The abuse potential of kratom according the 8 factors of the controlled substances act: implications for regulation and research

Abstract

RationaleConsideration by the US Drug Enforcement Administration and Food and Drug Administration of placing kratom into Schedule I of the Controlled Substances Act (CSA) requires its evaluation of abuse potential in the context of public health.ObjectiveThe objective of the study is to provide a review of kratom abuse potential and its evaluation according to the 8 factors of the CSA.ResultsKratom leaves and extracts have been used for centuries in Southeast Asia and elsewhere to manage pain and other disorders and, by mid-twentieth century, to manage opioid withdrawal. Kratom has some opioid effects but low respiratory depression and abuse potential compared to opioids of abuse. This appears due to its non-opioid-derived and resembling molecular structure recently referred to as biased agonists. By the early 2000s, kratom was increasingly used in the US as a natural remedy to improve mood and quality of life and as substitutes for prescription and illicit opioids for managing pain and opioid withdrawal by people seeking abstinence from opioids. There has been no documented threat to public health that would appear to warrant emergency scheduling of the products and placement in Schedule I of the CSA carries risks of creating serious public health problems.ConclusionsAlthough kratom appears to have pharmacological properties that support some level of scheduling, if it was an approved drug, placing it into Schedule I, thus banning it, risks creating public health problems that do not presently exist. Furthermore, appropriate regulation by FDA is vital to ensure appropriate and safe use.Electronic supplementary materialThe online version of this article (10.1007/s00213-017-4813-4) contains supplementary material, which is available to authorized users.

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

“…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).…”

Distinct kratom user populations across the United States: A regional analysis based on an online survey

“…Denmark, Finland, and Germany have restricted distribution of kratom to a prescription drug product or an unlicensed medicine. Although it remains legal on the federal level in the United States despite concern for public health by regulatory and enforcement agencies such as the U.S. Food and Drug Administration and the U.S. Drug Enforcement Administration, several U.S. states have placed kratom and its alkaloids in Schedule 1 effectively banning it (Henningfield, Fant, & Wang, ).…”

Critique of “Kratom Use and Toxicities in the United States”

“…4 Approximately 5 million Americans currently use kratom for analgesia, improved mood, and to avoid the risks posed by classical opioids. 5 The potential benefits to this large user population must be considered alongside any potential risks. Government agencies' push to ban kratom may force a return to classical opioid use among some kratom consumers, with the concomitant risk for dependence, misuse, and overdose.…”