A Kamloops family is dealing with the knowledge their loved one ingested a substance he likely thought would assist his drug recovery, when it instead contributed to his death.
Last September, KTW spoke with the parents of Aaron Manson, 26, who died from a fatal drug overdose in his home on April 26, 2021.
While a record number of people in B.C. continue to die from overdoses — the majority 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 the hope that others don’t suffer the same fate as her son.
The coroner’s report revealed Aaron died from a fatal mix of cocaine, kratom, diphenhydramine (an over-the-counter allergy medicine) and hydromorphone, an opioid used to treat pain that Manson was not prescribed.
“The combined effects of mitragynine (kratom), diphenhydramine and hydromorphone can cause life-threatening respiratory depression and failure,” the coroner’s report reads, classifying the death as accidental.
The amount of cocaine in Aaron’s system was described as within a concentration associated with “recreational use,” while the diphenhydramine and hydromorphone were within a “therapeutic range,” according to the coroner’s report.
The amount of kratom, however, 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, assuming his death would have involved an opioid like fentanyl.
The night before he died, Aaron had taken cocaine while out, returning home at about 1:30 a.m.
Aaron passed his father, Bart, a retired paramedic, in the hall on his way to bed at 6 a.m. and admitted to having used, but said he was feeling fine.
Troylana said she checked on her son at about noon, having heard him snoring a couple of hours earlier, but he couldn’t be roused. Two doses of naloxone and CPR did nothing to revive him and Aaron was pronounced deceased when paramedics arrived.
Parents found evidence of kratom use in son’s room
According to his family, Aaron felt ashamed of his addiction and took steps to address it on his own. They feel the stigma of drugs contributed to his death as it kept him from openly seeking treatment.
In the year preceding Aaron’s death, there was no record of treatment in hospital for substance misuse and he was not prescribed opioid agonist therapy by his physician, according to the coroner’s report. Upon examination of his room by the attending coroner, drug paraphernalia was found, including a paper flap with white residue, a drug baggie, a small bag of green/brown powder, a pill with white powder and text messages about acquiring illicit drugs, the report states. There was no evidence of traumatic injury or foul play.
According to Health Canada, kratom is a plant native to Southeast Asia that is widely available on the internet, often sold in pill or powder form. The psychoactive herb is known to create both stimulative and sedative effects, posing health risks when inhaled or swallowed, including drowsiness, nausea, vomiting and seizures, according to Health Canada, which advises against its use given the health risks.
While the sale of health products containing kratom is illegal in Canada, the federal agency said the substance is known to be sold alongside unproven claims for treatment of opioid addiction and withdrawal.
Troylana and Bart Manson figure their son was using kratom to help him detox from alcohol and opiates.
The parents said they found a cup with greenish-brown, watery residue in their son’s room after it was searched. However, they didn’t think much of the dirty cup at the time and had it washed before learning the results of the coroner’s report.
They now presume Aaron ingested the kratom with water the morning he died, which, Troylana said, could explain the amount of time that passed between him ingesting illicit drugs the night before and dying in his sleep.
She said a package of powder police seized from Aaron’s room had the words “Red MD,” which is a type of kratom, and “50 grams” handwritten on it.
“Although the kratom is what killed him, we also know he took it with good intentions,” Troylana said, noting that knowledge comforts her.
Kratom illegal to sell, but not classified as narcotics
Health Canada classifies kratom as a natural health product (NHP) that doesn’t have the required pre-market review and authorization 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 criminal offence comparable to selling narcotics. Its sale as a natural health product without Health Canada approval violates the Food and Drug Act. Health Canada encourages people with information about the sale or advertising of kratom to report it using its online complaint form.
Troylana said none of her son’s banking information indicated a purchase of kratom, so she believes he may have bought it in Kamloops with cash.
“If Aaron got this stuff here, he’s not the first one,” she said.
Dr. Tom Kosatsky, a public health leader at the B.C. Centre for Disease Control, told the Vancouver Sun that since kratom hasn’t been scheduled as a controlled substance, nor put on Canada’s list of drugs requiring prescriptions, people are allowed to import it for personal use. He said B.C. residents are known to buy it online, from local stores and from friends, but since it can’t be legally sold as a health product, it is often promoted as botanical powder for use in soap and candlemaking.
BC Coroners Service spokesperson Ryan Panton told KTW via email that kratom has been screened for involvement in fatal overdose investigations since 2019, due to its potential to contribute to death. Since then, the BC Coroners Service has detected kratom in 11 fatal overdoses across the province. Of those, three involved a potentially fatal concentration. Panton said the majority of overdose deaths involving kratom included traces of multiple drugs.
According to the Mayo Clinic in the United States, “poison-control centers in the United States received about 1,800 reports involving use of kratom from 2011 through 2017, including reports of death. About half of these exposures resulted in serious negative outcomes, such as seizures and high blood pressure. Five of the seven infants who were reported to have been exposed to kratom went through withdrawal. Kratom has been classified as possibly unsafe when taken orally.”
Health impacts of kratom differ from fentanyl
Dr. Carol Fenton, Interior Health’s Kamloops-based medical health officer, told KTW the metabolic byproduct of kratom (the parts that remain as it is broken down by the body) are four to 100 times as potent as the drug before it is ingested. She said this makes kratom impossible to dose with any certainty, as each person’s body will metabolize the substance at different speeds to varying degrees. It is, therefore, a risky substance to ingest, Fenton said.
Fentanyl works in the opposite way, as it is the drug itself, not its metabolic byproduct, that can cause overdoses. Once the body breaks down fentanyl molecules, it is no longer active.
“Fentanyl is dangerous because it’s so very concentrated,” Fenton said, noting a sand-sized grain of fentanyl can cause an overdose as there is little precision in street-level compounding of the drug.
Asked if kratom is a more dangerous than fentanyl, Fenton said it’s difficult to compare the two, noting there are many more overdose deaths from fentanyl.
Fenton said kratom could be dangerous on its own and, because it sticks around in the system for a long time — given a half-life of 23 hours — it could also be dangerous in combination with other drugs. Fenton doesn’t recommend people use kratom for opioid replacement therapy, noting suboxone is a much safer option. However, for anyone who is considering using kratom, Fenton recommends caution, using only the smallest of amounts to monitor how their body reacts.
Troylana said she has heard from people using kratom as opioid maintenance and wants the public to be aware of its potency, know that it is opioid-like and understand what their dosage should be, adding the product also needs to be labelled properly.
“In Aaron’s case, he didn’t know,” Troylana said. “It was just a bag that looked like it was a one-dose thing and he put it in his water and off it went. If he knew it was [supposed to be] a teaspoon, he would have done that, but there was nothing on there.”