Full length articlePatterns of Kratom use and health impact in the US—Results from an online survey
Introduction
Kratom preparations are extracts of the leaves of a tree (Mitragyna speciosa Korth., Rubiaceae) native to Southeast Asia (Shellard, 1989, Tanguay, 2011). The leaves are traditionally chewed in fresh or dried form to alleviate pain, decrease fatigue, and elevate mood (Warner et al., 2016). It has also been used to alleviate opioid withdrawal symptoms in opioid misuse or abuse such as heroin or morphine (Boyer et al., 2008, Hassan et al., 2013). Kratom extracts available in the US are primarily powders that can be dissolved in fluid or consumed with food. Most commercially available powdered Kratom products in the US are recommended in doses of 2–6 g depending on the Mitragyna strain used and the intended use. In most cases, users will titrate themselves starting with lower doses until they reach the desired effect.
Although Kratom has been available in the US for at least the past ten years as a dietary supplement, public attention has recently increased with a report by the Centers for Disease Control and Prevention (CDC) stating a significant increase in Kratom-related calls to poison control centers between 2011 and 2015 (Anwar et al., 2016). Among the 660 reported calls, 49 (7.4%) were classified as major, life-threatening with some residual disability.
Based on the CDC report, the Drug Enforcement Administration (DEA) issued the intent to place Kratom and its opioid-like active constituents mitragynine and 7-hydroxymitragynine in schedule I of the controlled substances act (DEA, 2016). This intent has since been withdrawn awaiting a final decision after a public commenting period that expired on December 1st 2016. An eight-factor analysis of Kratom as mandated by the FDA has been made available by Drs. Henningfield and Fant leading up to the deadline (Henningfield and Fant, 2016). Indeed, the alkaloids mitragynine and 7-hydroxymitragynine have been identified to interact with the opioid receptors although the interaction is not entirely elucidated with some researchers indicating a full agonist activity with lower potency than morphine and others suggesting a partial agonist activity with higher potency than morphine (Kruegel et al., 2016, Prozialeck et al., 2012). Receptor-binding studies identified both mitragynine and 7-hydroxymitragnine as partial agonists at the human μ-opioid receptor and a partial antagonist at human κ-opioid receptors with several other alkaloids present in Kratom only acting on μ-opioid receptors with lower potency (Kruegel et al., 2016). The oxidized alkaloid 7-hydroxymitragynine displays a stronger binding affinity towards the opioid receptors compared to the classical full opioid agonist morphine (Matsumoto et al., 2004). In addition, in vitro assays and animal studies indicate that mitragynine may also interact with several non-opioid receptors in the CNS including adrenergic and serotonergic receptors that may contribute to its antidepressant and mood-altering effects (Boyer et al., 2008).
Irrespective of its pharmacology, little is known about the use pattern and potential health impact of Kratom preparations in the US. The research underlying this article was conducted to answer the following questions:
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Who is consuming Kratom and for what purpose?
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What perceived beneficial and detrimental effects are reported by Kratom users if dose and frequency of consumption are considered?
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Does Kratom present with an abuse potential and withdrawal symptoms?
Section snippets
Survey setting, approval, and data collection
An online anonymous cross-sectional survey was conducted in October 2016 of 10,000 current Kratom users. Qualtrics (Qualtrics, Provo, UT) was used to collect the data. The survey was made available as an announcement on the homepage of the American Kratom Association (http://www.americankratom.org/) and their various social media outlets (American Kratom Association Facebook page, website forums, and membership email distribution) with follow-up reminders in weekly intervals until 10,000
Demographics
The survey was completed by 8049 participants (completion rate: 80.5%) and only completed responses were included in the data analysis. A majority of respondents were male (56.91%), between the ages of 31–50 years (55.09%), married or partnered (54.25%), white non-Hispanics (89.39%), employed for wages (56.83%), with private insurance through their employer or self-insurance (61.31%), an annual household income of $35,000 or higher (63.24%), and had at least some college education (82.32%) (
Discussion
The increasing use of Kratom is primarily associated with self-reported treatment of acute and chronic pain and for mood conditions such as anxiety and depression. Based on the known opioid-like mechanism for the active constituents mitragynine and 7-hydroxymitragynine, the results of this survey further support the use of Kratom for alleviation of acute and chronic pain. Interestingly, almost the same number of respondents took the preparation for a mood disorder indicating a differentiated
Financial disclosure
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
The author states no conflict of interest.
Contributors
Author approved of manuscript submitted to journal.
Acknowledgment
The author would like to thank the American Kratom Association for distribution of the survey and assisting in collection of responses. The author would like to thank the Centers for Disease Control and Prevention and Dr. Andrew Kruegel from Columbia University for their comments and feedback on the study design and survey results.
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