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

Schimmel, Jonathan; Amioka, Elise; Rockhill, Karilynn; Haynes, Colleen M.; Black, Joshua C.; Dart, Richard C.; Iwanicki, Janetta

doi:10.1111/add.15082

Cited by 95 publications

(96 citation statements)

References 23 publications

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“…In addition, it can modulate the release and synaptic actions of neurotransmitters such as norepinephrine and serotonin [ 7 , 10 , 11 ]. 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 ].…”

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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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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“…There is insufficient epidemiological documentation as to the extent of kratom use worldwide and in specific countries (119), so to estimate how many people use it and how many develop unwanted effects. Besides this, risks may increase, as many kratom users have concurrent other substance use (120), and this is difficult to disentangle. The most recent estimates in indicate kratom use in the adult US population is 0.8% for the past year and 1.3% lifetime (120).…”

Section: Discussionmentioning

confidence: 99%

“…Besides this, risks may increase, as many kratom users have concurrent other substance use (120), and this is difficult to disentangle. The most recent estimates in indicate kratom use in the adult US population is 0.8% for the past year and 1.3% lifetime (120). The debate on epidemiological issues is strong and ongoing, and points to the evergreen "more studies are needed" (121,122).…”

Section: Discussionmentioning

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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“…The tree is native to Southeast Asia, primarily Indonesia, Malaysia, and Thailand, and various products, among them most commonly the dried and powdered leaf material, reach an estimated 11 million consumers in the United States alone 124 . Although prevalence of use has not been investigated systematically, 2 recent studies estimated the lifetime prevalence of use in the general US population between 1.3% and 6.1% 125,126 . The most abundant alkaloid binding to opioid receptors is mitragynine, which acts as a partial biased μ‐opioid receptor without recruiting β‐arrestin following receptor activation 127 .…”

Section: Other Opioidsmentioning

confidence: 99%

Clinical Pharmacology, Toxicity, and Abuse Potential of Opioids

Vearrier

Grundmann

2021

The Journal of Clinical Pharma

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Opioids were the most common drug class resulting in overdose deaths in the United States in 2019. Widespread clinical use of prescription opioids for moderate to severe pain contributed to the ongoing opioid epidemic with the subsequent emergence of fentanyl‐laced heroin. More potent analogues of fentanyl and structurally diverse opioid receptor agonists such as AH‐7921 and MT‐45 are fueling an increasingly diverse illicit opioid supply. Overdose from synthetic opioids with high binding affinities may not respond to a typical naloxone dose, thereby rendering autoinjectors less effective, requiring higher antagonist doses or resulting in a confusing clinical picture for health care providers. Nonscheduled opioid drugs such as loperamide and dextromethorphan are associated with dependence and risk of overdose as easier access makes them attractive to opioid users. Despite a common opioid‐mediated pathway, several opioids present with unique pharmacodynamic properties leading to acute toxicity and dependence development. Pharmacokinetic considerations involve half‐life of the parent opioid and its metabolites as well as resulting toxicity, as is established for tramadol, codeine, and oxycodone. Pharmacokinetic considerations, toxicities, and treatment approaches for notable opioids are reviewed.

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

Cited by 95 publications

References 23 publications

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

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

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

Clinical Pharmacology, Toxicity, and Abuse Potential of Opioids

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