom plant at about 2% of the alkaloid content and is 10 times more potent than mitragynine. Reported side effects include agitation, nausea, vomiting, confusion, seizures, and fast heart rate. Due to activity at the mu opioid receptor, the receptor primarily associated with opioids such as fentanyl and morphine, severe cases can present similar to opioid overdoses. 7-OH mitragynine is further metabolized into mitragynine pseudoindoxyl which is 100 times more potent than mitragynine. Mitragynine pseudoindoxyl is also found in the kratom plant in low concentrations. Labs that test for mitragynine may not currently be testing for 7-OH mitragynine. Historically, the concern with kratom related toxicity has been centered on testing for mitragynine since that was the primary alkaloid in kratom products. However, new products may contain higher amounts of 7-OH mitragynine and/or mitragynine pseudoindoxyl and low or no amount of mitragynine which investigators and labs should be aware of moving forward with these cases.
Image from United States Food and Drug Administration showing 7-OH mitragynine extract (left), powder (middle), and gummies (right).
7-OH mitragynine products are manufactured by converting mitragynine in the kratom plant to 7-OH mitragynine. Available products containing primarily 7-OH mitragynine include concentrates, edibles, extracts, beverages, and tablets for chewing or swallowing. Testing of these products shows that they are primarily 7-OH mitragynine with a variable amount of unconverted mitragynine and other products that could be related to the synthesis process. These can often be found in stores that also sell kratom products and lead to confusion as to what the buyer is actually getting. Given the increase in potency of 7-OH mitragynine compared to mitragynine, the primary alkaloid in kratom, a naïve user may experience a toxic event if they are expecting the product to behave like kratom.
Image from United Nations Office on Drugs and Crime Laboratory and Scientific Services Portal showing 7-OH mitragynine tablets and testing results of the contents.
Interpretation can be tricky when it comes to mitragynine presence. It can be associated with kratom use or synthesis of mitragynine to produce the more potent 7-OH mitragynine instead of, or in addition to, mitragynine. A good indicator will be what products are found at the scene and if they are consistent in how they are labeled between products. A product labeled as kratom or mitragynine may actually be a 7-OH mitragynine product especially since the FDA is currently in the process of scheduling mitragynine only, which may lead to more products containing 7-OH mitragynine to avoid legal issues. Therefore, testing for both mitragynine and 7-OH mitragynine will be useful. Axis recommends that you check the testing scope with your lab to see if they test for one, both, or neither of these compounds. Axis currently screens with LC-QToF-MS for mitragynine and 7-OH mitragynine in our 70510 Comprehensive Panel with Analyte Assurance. Confirmation of mitragynine is quantitative using LC-MS/MS and 7-OH mitragynine is qualitative using LC-QToF-MS.
If you have any questions regarding this or other topics, please reach out to us via email [email protected] or call at 317-759-4869 option 3.
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