The Scheduling of Kratom and Selective Use of Data

Griffin, O. Hayden; Webb, Megan

doi:10.1080/02791072.2017.1371363

Cited by 36 publications

(23 citation statements)

References 43 publications

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“…Despite these perceived benefits, increasing rates of kratom use have led to concomitant increases in reports of adverse effects following consumption, although to date, no fatal overdoses have been attributed to kratom use alone (Cinosi et al, 2015;Kruegel & Grundmann, 2017). While the Drug Enforcement Administration recently decided to withhold its decision on classifying kratom as a Schedule I drug (Griffin & Webb, 2018;Grundmann, Brown, Henningfield, Swogger, & Walsh, 2018), reservations about the safety of kratom remain, leading to increased scrutiny of its current legal status in the United States (Henningfield, Fant, & Wang, 2018;Prozialeck, 2016).…”

Section: Introductionmentioning

confidence: 99%

G protein‐biased kratom‐alkaloids and synthetic carfentanil‐amide opioids as potential treatments for alcohol use disorder

Gutridge

Robins

Cassell

et al. 2020

British J Pharmacology

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Background and Purpose Mitragyna speciosa, more commonly known as kratom, is a plant that contains opioidergic alkaloids but is unregulated in most countries. Kratom is used in the self‐medication of chronic pain and to reduce illicit and prescription opioid dependence. Kratom may be less dangerous than typical opioids because of the stronger preference of kratom alkaloids to induce receptor interaction with G proteins over β‐arrestin proteins. We hypothesized that kratom (alkaloids) can also reduce alcohol intake. Experimental Approach We pharmacologically characterized kratom extracts, kratom alkaloids (mitragynine, 7‐hydroxymitragynine, paynantheine, and speciogynine) and synthetic carfentanil‐amide opioids for their ability to interact with G proteins and β‐arrestin at μ, δ, and κ opioid receptors in vitro. We used C57BL/6 mice to assess to which degree these opioids could reduce alcohol intake and whether they had rewarding properties. Key Results Kratom alkaloids were strongly G protein‐biased at all three opioid receptors and reduced alcohol intake, but kratom and 7‐hydroxymitragynine were rewarding. Several results indicated a key role for δ opioid receptors, including that the synthetic carfentanil‐amide opioid MP102—a G protein‐biased agonist with modest selectivity for δ opioid receptors—reduced alcohol intake, whereas the G protein‐biased μ opioid agonist TRV130 did not. Conclusion and Implications Our results suggest that kratom extracts can decrease alcohol intake but still carry significant risk upon prolonged use. Development of more δ opioid‐selective synthetic opioids may provide a safer option than kratom to treat alcohol use disorder with fewer side effects.

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Section: Introductionmentioning

confidence: 99%

G protein‐biased kratom‐alkaloids and synthetic carfentanil‐amide opioids as potential treatments for alcohol use disorder

Gutridge

Robins

Cassell

et al. 2020

British J Pharmacology

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“…Several US cities and states have banned kratom while awaiting federal action, including Alabama, Arkansas, Indiana, Vermont and Wisconsin [7]. It is not federally scheduled as a controlled substance, and although the Drug Enforcement Administration (DEA) intended to list kratom as Schedule I in 2016, it atypically postponed due to pressure from kratom advocacy organizations, a White House petition and a letter from Members of Congress [8]. The DEA considers kratom a drug of concern, and the Food and Drug Administration (FDA) considers it under active review, repeatedly expressing concern for abuse potential and harms associated with use [9,10].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and description of kratom (Mitragyna speciosa) use in the United States: a cross‐sectional study

et al. 2020

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Background and aims Mitragyna speciosa (‘kratom’) contains mu opioid partial agonists. It is widely available, and occasionally used as a home remedy for opioid use disorder. The Drug Enforcement Agency considers kratom a drug of concern; however, prevalence of use and role in drug misuse are unknown. This study aimed to characterize kratom use in the United States. Design Cross‐sectional Survey of Non‐Medical Use of Prescription Drugs (NMURx) Program, 2018 third quarter and 2019 first quarter. Setting A validated non‐probability online survey in the United States. Participants A total of 59 714 respondents aged 18 years or older, weighted to represent the adult US population (n = 252 063 800). Measurements In addition to prevalence of past‐year kratom and other drug use, behavior proportions were estimated. The Drug Abuse Screening Test (DAST‐10) estimated consequences of drug abuse. Findings The estimated prevalence of past‐year kratom use in the adult US population was 0.8% [95% confidence interval (CI) = 0.7–0.9], representing 2 031 803 adults. Life‐time prevalence was 1.3% (95% CI = 1.2–1.4), representing 3 353 624 adults. Kratom users were younger (mean 35 years, P < 0.001), with higher proportions of males (61.0 versus 48.6%, P < 0.001), students (14.1 versus 7.5%, P < 0.001) and health‐care professionals (9.7 versus 4.5%, P < 0.001) and fewer bachelor's/advanced degree graduates (33.4 versus 42.6%, P < 0.001) compared with non‐users. Results were inconclusive on whether there was a difference in kratom use by race, household income or employment status. Among those with past‐year kratom use, 36.7% (95% CI = 32.1–41.3) non‐medically used prescription opioids, 21.7% (95% CI = 18.0–25.5) used illicit opioids, 54.4% (95% CI = 49.5–59.3) used another illicit drug and 67.1% (95% CI = 62.5–71.8) used cannabis. The DAST‐10 profile was more often substantial/severe in kratom users (21 versus 1%, P < 0.001) compared with non‐users. Conclusions Estimated United States past‐year prevalence of kratom use is 0.8%, and kratom users tend to have more serious substance abuse profiles than non‐users or users of cannabis, alcohol or cigarettes. To our knowledge, this is the first description of kratom use at the national level.

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“…However, there was no definitive proof that kratom was the cause of the deaths. Almost all cases involved the use of other drugs including opioids, benzodiazepines or alcohol, or the presence of serious health conditions including refractory depression [ 25 , 26 , 27 , 28 ]. In some cases, the kratom products themselves may have been adulterated with exogenous materials such as synthetic opioids [ 25 , 29 ].…”

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

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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.

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The Scheduling of Kratom and Selective Use of Data

Cited by 36 publications

References 43 publications

G protein‐biased kratom‐alkaloids and synthetic carfentanil‐amide opioids as potential treatments for alcohol use disorder

G protein‐biased kratom‐alkaloids and synthetic carfentanil‐amide opioids as potential treatments for alcohol use disorder

Prevalence and description of kratom (Mitragyna speciosa) use in the United States: a cross‐sectional study

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

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