In a survey in Malaysia, researchers sought to determine the demographics and substance use habits of self-treated kratom users.8 Nearly 77% of participants reported histories of prior drug use, often heroin. At the time of the survey, more than 45% of participants were still using at least one other psychoactive substance. However, all participants reported greater productivity, better appetites, and reduced dependence on other drugs before beginning kratom use.8

Safety, interactions, side effects

The safety of this product is definitely in question. Due to its known opioid action, addiction and overdose are easily possible. In August 2016, the DEA published a notice of intent to classify this compound as a schedule I drug.9 Due to a huge public response, however, a formal retraction of that intent was published in October 2016, pending further review.9

Regardless of regulation, kratom should be considered an opioid compound and, as such, possess all of the potential side effects and interactions of the class. Until such studies are conducted that more clearly show safety and efficacy for specific uses, there is no current indication for this compound.

Kratom powder is a commonly used form in the United States

How supplied, dose, cost

Kratom is widely available in the United States either online or in most ‘head shops.’ It is available in a variety of forms including extract, powder, or capsule. Due to the lack of any quality control, there is no way to establish a ‘recommended dose.’ Also, the concentration of the active ingredient, mitragynine, varies widely based on the form of the product. Extracts tend to be more concentrated, while powders and capsules are weaker.

Those who report sporadic use for anxiety or other episodic concerns may only use 1 to 2 g at a time, whereas daily users managing chronic pain or intense withdrawal from other opiates report using as much as 15 to 20 g or more per day. The type of product and the amount used dictate cost, with an average cost per ounce of about $30.

Summary

With the abundance of approved medications at the disposal of healthcare providers, the use of an unproven and potentially dangerous product such as kratom is not justified. However, providers must be aware of the growing use of this compound in the United States and, when opioid use is either ongoing or newly initiated, screen for use of this product.

References

  1. Rech MA, Donahey E, Dziedzic JMC, Oh L, Greenhalgh E. New drugs of abuse. Pharmacotherapy. 2015;35:189-197.
  2. Assanangkornchai S, Muekthong A, Sam-Angsri N, Pattanasattayawong U. The use of Mitragynine speciosa (“Krathom”), an addictive plant, in Thailand. Subst Use Misuse. 2007;42:2145-2157.
  3. Raffa RB, ed. Kratom and Other Mitragynines: The Chemistry and Pharmacology of Opioids from a Non-Opium Source. Boca Raton, FL: CRC Press; 2014.
  4. León F, Habib E, Adkins JE, Furr EB, McCurdy CR, Cutler SJ. Phytochemical characterization of the leaves of Mitragyna speciosa grown in the USA. Nat Prod Commun. 2009;4:907-910.
  5. Adkins JE, Boyer EW, McCurdy CR. Mitragyna speciosa, a psychoactive tree from Southeast Asia with opioid activity. Curr Top Med Chem. 2011;11:1165-1175.
  6. Suhaimi FW, Yusoff NH, Hassan R, et al. Neurobiology of Kratom and its main alkaloid mitragynine. Brain Res Bull. 2016 Sep;126(Pt 1):29-40.
  7. Boyer EW, Babu KM, Adkins JE, McCurdy CR, Halpern JH. Self-treatment of opioid withdrawal using kratom (Mitragynia speciosa korth). Addiction. 2008;103:1048-1050.
  8. Vicknasingam B, Narayanan S, Beng GT, Mansor SM. The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy. Int J Drug Policy. 2010. 21: 283-288.
  9. US Drug Enforcement Administration. Federal Register. Withdrawal of notice of intent to temporarily place mitragynine and 7-hydroxymitragynine into schedule I. https://www.federalregister.gov/d/2016-24659. Published October 13, 2016. Accessed December 9, 2016. 

This article originally appeared on Clinical Advisor