Kratom is used not only to treat pain but also to alleviate anxiety, increase energy, elevate mood, and reduce the symptoms of posttraumatic stress disorder. It is sold in varying amounts such as ounces, all the way to kilos, and usually comes in a powdered form, but it can also be sold as leaves to make tea. 7 Kratom can be purchased over-the-counter and online. The half-life of 7-hydroxymitragynine is 98.7 minutes in human plasma. 6 As an agonist, 7-hydroxymitragynine has high affinity for mu receptors and low affinity for kappa receptors. Mitragynine acts as an agonist on mu and delta receptors. The main alkaloid, mitragynine, is metabolized in the liver by CYP3A4 to 7-hydroxymitragynine. Kratom acts as an analgesic and is used similarly to an opioid. Kratom is a plant of the Rubiaceae family and is found in southeast Asia. And like I said it comes right back after a relapse, but in more places.” 5 4 A 5-year user who tanned regularly reported several “permanent bruise-looking things.” 4 Another Reddit user who noticed hyperpigmentation on the forehead in the winter said that it “fades considerably but it takes months. For example, a female user who took a self-reported 40 g/day of kratom for 3 years reported darkening below her eyes and in the cheek bone area. One report describes “skin pigmentation on the cheeks, due to the capacity of mitragynine to increase the production of melanocytes-stimulating substance.” 3 Online forums such as Reddit have mentions of kratom hyperpigmentation. 2įew reports of kratom-associated hyperpigmentation can be found in the medical literature. According to the survey, 97.7% lived in the United States, 60.7% were female, 89.8% were White, and 40.9% used kratom for opioid withdrawal. 1 An anonymous, cross-sectional survey conducted from January 2017 to December 2017 identified 2798 kratom users. As measured by call reports to the United States National Poison Data System, in 2011, there were 11 reported kratom exposures and in the first 7 months of 2018, there were 357 reported exposures. Kratom use in the United States has increased dramatically over the past decade. Continue to ensure access to necessary medical care, and to emergency services if needed and if in alignment with resident goals of care.Kratom hyperpigmentation on the left hand.Frequently clean often-touched surfaces in the memory care unit, especially in hallways and common areas where residents and staff spend a lot of time.Limit the number of residents or space residents at least 6 feet apart as much as feasible when in a common area, and gently redirect residents who are ambulatory and are in close proximity to other residents or personnel.Provide safe ways for residents to continue to be active, such as personnel walking with individual residents around the unit or outside.Continue to provide structured activities, which may need to occur in the resident’s room or be scheduled at staggered times throughout the day to maintain social distancing.Limit personnel on the unit to only those essential for care. Dedicate personnel to work only on memory care units when possible and try to keep staffing consistent.Cloth face coverings should not be used for anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove the mask without assistance. Try to keep their environment and routines as consistent as possible while still reminding and assisting with frequent hand hygiene, social distancing, and use of cloth face coverings (if tolerated). Routines are very important for residents with dementia.A Test-based strategy is no longer recommended unless the employee is immunocompromised, or symptoms persist for > 20 days. – At least 10 days have passed since symptoms first appeared.Those who show severe signs and symptoms may require an isolation period of up to 20 days. – At least 24 hours have passed since recovery defined as, resolution of fever without the use of fever-reducing medications, and improvement in respiratory symptoms (e.g., cough, shortness of breath) and – The employee will remain off work (continue isolation) until 10 days have passed since first specimen collection.Symptom-based strategy (exclude from work/continue isolation until): – If positive result is confirmed via PCR swab, then THE CRITERIA BELOW ALSO APPLIES TO DISCONTINUATION OF ISOLATION-BASED PRECAUTIONS – PER CDCAsymptomatic employees:
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