<p>Current perspectives on the impact of Kratom use</p>

Abstract

The leaves from the tree Mitragyna speciosa, commonly known as Kratom, in the coffee plant family (Rubiaceae) are commonly used in their native habitat of Southeast Asia as a stimulant to sustain energy during hard day labor and as an opioid-like analgesic and sedative. Traditional and modern uses overlap based on the effects of the leaf extract which has also gained popularity in the United States and Europe in the last two decades. Kratom has and is being used for the mitigation of opioid withdrawal symptoms and as a harm reduction agent with a minority of users subsequently developing a dependence on the extract. The respective demographic use patterns of Kratom differ between Southeast Asia and the Western world. While pure Kratom is primarily used by day laborers and misused in conjunction with cough medicine by youth in Southeast Asia, a majority of users in the United States is middle-aged, has at least middle income, private health insurance, and completed some college. Deaths attributed to the use of Kratom have been reported in Europe and the United States but not in Southeast Asia. Although Kratom was detected as the alkaloid mitragynine in the blood of the decedents, causality could not be established in almost all cases because of poly-drug exposures. It is notable that Kratom can cause herbdrug interactions, especially with other central nervous system-active substances. Given the mostly unregulated market for Kratom products in Western countries, consumers may be exposed to adulterated or contaminated products, especially if purchased through websites or the darknet. A number of countries have scheduled Kratom because of its stimulant-and opioid-like effects and the established interaction of the alkaloid mitragynine with opioid receptors.

Refined Prediction of Pharmacokinetic Kratom-Drug Interactions: Time-Dependent Inhibition Considerations

“…Based on these latter effects, Malaysian authorities deemed kratom to have addiction potential, prohibiting kratom use in that country (Khalil et al, 2020). The legal status of kratom varies in other countries depending on region, and in the US, by state, city, and county (Veltri and Grundmann, 2019). Accordingly, sales in the US and several European countries continue to flourish (Henningfield et al, 2018).…”

Drs. Eggleston et al. Reply to Drs. Grundmann et al

“…4 Kratom can also cause dependence and addiction, which was highlighted in a recent review co-authored by Dr. Grundmann. 5 It is our opinion that the current evidence regarding the side effects and potential for adverse consequences associated with kratom use are sufficient to conclude that it should not remain available as an herbal supplement.…”

Pharmacology of Herbal Sexual Enhancers: A Review of Psychiatric and Neurological Adverse Effects

“…Studies have found that 7-hydroxymitragynine is the main contributor to the plant’s toxicity and the development of addiction symptoms. In 2014, Singh et al [ 51 ] reported a cross-sectional survey investigating the correlation between frequency and quantity of kratom consumption, and the risk of addiction development and the severity of withdrawal symptoms and craving in regular user [ 216 ]. Cessation of kratom use produced physical withdrawal symptoms similar to those of opiate addiction including pain, sleep disorders, muscle spasms, watery eyes, runny nose, hot flashes, fever, decreased appetite, diarrhea, and craving.…”