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Research Gate

March 25, 2014

Journal of Health Research, 01/2010; 24(1):43-47

Wichian Tungtananuwat and Somsong Lawanprasert

 Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330,Thailand.


A corpse of 21-years-old man (Muslim) was investigated for the cause of death. His family declined consent for full autopsy. Thus, only blood and urine were used for toxicological analysis by liquid chromatography-electrosray ionization-time of flight mass spectrometry. These following substances were found in the blood and urine samples: mitragynine (an alkaloid found in Kratom; Mitragyna speciosa leaves), caffeine, diphenhydramine, alprazolam, nortriptyline, methadone, tramadol, methamphetamine and some of their metabolites. The findings of this case suggested the possibility of polydrugs abuse calls “4×100”, a Kratom juice cocktail that has been popular in Southernmost provinces of Thailand. It is made from four major ingredients, boiled Kratom leaves, Cola soft drink, cough syrup and tranquilizers [or antidepressants] or mosquito coils. In this case, the cause of death might be due to multidrugs intoxication of the  additive adverse effects especially CNS and respiratory depression.


Mitragyna speciosa Korth.) juice cocktail called “4×100” formulae is becoming abused by youth addicts and causes a terrible social problem in Thailand, especially in
young Muslim in Bangkok and people in three southernmost provinces of Thailand. The origin of the name “4×100” is unclear, but it likely came from its four ingredients. Boiled Kratom leaves, Cola soft drink and codeine- or diphenhydramine- containing cough syrup are three major ingredients while the forth ingredient depends on the producer’s satisfaction or is whatever that makes them drunk i.e. mosquito coils, anxiolytic drugs or antidepressants (alprazolam, diazepam, amitriptyline, nortriptyline, etc.), analgesic (paracetamol, tramadol), some of drug abuse (methadone, marijuana, methamphetamine), herbicide, or even the powder
peeled from the inside of fluorescent light bulbs.
After War on Drug Campaign in 2003, some addicts switch to other inebriate substances such as alcohol, tranquilizers and Kratom. In this regard, “4×100” has become popular as a cocktail drug abuse formulae in youthful Muslim because consuming this cocktail formulae causes a feeling like drinking alcohol which is prohibited in their religious regulation.