Severity of Pain and Sleep Problems during Kratom (Mitragyna speciosaKorth.) Cessation among Regular Kratom Users

Singh, Darshan; Narayanan, Suresh; Vicknasingam, Balasingam; Prozialeck, Walter C.; Ramanathan, Surash; Zainal, Hadzliana; Harun, Sabariah Noor

doi:10.1080/02791072.2018.1443234

Cited by 26 publications

(26 citation statements)

References 41 publications

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“…Psychological withdrawal was characterized by mood swings such as anger, nervousness, restlessness, disturbed sleep, tension, and sadness 21. Despite these findings that are similar to opioid withdrawal and craving symptoms, a majority of participants in surveys and case studies as well as their providers and caretakers do not characterize Kratom withdrawal and cravings as severe as those experienced during opioid withdrawal and those symptoms were of shorter duration 18,21,22. Although Kratom dependence is widespread, treatment admissions for withdrawal have increased in recent years from 1,000 in 2007 to almost 3,000 in 2011 in Thailand where Kratom accounts for approximately 2% of all drug treatment admissions 11.…”

Section: Kratom Use Pattern In Southeast Asiamentioning

confidence: 99%

Current perspectives on the impact of Kratom use

Veltri

Grundmann

2019

SAR

107

108

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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.

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Section: Kratom Use Pattern In Southeast Asiamentioning

confidence: 99%

Current perspectives on the impact of Kratom use

Veltri

Grundmann

2019

SAR

107

108

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“…Dependence in kratom is well documented in human ( Suwanlert, 1975 ; Vicknasingam et al, 2010 ; Ahmad and Aziz, 2012 ; Singh et al, 2014 ). Nevertheless, although kratom has been reported to cause dependence and withdrawal signs, these symptoms are usually milder than after opiate withdrawal ( Prozialeck, 2016 ; Saingam et al, 2016 ; Grundmann, 2017 ; Singh et al, 2018b ; Swogger and Walsh, 2018 ). Singh et al (2018b) reported that kratom depended patients did not seek for medication as kratom withdrawal symptoms were mostly rather mild and only lasted between one to three days.…”

Section: Discussionmentioning

confidence: 99%

Methadone, Buprenorphine, and Clonidine Attenuate Mitragynine Withdrawal in Rats

et al. 2021

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Background: Kratom or Mitragyna speciosa Korth has been widely used to relieve the severity of opioid withdrawal in natural settings. However, several studies have reported that kratom may by itself cause dependence following chronic consumption. Yet, there is currently no formal treatment for kratom dependence. Mitragynine, is the major psychoactive alkaloid in kratom. Chronic mitragynine treatment can cause addiction-like symptoms in rodent models including withdrawal behaviour. In this study we assessed whether the prescription drugs, methadone, buprenorphine and clonidine, could mitigate mitragynine withdrawal effects. In order to assess treatment safety, we also evaluated hematological, biochemical and histopathological treatment effects.Methods: We induced mitragynine withdrawal behaviour in a chronic treatment paradigm in rats. Methadone (1.0 mg/kg), buprenorphine (0.8 mg/kg) and clonidine (0.1 mg/kg) were i.p. administered over four days during mitragynine withdrawal. These treatments were stopped and withdrawal sign assessment continued. Thereafter, toxicological profiles of the treatments were evaluated in the blood and in organs.Results: Chronic mitragynine treatment caused significant withdrawal behaviour lasting at least 5 days. Methadone, buprenorphine, as well as clonidine treatments significantly attenuated these withdrawal signs. No major effects on blood or organ toxicity were observed.Conclusion: These data suggest that the already available prescription medications methadone, buprenorphine, and clonidine are capable to alleviate mitragynine withdrawal signs rats. This may suggest them as treatment options also for problematic mitragynine/kratom use in humans.

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“…It is expected that upon discontinuing, rebound mood and anxiety symptoms emerge. In regular users, withdrawal symptoms may occur which are more intense in long-time users or after stopping heavy use, and involve usually moderate anxiety and depression (72), as well as aching and disordered sleep (73).…”

Section: Introductionmentioning

confidence: 99%

“…However, kratom withdrawal syndromes are usually mild and transient (72)(73)(74), similar to but milder than those of opiate withdrawal (74,75), but may be complicated in some users (54).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Treatment of Kratom Use Disorder With a Classical Tricyclic Antidepressant

Vento

Persis²,

Filippis³

et al. 2021

Front. Psychiatry

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Kratom or Mitragyna speciosa (Korth.) is an evergreen tree of the coffee family native to South-East Asia and Australasia. It is used by locals recreationally to induce stimulant and sedative effects and medically to soothe pain and opiate withdrawal. Its leaves are smoked, chewed, or infused, or ground to yield powders or extracts for use as liquids. It contains more than 40 alkaloids; among these, mitragynine and 7-hydroxymitragynine are endowed with variable mu, delta, and kappa opioid stimulating properties (with 7-hydroxymitragynine having a more balanced affinity), rhynchophylline, which is a non-competitive NMDA glutamate receptor antagonist, but is present in negligible quantities, and raubasine, which inhibits α1-adrenceptors preferentially over α2-adrenceptors, while the latter are bound by 7-hydroxymitragynine, while mitragynine counters 5-HT2A receptors. This complexity of neurochemical mechanisms may account for kratom's sedative-analgesic and stimulant effects. It is commonly held that kratom at low doses is stimulant and at higher doses sedative, but no cut-off has been possible to define. Long-term use of kratom may produce physical and psychological effects that are very similar to its withdrawal syndrome, that is, anxiety, irritability, mood, eating, and sleep disorders, other than physical symptoms resembling opiate withdrawal. Kratom's regulatory status varies across countries; in Italy, both mitragynine and the entire tree and its parts are included among regulated substances. We describe the case of a patient who developed anxiety and dysphoric mood and insomnia while using kratom, with these symptoms persisting after withdrawal. He did not respond to a variety of antidepressant combinations and tramadol for various months, and responded after 1 month of clomipramine. Well-being persisted after discontinuing tramadol.

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Severity of Pain and Sleep Problems during Kratom (Mitragyna speciosaKorth.) Cessation among Regular Kratom Users

Cited by 26 publications

References 41 publications

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

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

Methadone, Buprenorphine, and Clonidine Attenuate Mitragynine Withdrawal in Rats

Case Report: Treatment of Kratom Use Disorder With a Classical Tricyclic Antidepressant

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