The relationship between Mitragynine blood concentrations and death in Thailand

Abstract

Kratom (Mitragyna speciosa Korth) is a plant that is indigenous to Thailand and leads to addiction. In Thailand, every part of the Kratom plant is classified as a Penal Drug in a Category-5 Narcotic under the Narcotics Act B.E. 2522 (1979). Mitragynine and its derivatives are a type of alkaloids from the Kratom plant that have pharmaco-toxicological effects. Blood samples of the deceased whose urine screening with Toxtyper^TM was positive for Mitragynine (N = 34) and blood samples of persons suspected of Kratom abuse (N = 7) were obtained from the Institute of Forensic Medicine under the Royal Thai Police Headquarters from January 2017 to December 2017. The purpose of this research is to study the Mitragynine blood levels in Thai people. The average blood Mitragynine concentration of all 41 samples (categorized into 7 groups) was 197.71338.16 ng/ml (ranged 2.98 - 1,554.23). Group A (N = 15), a group of people whose the autopsy results were not able to determine the exact cause of death, indicated the average blood Mitragynine concentrations of 332.96495.27 ng/ml, while the average blood Mitragynine concentration of Group B (N = 12), fatal accident victims, was 114.99145.19 ng/ml. Moreover, Group C  (N = 2) with homicidal cases reported the blood Mitragynine concentration at 347.84205.47 ng/ml, Group D (N = 1) with a suicide case reported at 60.40 ng/ml, Group E (N = 1) in which a person died from cancer reported at 2.98 ng/ml, Group F (N = 3) in which people died from cardiovascular disorders reported at 232.60333.10 ng/ml, and Group G (N = 7) who were suspected of Kratom abuse reported at 39.2932.29 ng/ml. High blood Mitragynine concentrations can also cause death. This is the first study in Thailand investigating the level of Mitragynine in blood samples of the deceased and the accused.