Introducing a new tool - PsychCombo

That case report was not kratom alone:

"polysubstance overdose, with gas chromatography / mass spectrometry (GC/MS) during that admission positive for bupropion, venlafaxine, and kratom."

I'm also not sure that the conclusion of the animal study supports your statement about dried vs fresh either, its only comparing morphine, 7-OH mitragynine, and mitragynine and the conclusion is that 7-OH mitragynine can induce respiratory depression in a dose dependent fashion while mitragynine does not. 7-OH mitragynine is a very minor component of most dried leaf preparations afaik rather it is an active metabolite of mitragynine
 
LiamEngel said:
CmonYouShouldKnowBetter - could you please PM or email ([email protected]) me your email address or GitHub username so we can add you to the project? Thanks again for collecting these papers!

I agree that kratom, relative to most common opioids, has less respiratory risk, but I think there is still some risk of respiratory depression with kratom.

In this case report, kratom seemed to induce significant respiratory depression.

In this animal study "respiratory depressant effects of mitragynine showed a ceiling effect... In contrast, 7-OH mitragynine induced a dose-dependent effect on mouse respiration." This suggests respiratory depression is a greater risk for dried kratom relative to fresh.

In my view, it seems safest to treat Kratom like a typical opioid when we estimate risk for the public, until there is more evidence around this combination.
Click to expand...
I agree 100. Kratom is an opioid agonist and should be treated as such. Thanks for these studies! Ill email you my info...
 
LiamEngel said:
CmonYouShouldKnowBetter - could you please PM or email ([email protected]) me your email address or GitHub username so we can add you to the project? Thanks again for collecting these papers!

I agree that kratom, relative to most common opioids, has less respiratory risk, but I think there is still some risk of respiratory depression with kratom.

In this case report, kratom seemed to induce significant respiratory depression.

In this animal study "respiratory depressant effects of mitragynine showed a ceiling effect... In contrast, 7-OH mitragynine induced a dose-dependent effect on mouse respiration." This suggests respiratory depression is a greater risk for dried kratom relative to fresh.

In my view, it seems safest to treat Kratom like a typical opioid when we estimate risk for the public, until there is more evidence around this combination.
Click to expand...
Interesting!! Yes I agree, without concrete evidence - kratom should be treated as the opioid agonist that it is. I sent you an email. :)
 
You need to either take a massive amount of kratom or extract/7-OH isolate or take it alongside other drugs that increase metabolism or otherwise induce recruitment of beta arrestin to induce respiratory depression

"At the same time, we have also found that both mitragynine and 7-OH are G protein-biased agonists of the mu-opioid receptor (MOR).21,25 We have thus classified the kratom alkaloids as “atypical opioids” and have postulated that these compounds may provide a greater therapeutic window between analgesia and classical opioid side effects. For example, other MOR agonists that activate G protein signaling without recruiting the beta-arrestin pathway exhibit attenuated respiratory depression and reduced inhibition of gastrointestinal (GI) transit compared to classical opioids."

www.ncbi.nlm.nih.gov

7-Hydroxymitragynine Is an Active Metabolite of Mitragynine and a Key Mediator of Its Analgesic Effects

Mitragyna speciosa, more commonly known as kratom, is a plant native to Southeast Asia, the leaves of which have been used traditionally as a stimulant, analgesic, and treatment for opioid addiction. Recently, growing use of the plant in the United States and ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

The evidence that it is G protein biased already exists
 
Great stuff someguyontheinternet - I had thought 7-OH was more present in dried vs. fresh kratom, but I can't find anything to back that up - not sure where I heard that one. I'm definitely excited for the future of kratom research, there is a lot to learn I think.

In the case study paper "during that admission" refers to a previous hospital admission, during the admission focused on "GC/MS analysis of her urine during this visit was positive only for the presence of kratom and did not show other opioids", so this does seem to be a novel instance of kratom overdose.

I completely agree that there is relatively less risk of respiratory depression with, for example, kratom + opioids vs. poppies + opioids. However, being risk averse we left rated both of these combinations as greater risk. someguy - are you in suggesting we reduce kratom + opioids to minor risk?

CmonYouShouldKnowBetter - stoked to have you on board, I just replied :)
 
Frankly I don't know how I would rate that risk, my current knowledge only allows me to comment on mechanisms and interpretation of the literature

But you are correct on the case report, I apologize I misread it although I definitely don't put a lot of value in single case reports as it is an n of 1 and there can be many other factors involves such as opioid research chemicals. Considering the current state of the black market and the prevalence of counterfeit pills and weird shit in "dope" we can only really guess. When doing GCMS on complex mixtures like urine looking for metabolites, possibly unknown metabolites for novel compounds we really can't be sure.

The mouse study linked earlier on respiratory depression I think is the strongest evidence currently in this thread for the relative risk of kratom consumption

That being said mitratgynine does get metabolized to 7-OH mitragynine and that does have a does dependent effect on respiratory depression. Considering this fact I would say that there would be an additive effect when combining with other opioids that also have a dose dependent effect of respiratory depression and should probably be avoided
 
LiamEngel said:
I had thought 7-OH was more present in dried vs. fresh kratom, but I can't find anything to back that up - not sure where I heard that one
Click to expand...
supposedly, oxidation (by sun+air) helps convert mitragynine into 7OH. This may be lore but I did see good peer-reviewed something on it once.
 
Very helpful tool, I hope to see them add even more substances in the future. 😃
 
I had a nightmare experience with MDMA and cannabis 2+ years ago, full-blown psychosis for a few hours, lost my sh1t, cognition etc, was incredibly scary, ended up in hospital. Maybe because I smoked weed only a few minutes after I popped MDMA. Learnt my lesson anyway... So, surprised to see it listed as a low risk.
 
robbli777 said:
I had a nightmare experience with MDMA and cannabis 2+ years ago, full-blown psychosis for a few hours, lost my sh1t, cognition etc, was incredibly scary, ended up in hospital. Maybe because I smoked weed only a few minutes after I popped MDMA. Learnt my lesson anyway... So, surprised to see it listed as a low risk.
Click to expand...
I can almost guarantee its because we have to go by what we have in studies. Not saying that your experience isnt valid but if we went by anecdote only for harm reduction you can imagine what kind of bad info would be used.
 
You must log in or register to reply here.
Top