Kratom (Mitragyna speciosa): User demographics, use patterns, and implications for the opioid epidemic

Hillemacher

2020

Heliyon

Background Kratom is a Southeast Asian plant, which is widely used in this region, and making an increasing appearance in Europe and the US. Case report We present the case of a 26-year-old man in Substitol-assisted treatment of excessive Kratom and Tilidin use expressing the wish for a drug-free management of a chronic pain condition. After an accidental calcaneus impression fracture, the patient was suffering from severe chronic pain and anxiety of further accidents. This was managed initially with Tilidin. Resulting from the wish to self-manage the pain condition in a way that permitted continuation of a job, the patient searched for a ‘natural’ treatment alternative obtained from an Internet vendor. He successfully instrumentalized Kratom for 3 years with daily consumption intermixed with occasional Tilidin for pain management. However, the dose of Kratom was increased considerably up to a level of effect reversal, when no analgesic and behaviorally activating effects occurred any more, but only intense drowsiness. The patient was treatment seeking and subsequently detoxified from Kratom and Tilidin. Pain management was shifted to retarded morphine. Conclusion Kratom instrumentalization for pain management might appear to be more problematic for addiction development than when its use is established for other consumption motives.

Section: Discussionmentioning

confidence: 99%

Kratom instrumentalization for severe pain self-treatment resulting in addiction – A case report of acute and chronic subjective effects

Hillemacher

2020

Heliyon

“…Even though kratom has been used in Southeast Asia for generations, it is only over the past 25 years that kratom use has expanded to Europe and North America [ 1 , 2 , 4 , 12 , 13 , 14 ]. In the US, kratom products are used extensively for the self-management of pain, depression and opioid use disorders [ 15 , 16 , 17 , 18 ]. The most widely used products include chopped, dried leaf material (either alone or in capsule or tablet form) or concentrated extracts that are formulated as liquids or capsules [ 2 , 12 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Mitragynine Content, Levels of Toxic Metals and the Presence of Microbes in Kratom Products Purchased in the Western Suburbs of Chicago

Prozialeck

Edwards

Lamar

et al. 2020

IJERPH

Kratom (Mitragyna speciosa, Korth) is a tree-like plant that is indigenous to Southeast Asia. Kratom leaf products have been used in traditional folk medicine for their unique combination of stimulant and opioid-like effects. Kratom is being increasingly used in the West for its reputed benefits in the treatment of pain, depression and opioid use disorder. Recently, the United States Food and Drug Administration and Centers for Disease Control have raised concerns regarding the contamination of some kratom products with toxic metals (Pb and Ni) and microbes such as Salmonella. To further explore this issue, eight different kratom products were legally purchased from various “head”/”smoke” shops in the Western Suburbs of Chicago and then tested for microbial burden, a panel of metals (Ni, Pb, Cr, As, Hg, Cd), and levels of the main psychoactive alkaloid mitragynine. All of the samples contained significant, but variable, levels of mitragynine (3.9–62.1 mg/g), indicating that the products were, in fact, derived from kratom. All but two of the samples tested positive for the presence of various microbes including bacteria and fungi. However, none of the samples tested positive for Salmonella. Seven products showed significant levels of Ni (0.73–7.4 µg/g), Pb (0.16–1.6 µg/g) and Cr (0.21–5.7 µg/g) while the other product was negative for metals. These data indicate that many kratom products contain variable levels of mitragynine and can contain significant levels of toxic metals and microbes. These findings highlight the need for more stringent standards for the production and sale of kratom products.

“…Matured leaves are freshly harvested and eaten raw, or brewed and consumed as an herbal solution (e.g., kratom juice) [3]. Due to its pain mitigating effects [4], kratom use is increasing among opioid users, who use it as an alternative to prescription and illicit opioids in the United States to treat pain, opioid withdrawal, and psychological problems [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Two of the most widely studied alkaloids with psychoactive properties and opioid-like effects include mitragynine and 7-hydroxymitragyine [4,8]. Despite the widespread sales of kratom products on the internet and convenience stores in the United States, and being backed by positive customer reviews regarding kratom's painrelieving effects [5][6][7], hitherto the US Food and Drug Administration (FDA) has not approve kratom use, as the herbal plant is alleged to have various risks, such as addiction, abuse, and dependence [9]. As a result of the incremental kratom toxicity recurrence [10,11], both the FDA and the Drug Enforcement Administration (DEA) are contemplating to regulate mitragynine and 7-hydroxymitragynine into Schedule 1 of the Control Substances Act [4].…”

Section: Introductionmentioning

confidence: 99%

Lipid profile of regular kratom (Mitragyna speciosa Korth.) users in the community setting

et al. 2020

Background and aim Kratom, or Mitragyna speciosa Korth., is a tropical plant that has been reported to exhibit opioid-like effects. Although opioids have been demonstrated to alter the lipid profile of regular users, data on the lipid-altering effects of kratom are scarce. This study aimed to compare the fasting lipid profile of regular kratom users to that of healthy subjects who do not use kratom. It also determined the association between various characteristics of kratom users and the serum triglycerides, total cholesterol, low-density lipoprotein (LDL), and highdensity lipoprotein (HDL) levels of regular kratom users. Methods A total of 200 participants (n = 100 kratom users and n = 100 healthy subjects who do not use kratom) were recruited for this analytical cross-sectional study. Data on sociodemographic status, kratom use characteristics, cigarette smoking, physical activity, body mass index (BMI), fasting serum lipid profile, and liver function were collected from all participants.