Responses to a “Typical” Morning Dose of Kratom in People Who Use Kratom Regularly: A Direct-Observation Study

Abstract

Introduction Use of kratom has outpaced systematic study of its effects, with most studies reliant on retrospective self-report. Methods We aimed to assess acute effects following kratom use in adults who use regularly, and quantify alkaloids in the products, urine, and plasma. Between July and November 2022, 10 adults came to our clinic and orally self-administered their typical kratom dose; blinding procedures were not used. Physiological measures included blood pressure, respiratory rate, heart rate, pulse oximetry, temperature, and pupil diameter. Subjective outcomes included Subjective Opioid Withdrawal Scale, Addiction Research Center Inventory, and Drug Effects Questionnaire. Psychomotor performance was also assessed. Results Participants were 6 men and 4 women, mean age 41.2 years. Nine were non-Hispanic White; 1 was biracial. They had used kratom for 6.6 years (SD, 3.8 years) on average (2.0–14.1). Sessions were 190.89 minutes on average (SD, 15.10 minutes). Mean session dose was 5.16 g (median, 4.38 g; range, 1.1–10.9 g) leaf powder. Relative to baseline, physiological changes were minor. However, pupil diameter decreased (right, b = −0.70, P < 0.01; left, b = −0.73, P < 0.01) 40–80 minutes postdose and remained below baseline >160 minutes. Subjective Opioid Withdrawal Scale pre-dosing was mild (5.5 ± 3.3) and decreased postdose (b = [−4.0, −2.9], P < 0.01). Drug Effects Questionnaire “feeling effects” increased to 40/100 (SD, 30.5) within 40 minutes and remained above baseline 80 to 120 minutes (b = 19.0, P = 0.04), peaking at 72.7/100; 6 participants rated euphoria as mild on the Addiction Research Center Inventory Morphine-Benzedrine-scale. Psychomotor performance did not reliably improve or deteriorate postdosing. Conclusions Among regular consumers, we found few clinically significant differences pre- and post-kratom dosing. Alkaloidal contents in products were within expected ranges.

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

“…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 ). More recently, among adults who use kratom regularly and prefer it to other substances, most do not use to become intoxicated or “high”, even among people with OUD history ( 12 ).…”

“…Kratom is also used nonmedically to attenuate withdrawal symptoms from opioids, stimulants and alcohol ( 13 , 14 ). One survey found that a majority (94.8%) of kratom consumers had abstained from other substance use for at least 6 months, highlighting kratom’s role in nonmedically managing addiction ( 11 , 12 , 15 , 16 ).…”

Growing pains with kratom: experiences discussed in subreddits contrast with satisfaction expressed in surveys

“…While kratom has only recently proliferated in the US, rural populations in Southeast Asia have historically used kratom as a remedy for common ailments, to ameliorate fatigue, and as an adjunct to social and religious events ( Singh et al, 2017 ). Reports of perceived benefits have not been tested in randomized trials but have been recently systematically documented, along with other effects, using intensive longitudinal assessment in consumers’ daily lives ( Smith et al, 2024a ) and laboratory-based direct-observation of the acute effects of consumers’ self-selected dose ( Smith et al, 2024b ).…”