Changing trends in the use of kratom (<i>Mitragyna speciosa</i>) in Southeast Asia

Singh, Darshan; Narayanan, Suresh; Vicknasingam, Balasingam; Corazza, Ornella; Santacroce, Rita; Román-Urrestarazu, Andrés

doi:10.1002/hup.2582

Cited by 64 publications

(50 citation statements)

References 22 publications

(78 reference statements)

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“…A distinction can be made in regard to the income of kratom users, which appears to be primarily among the lower end in Southeast Asian countries although it is used across all income categories in the United States. A minority of users in both populations do take kratom to mitigate withdrawal symptoms from an illicit drug, and even fewer do develop addiction or dependence on kratom (Grundmann, ; Singh et al, ).…”

Section: Discussionmentioning

confidence: 99%

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Distinct kratom user populations across the United States: A regional analysis based on an online survey

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Veltri

et al. 2019

Human Psychopharmacology

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Objective Kratom preparations have raised concerns of public health and safety in the United States. This paper analyzed the patterns and predictors of kratom use by four U.S. regions according to the U.S. Census. Method An anonymous cross‐sectional online survey yielded 8,049 valid responses. The data were categorised by regions (Northeast, South, Midwest, and West) and analyzed for the following predictors: age, gender, marital status, ethnicity, employment status, insurance coverage, education, and household income. Results After adjusting for state population, the survey response rates were highest from Oregon, Idaho, and Florida. Kratom use was significantly lower for both prescription drug dependency and acute or chronic pain in the Northeast region than the rest of the country. Multiple logistic regression models found that gender, employment, and education were significant on the regional level. Higher education was associated with lower kratom use for an illicit drug dependency (p = .002) independent of region whereas men were less likely to use kratom for acute or chronic pain in the Northeast (p < .001) but more likely in the Midwest (p = .041). Conclusions The regional pattern of kratom use differed from opioid use data in both demographics and trend direction warranting further investigation.

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Section: Discussionmentioning

confidence: 99%

“…A minority of users in both populations do take kratom to mitigate withdrawal symptoms from an illicit drug, and even fewer do develop addiction or dependence on kratom (Grundmann, 2017;Singh et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Distinct kratom user populations across the United States: A regional analysis based on an online survey

Nicewonder

Buros

Veltri

et al. 2019

Human Psychopharmacology

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“…), or consumed for non‐medical purposes in the form of a cocktail with other illicit substances to induce euphoria (Singh, Narayanan, & Vicknasingam ; Singh et al . ). A recent CNN article titled “Can the kratom plant help fix the opioid crisis?” highlighted positive reports from users of ketum products (which are sold as supplements), to manage chronic pain and to wean users off opiates (Nadia Kounang, CNN Health+ ).…”

Section: Introductionmentioning

confidence: 97%

Rate and extent of mitragynine and 7‐hydroxymitragynine blood–brain barrier transport and their intra‐brain distribution: the missing link in pharmacodynamic studies

et al. 2018

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Mitragyna speciosa is reported to be beneficial for the management of chronic pain and opioid withdrawal in the evolving opioid epidemic. Data on the blood-brain barrier (BBB) transport of mitragynine and 7-hydroxymitragynine, the active compounds of the plant, are still lacking and inconclusive. Here, we present for the first time the rate and the extent of mitragynine and 7-hydroxymitragynine transport across the BBB, with an investigation of their post-BBB intra-brain distribution. We utilized an in vitro BBB model to study the rate of BBB permeation of the compounds and their interaction with efflux transporter P-glycoprotein (P-gp). Mitragynine showed higher apical-to-basolateral (A-B, i.e. blood-to-brain side) permeability than 7-hydroxymitragynine. 7-Hydroxymitragynine showed a tendency to efflux, with efflux ratio (B-A/A-B) of 1.39. Both were found to inhibit the P-gp and are also subject to efflux by the P-gp. Assessment of the extent of BBB transport in vivo in rats from unbound brain to plasma concentration ratios (K ) revealed extensive efflux of both compounds, with less than 10 percent of unbound mitragynine and 7-hydroxymitragynine in plasma crossing the BBB. By contrast, the extent of intra-brain distribution was significantly different, with mitragynine having 18-fold higher brain tissue uptake in brain slice assay compared with 7-hydroxymitragynine. Mitragynine showed a moderate capacity to accumulate inside brain parenchymal cells, while 7-hydroxymitragynine showed restricted cellular barrier transport. The presented findings from this systematic investigation of brain pharmacokinetics of mitragynine and 7-hydroxymitragynine are essential for design and interpretation of in vivo experiments aiming to establish exposure-response relationship.

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“…Although caution regarding compounds such as kratom alkaloids that bind to opioid receptors is warranted, equating kratom with more dangerous known opioids runs the risk of casting premature judgment on a herbal product used by millions as an opioid substitute. For some consumers, decreased access to kratom has the potential to increase risk of resumption of opioid use, with potential for disordered use, overdose and death .…”

mentioning

confidence: 99%

“…In light of this, we urge the FDA and regulatory bodies world‐wide to reconsider recent scientific evidence regarding the effects and safety of kratom, and use flexibility in developing an approach within legal frameworks that ensures continued lawful and safe access to kratom for those using it therapeutically and as a self‐treatment for opioid and prescription drug dependence . Precedents for such regulatory approaches may be found internationally among legislative controls for herbal medicines that vary widely with respect to definition, licensing, dispensing, manufacturing and trade, based on well‐established standards of evidence for safety, quality and efficacy of herbal products .…”

mentioning

confidence: 99%

The therapeutic potential of kratom

et al. 2018

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Changing trends in the use of kratom (Mitragyna speciosa) in Southeast Asia

Abstract: Legal sanctions appear to have preceded serious scientific investigations into the claimed benefits of ketum. More objective-controlled trials and experiments on humans need to be conducted to validate self-report claims by kratom users in the community.

Cited by 64 publications

References 22 publications

Distinct kratom user populations across the United States: A regional analysis based on an online survey

Distinct kratom user populations across the United States: A regional analysis based on an online survey

Rate and extent of mitragynine and 7‐hydroxymitragynine blood–brain barrier transport and their intra‐brain distribution: the missing link in pharmacodynamic studies

The therapeutic potential of kratom

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