Coroner unfairly blamed re: kratom

There has been much interest and many articles recently over the use of kratom and its role in the demise of Sgt. Dana of Tupper Lake. There has been much criticism and vitriol directed primarily at Tupper Lake Coroner Shawn Stuart.

This letter is to take the heat off Tupper Lake Coroner Stuart and to try to clear the air. It should definitely be noted that Stuart’s comments are based directly on my pathological report. I was the one who concluded that Sgt. Dana’s death was the result of mitragynine (kratom) overdose. It is generally inappropriate for me to discuss specific information regarding the autopsy findings in coroner’s cases. Since the release of the cause of death has gone public, I think it is appropriate for me to make some comments.

The pathologic findings in this case can be associated with various conditions, one of which would be an overdose of a medication. In the absence of any other anatomical or toxicological findings which could cause the changes seen in Sgt. Dana, I came to the conclusion that it was the high level of mitragynine (kratom) found at toxicological examination. This level is twice as high as other reported cases in the literature, and in some cases death has been attributed to kratom in levels as low as one-fifth this level. I believe that Sgt. Dana was taking kratom to relieve pain caused by severe arthritis of the upper spine.

It should be made clear that the accusation that the coroner is acting in collusion with federal agencies is entirely untrue.

The controversy over the suggestion of making kratom illegal is well documented. Neither the coroner nor I have any interest in contributing to this controversy. It is well recognized that thousands, perhaps millions of people use kratom as an analgesic, muscle relaxant, anti-inflammatory, anti-oxidant and slight mood elevator. They do this for the relief of chronic pain and anxiety. Apparently, in spite of the widespread use of this substance, only a very few reported cases of overdose have been reported. In my opinion, the findings in this case do not impact on the safety of kratom since the rate of reported fatalities is so low.

It should be recognized that virtually any substance which has pharmacological activity could be implicated in one’s death. Case in point; aspirin, Tylenol, Benadryl and even water have been implicated in deaths due to their overdose.

I have no ax to grind in this case, and I recognize that the storm of controversy elicited by this case is probably the result of only the perceived negative influence that this death might have. It is apparent to me that the turmoil is the result of defense of this drug’s use, since so many use it and do not want to see it become a controlled substance. I personally do not believe that this drug should be made illegal, regardless of the pathological findings in this case. It appears that the overwhelming number of users of kratom find significant analgesic and psychological benefit from using it without exposing themselves to significant danger. Nonetheless, the toxicological findings in this case are hard to refute. Some cases associated with mitragynine deaths have had levels varying between 200 and 600 ng, and most are associated with other potent medications. In the literature many of the reported fatal cases had approximately one-half of the levels in this case and were usually associated with other significant pharmacologically active substances. In this case, the value was 3,500 ng/mL.

This information was given to the coroner by me, and unfortunately he is left to defend his report. Neither he nor I believe that the use of kratom should be regulated; this case only indicates that one should be concerned enough to use this and every other pharmacologically active substance judiciously.

C. Francis Varga, M.D., FACP, is a pathologist who lives in Lake Placid.

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