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kratom

Mitragyna speciosa Korth, also known by its Thai name Kratom, is a tree native to southeast Asia. Its leaves have been traditionally used to treat fatigue, pain, opioid withdrawal, diabetes, and more. It is commonly ingested as a tea, ground leaf powder, or capsule, but can also be smoked or snorted. Most adults report using it to help with pain, mental health, or detoxing from other substances. They generally do not report any negative health or social effects (29-32).

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Pharmacology

There is disagreement among experts on how exactly kratom works, including which receptors kratom binds to, and if its effects are agonistic or antagonist (1, 2, 3). Studies consistently report that kratom causes stimulant-like effects at doses less than 5g and opioid-like effects at doses over 5g (3-7). There are also reports of insulin-like effects in lab testing (11), which may support traditional use as a treatment for diabetes.  Reported effects in humans include: pain relief, anti-anxiety, anti-diabetic, anti-leukemic, anti-hypertensive, immunostimulant, temporary darkening of the skin, dry mouth, increased urination, decreased appetite, dehydration, insomnia, anti-inflammation, and constipation (2, 4, 7, 11). The half life of kratom is reported to be between 13-23 hours (29,30).

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Treatment

Buprenorphine (Suboxone) treatment is recommended for people with kratom use disorder  (8, 12, 17, 18). Treatment course is similar to that of opioid use disorder.

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Pregnancy

There are no reports of pregnancy-specific effects.There are several case reports of infants experiencing withdrawal signs after prenatal kratom exposure, however, nearly all of them involved polysubstance use (1, 5, 6, 9, 13, 17, 18). The only infant born exposed to kratom without other substances had inconclusive symptoms, such as irritability, excessive sucking, and sneezing. This makes it difficult to be sure of a withdrawal diagnosis. Morphine and then clonidine treatment resulted in over sedation, and after 2 failed trials of medications, he spontaneously recovered and was sent home at 8 days (1).

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Lactation

There are no reports of lactation-specific effects.

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Overdose

There are several reports of overdose death involving kratom, but no cases in which kratom was the only cause. All reports found multiple drug exposures and/or other conditions that could have caused or contributed to death, like traumatic brain injury or seizures. (3, 4, 7, 8, 19, 14-16, 20-28).

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Withdrawal

​Withdrawal signs and symptoms in adults are reported to be similar to opioid withdrawal, but less intense and longer lasting. These effects are mostly, but not always reported in the context of polysubstance use (8, 12, 15).

References:

  1. Eldridge, W. B., Foster, C., & Wyble, L. (2018). Neonatal Abstinence Syndrome Due to Maternal Kratom Use. Pediatrics, 142(6), e20181839. https://doi.org/10.1542/peds.2018-1839

  2. Hassan, Z., Bosch, O. G., Singh, D., Narayanan, S., Kasinather, B. V., Seifritz, E., Kornhuber, J., Quednow, B. B., & Müller, C. P. (2017). Novel Psychoactive Substances-Recent Progress on Neuropharmacological Mechanisms of Action for Selected Drugs. Frontiers in psychiatry, 8, 152. https://doi.org/10.3389/fpsyt.2017.00152

  3. Toce, M. S., Chai, P. R., Burns, M. M., & Boyer, E. W. (2018). Pharmacologic Treatment of Opioid Use Disorder: a Review of Pharmacotherapy, Adjuncts, and Toxicity. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 14(4), 306–322. https://doi.org/10.1007/s13181-018-0685-1

  4. Fluyau, D., & Revadigar, N. (2017). Biochemical Benefits, Diagnosis, and Clinical Risks Evaluation of Kratom. Frontiers in psychiatry, 8, 62. https://doi.org/10.3389/fpsyt.2017.00062 

  5. Mackay, L., & Abrahams, R. (2018). Novel case of maternal and neonatal kratom dependence and withdrawal.

  6. Pizarro-Osilla C. (2017). Introducing… Kratom. Journal of emergency nursing, 43(4), 373–374. https://doi.org/10.1016/j.jen.2017.03.016 

  7. Prozialeck, W. C., Jivan, J. K., & Andurkar, S. V. (2012). Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic and opioid-like effects. The Journal of the American Osteopathic Association, 112(12), 792–799.

  8. Boyer, E. W., Babu, K. M., Adkins, J. E., McCurdy, C. R., & Halpern, J. H. (2008). Self-treatment of opioid withdrawal using kratom (Mitragynia speciosa korth). Addiction (Abingdon, England), 103(6), 1048–1050. https://doi.org/10.1111/j.1360-0443.2008.02209.x

  9. Murthy, P., & Clark, D. (2019). An unusual cause for neonatal abstinence syndrome. Paediatrics & child health, 24(1), 12–14. https://doi.org/10.1093/pch/pxy084

  10. Trakulsrichai, S., Tongpo, A., Sriapha, C., Wongvisawakorn, S., Rittilert, P., Kaojarern, S., & Wananukul, W. (2013). Kratom abuse in Ramathibodi Poison Center, Thailand: a five-year experience. Journal of psychoactive drugs, 45(5), 404–408. https://doi.org/10.1080/02791072.2013.844532

  11. Purintrapiban, J., Keawpradub, N., Kansenalak, S., Chittrakarn, S., Janchawee, B., & Sawangjaroen, K. (2011). Study on glucose transport in muscle cells by extracts from Mitragyna speciosa (Korth) and mitragynine. Natural product research, 25(15), 1379–1387. https://doi.org/10.1080/14786410802267627

  12. Smid, M. C., Charles, J. E., Gordon, A. J., & Wright, T. E. (2018). Use of Kratom, an Opioid-like Traditional Herb, in Pregnancy. Obstetrics and gynecology, 132(4), 926–928. https://doi.org/10.1097/AOG.0000000000002871 

