Family upheaval after little-known drug kratom contributes to fatal overdose of BC man – Terrace Standard

– Kamloops this week

A Kamloops family struggles with the knowledge that their loved one has ingested a substance they probably thought would aid in his drug rehabilitation, when instead it contributed to his death.

Last September, KTW spoke to the parents of Aaron Manson, 26, who died of a fatal drug overdose at his home on April 26, 2021.

While a record number of people in BC continue to die from drug overdoses – most of which are fentanyl-related deaths, according to his coroner’s report – Aaron’s death was caused by a plant extract with opioid properties known as kratom (Mitragyna speciosa).

Aaron’s mother, Troylana Manson, is now spreading the word about the dangers of kratom in hopes that others will not suffer the same fate as her son.

The coroner’s report revealed that Aaron died from a deadly mix of cocaine, kratom, diphenhydramine (an over-the-counter allergy medication) and hydromorphone, an opioid used to treat pain that Manson was not prescribed.

“The combined effects of mitragynine (kratom), diphenhydramine, and hydromorphone can result in life-threatening respiratory depression and respiratory failure,” the coroner’s report said, but the death was an accident.

The amount of cocaine in Aaron’s system was described as being within a concentration associated with “recreational use,” while diphenhydramine and hydromorphone were within a “therapeutic range,” according to the coroner’s report.

However, the amount of kratom was within the range associated with fatalities, according to the report.

Troylana said she was shocked to learn her son’s death was caused by kratom as she believed an opioid such as fentanyl might have been involved in his death.

The night before his death, Aaron had taken cocaine on the go and returned home around 1:30 a.m

Aaron passed his father, Bart, a retired paramedic, at 6 a.m. on his way to bed and admitted to using it, but said he felt fine.

Troylana said she checked on her son around noon after hearing him snoring a few hours earlier, but could not be woken. Two doses of naloxone and CPR did nothing to revive him, and Aaron was pronounced dead when paramedics arrived.

Parents found evidence of kratom use in their son’s room

According to his family, Aaron was ashamed of his addiction and took steps to address it himself. They believe the stigma surrounding drugs contributed to his death as it discouraged him from openly seeking treatment.

In the year before Aaron’s death, there were no records of hospital treatment for substance abuse, and according to the coroner’s report, he was not prescribed opioid agonist therapy by his doctor. Upon examination of his room by the attending coroner, drug paraphernalia were found, including a paper flap with white residue, a drug pouch, a small bag of green/brown powder, a pill containing white powder, and text messages about illegal drug acquisition to report conditions. There was no evidence of traumatic injury or third-party negligence.

According to Health Canada, kratom is a plant native to Southeast Asia that is widely available online and often sold in pill or powder form. The psychoactive herb is known for having both stimulant and sedative effects that pose health risks if inhaled or ingested, including drowsiness, nausea, vomiting, and seizures, according to Health Canada, which discourages its use given the health risks.

While selling health products containing kratom is illegal in Canada, the federal agency said the substance is known to be sold alongside unsubstantiated claims to treat opioid addiction and withdrawal.

Troylana and Bart Manson believe their son used kratom to help him detox from alcohol and opiates.

The parents said they found a cup containing greenish-brown, watery residue during a search of their son’s room. They didn’t think much of the dirty cup at the time, however, and had it washed before learning the results of the coroner’s report.

They now believe Aaron ingested the kratom with water the morning of his death, which Troylana says could explain the time that elapsed between taking illegal drugs the night before and dying in his sleep.

She said a packet of powder seized by police from Aaron’s room had the words “Red MD,” a type of kratom, and “50 grams” handwritten on it.

“Even though the kratom killed him, we also know that he took it with good intentions,” Troylana said, finding comfort in the knowledge.

Kratom cannot be sold, but is not classified as a narcotic

Health Canada classifies kratom as a natural health product (NHP) that does not have the necessary pre-market verification and approval to be sold in Canada, making its sale illegal.

According to a 2018 article in the Vancouver Sun, selling kratom in Canada is not a crime comparable to selling narcotics. Selling it as a natural health product without Health Canada’s approval violates the Food and Drug Act. Health Canada encourages anyone with information regarding the sale or promotion of kratom to report it through its online complaints form.

Troylana said none of her son’s banking information indicates a purchase of kratom, so she believes he may have bought it in Kamloops with cash.

“If Aaron has this stuff here, he’s not the first,” she said.

dr Tom Kosatsky, a public health director at the BC Center for Disease Control, told the Vancouver Sun that since kratom is not classified as a controlled substance, nor is it included on Canada’s prescription drug list, it is allowed to be imported for personal use. He said BC residents have been known to buy it online, in local stores and from friends, but because it can’t legally be sold as a health product, it’s often advertised as a botanical powder for use in soap and candle making .

BC Coroners Service spokesman Ryan Panton emailed KTW that kratom has been under investigation since 2019 for its involvement in fatal overdose investigations due to its potential to contribute to death. Since then, the BC Coroners Service has detected kratom in 11 fatal drug overdoses across the province. Three of these were at potentially lethal concentrations. Panton said the majority of kratom overdose deaths contained trace amounts of multiple drugs.

According to the Mayo Clinic in the United States, “Poison centers in the United States received approximately 1,800 reports of kratom use from 2011 through 2017, including death reports. About half of these exposures resulted in serious adverse outcomes such as seizures and high blood pressure. Five of the seven infants reported to have been exposed to kratom went through withdrawal. Kratom has been assessed as Possibly Unsafe when taken orally.”

READ MORE: BC paramedics receive record number of overdose calls in 2021, up 31% since 2020

The health effects of kratom differ from those of fentanyl

dr Carol Fenton, medical health officer of Interior Health in Kamloops, told KTW that kratom’s metabolic byproduct (the bits left behind when it’s broken down by the body) is four to 100 times more potent than the drug before it is taken. She said this makes it impossible to dose kratom with certainty, as each person’s body will metabolize the substance at different rates and to different degrees. It’s therefore a risky substance to take, Fenton said.

Fentanyl works in the opposite way as it is the drug itself, not its metabolic by-product that can cause overdoses. Once the body breaks down fentanyl molecules, it is no longer active.

“Fentanyl is dangerous because it’s so highly concentrated,” Fenton said, noting that a sand-sized grain of fentanyl can cause an overdose because there’s little precision in manufacturing the drug at street level.

When asked if kratom was more dangerous than fentanyl, Fenton said it was difficult to compare the two, noting that there were many more overdose deaths from fentanyl.

Fenton said that kratom could be dangerous on its own, and because it stays in the system for a long time – with a half-life of 23 hours – it could also be dangerous in combination with other drugs. Fenton advises against using Kratom for opioid replacement therapy as Suboxone is a much safer option. However, Fenton advises anyone looking to use kratom to exercise caution, using only the smallest amounts to monitor how their body is reacting.

Troylana said she’s heard from people using kratom as opioid maintenance and wants the public to be aware of its potency, know it’s opioid-like and understand what their dosage should be, adding, that the product must also be labeled correctly.

“In Aaron’s case, he didn’t know,” Troylana said. “It was just a sachet that looked like it was a single dose and he put it in his water and off we went. If he knew [supposed to be] a teaspoon, he would have done that, but there was no truth to it.”

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