The woman had used oxycodone for nearly a decade, but told her doctors that she had been sober for two years. She never touched narcotics during her pregnancy, she said and had completed the withdrawal clinic.
But her newborn son was in withdrawal: nervous, screaming, and required an infusion of morphine to stay alive. The kid was looking for drugs, but why?
In the midst of an opioid epidemic, the boy's doctors did not blame heroin, fentanyl, or other illegal substances. Instead, the child had become dependent on a controversial herbal supplement: Kratom
"A false sense of security"
According to a case report published Wednesday in the journal Pediatrics, both the unnamed woman and her child were passed Urine tests specifically looking for oxycodone and other opioids. However, these tests did not look for kratom, a legal drug that has opioid-like effects at high doses.
The plant, which is native to Southeast Asia, is commonly used to treat pain and control opioid cravings. They act on the same brain receptors as morphine and similar drugs and are hailed by some as a solution to the opioid epidemic, but derided by the US Food and Drug Administration as a potentially dangerous psychoactive drug.
The mother denied using any substances during her pregnancy ̵
"I fear that women making real commitments to overcoming their dependency may develop a false sense of security," said Whitney Eldridge, a BayCare Health System neonatologist in Florida, who was the lead author of the case report.
The mother was well-intentioned, but because tests did not show any other drugs on her or the infant, her doctors said that Kratom probably caused her son's condition, clinically known as neonatal abstinence syndrome. On his eighth day, after being weaned from opioids and watched without medication, the boy was released to his parents.
It's rare, but FDA Commissioner Dr. Scott Gottlieb said in a statement, "This case is He believes the FDA knows four cases in which newborns were exposed to cratoma while in utero and experienced a newborn opioid withdrawal syndrome after delivery . "
He called the new report" a tragic case of harm "and said," it further illustrates the FDA's concern over kratom, including the potential for abuse and addiction. "
And while Eldridge hopes that further research will help legislators better regulate kratom, physicians now believe that "women who are pregnant need advice on the risk of a cratom, as with any other legal substance would be the case that may have a negative impact on their newborn. "
Ex Experts Urge Caution, Cast Doubts
Some experts are reluctant to draw conclusions from the report. They note that while the use of maternal cri- teres could theoretically cause neonatal abstinence syndrome, there was no explicit relationship between kratom and the child's withdrawal syndrome.
"I'm not surprised that this is possible," Dr. Researcher at Columbia University, Andrew Kruegel, researcher at Columbia University, says, "Because kratom undoubtedly has opioid effects and can induce user tolerance, especially at higher doses."
But Kruegel, who has been studying the facility for seven years, found that doctors did not test The biggest caveat is that we do not know anything about the dosage of the mother, "he said. "Without this information, you can not really extrapolate too much."
And the mother might not have taken a kratom at all, said Dr. Edward W. Boyer, associate professor at Harvard Medical School and a doctor in the emergency department at Brigham and Women's Hospital.
"It's the husband who reported the use of the cratom," he said. "The woman who actually took the product she thought was kratom and the authors of the case herself report that none of these people actually confirmed that they were taking kratom."
Kratom's stony past and uncertain future
Despite the FDA's warnings, kratom is easy to buy and is sometimes sold as tea in cafes. The non-profit American Kratom Association estimates that 3 to 5 million Americans use the substance, and the group indicates that warnings for kratom products are available.
"We believe that, as in many supplements, there should be a warning for pregnant women women should not stand it," said the association's chairman, Dave Herman. "That's not because we think it's harmful. This is because it is a security measure.
Kratom affects opioid receptors, which, according to the FDA, is evidence of its potential for abuse. The agency points to 44 deaths related to kratom, but Kruegel said, "Looking at these 44 deaths, most refer to other substances, including other potent opioids."
Boyer said crater could have other risks, such as seizures, but he noted that it could be safer than most opioids, because "there does not seem to be any respiratory depression when kratom is used alone."
Respiratory depression – slow and ineffective breathing – makes opioid overdoses so deadly. For this reason, Boyer believes that a well-regulated kratom could someday be used in the fight against opioid addiction to deter users of more dangerous drugs.
"If you do the right thing and do the rigorous studies, there is no reason for it [kratom] should not be a prescription drug that serves as a bridge to formal medical treatment, especially for people who can not get therapy"
Challenges in the Development of Kratom-Based Drugs
The American According to the Kratom Association, there is little incentive for pharmaceutical companies to study Krratom as a potentially prescription drug, mainly because they can not patent the raw plant.
"If I'm a pharmaceutical company, I think it costs somewhere between $ 1.2 and $ 1.8 billion, depending on who you speak with, to bring a new drug to market," he said Herman. "Who would spend so much money when another guy just gets on a boat, goes down a river, and gets one Tree Can Take? "
Since Kratom is considered a dietary supplement, manufacturers do not need to sell FDA approval unless their products claim to cure or treat certain conditions or symptoms.
But some companies have done just that by blaming the FDA for their products because they say their products could "relieve opioid withdrawal" or "treat a myriad of complaints". "The association says these cases are anomalies.
" The reality is, we believe this is America, "Herman said," and if a product is useful for your health and well-being, you should have the right to take it as long as it does not harm you, and we have not seen any evidence of this damage. "
However, the FDA continues to warn against kratom, even suggesting that it could exacerbate the opioid epidemic.
"Kratom has never been studied in humans" Gottlieb said in the statement. "What consumers and healthcare providers need to understand is that there are no proven medical applications for kratom. Instead, Kratom, as the FDA has warned, can cause serious harm and contribute to the opioid crisis. "