Kratom’s Emergence and Persistence Within the US Polydrug Epidemic

Abstract

Purpose of Review Use of “kratom” products, derived from the bioactive botanical Mitragyna speciosa have increased amidst US polydrug use epidemics. Kratom alkaloids interact with opioid, serotonergic, adrenergic, and other receptors and regular users have described experiencing a wide range of effects. Some with polydrug use histories have reported using kratom as a substitute for other drugs or to nonmedically self-manage substance use disorder (SUD) symptoms. Data describing this remain scare and come from self-report. We review this literature describing kratom use as a drug substitute, or as a nonmedical “self-treatment” for attenuating dependence or SUD symptoms. Recent Findings Kratom products have been documented as being used as a licit and illicit opioid substitute. Use to reduce alcohol or stimulant consumption is less well documented. Although prior and current polydrug use appear common among a some kratom users, it is unclear if co-use is contemporaneous or concomitant. Temporal order of use initiation is typically undocumented. Use for energy and recreation are also increasingly reported. Summary Data on kratom consumption come primarily from self-report with significant limitations. Until controlled human laboratory studies have been conducted, we can presently only describe what is known about human kratom use based on self-report. Such data describe real-world kratom use, leaving unaddressed human abuse liability or therapeutic potential of kratom alkaloids. Clinicians should be mindful of use motivations among people with SUD histories, sensitively assessing use. The paucity of data highlights the urgent need to increase funding and research for understanding kratom’s effects in humans.

Prevalence of Kratom Use Disorder Among Kratom Consumers

“…These findings are aligned with prior surveys that evaluated the consumption patterns of kratom. 22,23 Our survey also explored participants' history with adverse effects that could reasonably be related to their kratom consumption, with the most frequently reported adverse effects being withdrawal and tolerance (Supplement Table 2, http://links.lww.com/JAM/ A491). One of the caveats in diagnosing a SUD is that tolerance and withdrawal can occur in appropriate therapeutic doses and for medical use of prescribed medications.…”

Research and publication gaps on kratom and kratom products: a scoping review of current literature

“…The current review also indicates that researchers in the kratom field continue to conflate kratom alkaloids, such as mitragynine, kratom products derived from dried and processed leaf material, and fresh leaf preparations without considering potential health and safety implications related to the overall differences in chemical content or potency of these different types of kratom products [4]. Currently, there is a paucity of published research, investigating potential effects of different plant cultivation methods, methods of processing of plant material, and manufacturing processes and standards utilized in production of consumed products.…”

“…Historical claims of medicinal or pharmacological effects of chewing fresh leaves of kratom tree (Mitragyna speciosa) native to Southeast Asia [1][2][3], supplemented by narrative accounts of potential health benefits of products derived from kratom and consumed in the United States and other countries in the West [4] garnered an increasing interest among researchers, clinicians, and the public in recent years. Although there is a growing demand for kratom-derived products among the United States consumers, there is also a paucity of rigorously collected scientific data on human pharmacological safety profile of kratom phytochemicals and very limited scientific data on their dose-related effects in humans [5].…”

Commentary: Presence of kratom in opioid overdose deaths: findings from coroner postmortem toxicological report

“…Complexities of kratom use confound interpretation of use-related risk or adverse events. One example is that kratom persists as a harm-reduction method to reduce opioid and other substance use ( 8 , 9 ). Previously, some consumers with opioid use disorder (OUD) history reported that kratom is not preferred over illicit opioids and do not report using kratom to achieve a euphoric “high” ( 10 , 11 ).…”