Complications from alternative opioids continue to be reported by ToxIC participants. Recently, agitated delirium in a user of Akuamma, an opioid alternative derived from seeds of the Picralima nitida tree, was reported. Studies have shown Akuamma alkaloids to have affinity for mu-, delta-, and kappa- opioid binding sites, and for effects to be antagonized by naloxone.
Interestingly, this patient had initially detoxed from OxyContin using another natural opioid alternative, Kratom (Mitragyna speciosa), but switched to Akauamma due to the high cost of purchasing Kratom. Clinicians, please remember to ask patients about use of opioid alternatives and to remind them of serious complications that can occur.