  13. Davidson, L., Rawat, M., Stojanovski, S., & Chandrasekharan, P. (2019). Natural drugs, not so natural effects: Neonatal abstinence syndrome secondary to 'kratom'. Journal of neonatal-perinatal medicine, 12(1), 109–112. https://doi.org/10.3233/NPM-1863

  14. Anwar, M., Law, R., & Schier, J. (2016). Notes from the Field: Kratom (Mitragyna speciosa) Exposures Reported to Poison Centers - United States, 2010-2015. MMWR. Morbidity and mortality weekly report, 65(29), 748–749. https://doi.org/10.15585/mmwr.mm6529a4

  15. Cumpston, K. L., Carter, M., & Wills, B. K. (2018). Clinical outcomes after Kratom exposures: A poison center case series. The American journal of emergency medicine, 36(1), 166–168. https://doi.org/10.1016/j.ajem.2017.07.051

  16. Forrester M. B. (2013). Kratom exposures reported to Texas poison centers. Journal of addictive diseases, 32(4), 396–400. https://doi.org/10.1080/10550887.2013.854153

  17. Faucher, M. A., Morillos, S., Cordova, P., McNeil-Santiel, J., Onisko, N., Adhikari, E. H., & Nelson, D. B. (2024). Kratom (Mitragyna speciosa): A Case Review of Use Before and During Pregnancy. Journal of midwifery & women's health, 69(1), 144–149. https://doi.org/10.1111/jmwh.13558

  18. Nellhaus, E., Andrews, L., Haas, J., Miskell, D., Kurek, K., Hansen, Z., & Davies, T. (2018). Neonatal Withdrawal Following in Utero Exposure to Kratom. International Journal Of Clinical Pediatrics, 7(4), 55-58.

  19. Spungen, H. H., Mody, K., Micetic, B., Wade, C., & Kang, A. M. (2024). Neonatal and Maternal Ichthyosiform Dermopathy in Association with Kava Use during Pregnancy. , (3), 308–313. https://doi.org/10.1007/s13181-024-01016-x

  20. Alsarraf, E., Myers, J., Culbreth, S., & Fanikos, J. (2019). Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities. , (4), 141–168. https://doi.org/10.1007/s40138-019-00194-1

  21. Behonick, G. S., Vu, C., Czarnecki, L., El-Ters, M., & Shanks, K. G. (2022). Two Single-Drug Fatal Intoxications by Mitragynine. , (5), e110–e114. https://doi.org/10.1093/jat/bkac016

  22. Mata, D. C., & Chang, H. H. (2023). Postmortem Mitragynine Distribution in a Single Drug Fatality Case. Academic forensic pathology, 13(1), 34–40. https://doi.org/10.1177/19253621231160417

  23. Overbeek, D. L., Abraham, J., & Munzer, B. W. (2019). Kratom (Mitragynine) Ingestion Requiring Naloxone Reversal. , (1), 24–26. https://doi.org/10.5811/cpcem.2018.11.40588

  24. Palasamudram Shekar, S., Rojas, E. E., D'Angelo, C. C., Gillenwater, S. R., & Martinez Galvis, N. P. (2019). Legally Lethal Kratom: A Herbal Supplement with Overdose Potential. , (1), 28–30. https://doi.org/10.1080/02791072.2018.1562591

  25. Papsun, D. M., Chan-Hosokawa, A., Friederich, L., Brower, J., Graf, K., & Logan, B. (2019). The Trouble With Kratom: Analytical and Interpretative Issues Involving Mitragynine. , (8), 615–629. https://doi.org/10.1093/jat/bkz064

  26. Post, S., Spiller, H. A., Chounthirath, T., & Smith, G. A. (2019). Kratom exposures reported to United States poison control centers: 2011-2017. , (10), 847–854. https://doi.org/10.1080/15563650.2019.1569236

  27. Striley, C. W., Hoeflich, C. C., Viegas, A. T., Berkowitz, L. A., Matthews, E. G., Akin, L. P., Iheanyi-Okeahialam, C., Mansoor, U., & McCurdy, C. R. (2022). Health Effects Associated With Kratom () and Polysubstance Use: A Narrative Review. , , 11782218221095873. https://doi.org/10.1177/11782218221095873

  28. Gershman, K., Timm, K., Frank, M., Lampi, L., Melamed, J., Gerona, R., & Monte, A. A. (2019). Deaths in Colorado Attributed to Kratom. , (1), 97–98. https://doi.org/10.1056/NEJMc1811055

  29. Kong, W. M., Mohamed, Z., Alshawsh, M. A., & Chik, Z. (2017). Evaluation of pharmacokinetics and blood-brain barrier permeability of mitragynine using in vivo microdialysis technique. , , 43–47. https://doi.org/10.1016/j.jpba.2017.05.020

  30. McCurdy, C. R., Sharma, A., Smith, K. E., Veltri, C. A., Weiss, S. T., White, C. M., & Grundmann, O. (2024). An update on the clinical pharmacology of kratom: uses, abuse potential, and future considerations. , (2), 131–142. https://doi.org/10.1080/17512433.2024.2305798

  31. Boyer, E. W. et al. (2008). Self-treatment of opioid withdrawal using kratom (Mitragynia speciose korth). Addiction. 103(6). 1048-1050.

  32. Grundmann, O., Veltri, C. A., Morcos, D., Knightes, D., 3rd, Smith, K. E., Singh, D., Corazza, O., Cinosi, E., Martinotti, G., Walsh, Z., & Swogger, M. T. (2022). Exploring the self-reported motivations of kratom ( Korth.) use: a cross-sectional investigation. , (4), 433–444. https://doi.org/10.1080/00952990.2022.2041026

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