![]() ![]() ![]() Due to the potential for adulteration of kratom products the unregulated status of kratom in most United States remains a concern.Īlthough the rise of kratom use in the West has been an opportunity for increased scientific study, the resultant publication of a great deal of research of limited rigor has created confusion for health practitioners attempting to understand the benefits and risks of the plant and the heterogeneity of kratom products. This gap in regulatory policy prompted the American Kratom Association (AKA) to develop voluntary industry guidelines through a Good Manufacturing Practice (GMP) Standards Program that tests for purity and contaminants ( American Kratom Association, 2019). Kratom is currently not recognized as a dietary supplement in the United States, and the Food and Drug Administration (FDA) has not issued guidance or regulatory standards on kratom regarding allowable product contents, alkaloid concentrations, packaging, labeling, or marketing of kratom products that is usually provided for dietary ingredients ( Coe et al., 2019). Whereas in Southeast Asia users typically buy kratom leaves directly from a grower, Westerners often purchase capsules, powders, or extracts via the internet, specialty smoke shops, and gas stations ( Prozialeck et al., 2012 Singh et al., 2016). Over the past 2 decades, kratom has gained popularity beyond Asian borders, particularly in North America and Europe ( Boyer et al., 2007 Grundmann, 2017).Īn estimated 10–16 million people in the United States take kratom, though current prevalence ranges of 1.3%–6.1% from national representative surveys may underestimate regular kratom users ( Henningfield et al., 2019 Covvey et al., 2020). In addition to analgesia produced at higher doses, kratom is reported to have relaxing, anxiolytic effects. Because of its purported analgesic properties, kratom is used to treat pain and, notably, as a means to alleviate opioid withdrawal or as an opioid replacement among people with opioid use disorder (OUD) ( Smith and Lawson, 2017 Henningfield et al., 2018 Bath et al., 2020). Kratom can also be smoked, vaporized, or consumed as a powder. Consumption remains widespread in kratom’s native lands, where people commonly chew raw kratom leaves or boil leaves to make tea ( Swogger and Walsh, 2018). For example, at low doses, kratom has long been consumed orally as a stimulant to enhance stamina and productivity, making it particularly popular among field laborers working long days in arduous conditions ( Tanguay, 2011 Prozialeck et al., 2012 Hassan et al., 2013 Warner et al., 2016). Nonetheless, widespread use for health and well-being include diverse uses reported by consumers as reasons for their use. Despite such traditional medicinal use, it is important to recognize that neither kratom, nor its constituents (e.g., “alkaloids”), nor metabolites have been approved as safe and effective medicines for any therapeutic use. Kratom ( Mitragyna speciosa Korth., Rubiaceae also known as ketum) is made from the leaves of a tropical tree in the coffee family indigenous to Southeast (SE) Asia, where it has been used for centuries as medicine for various ailments, including hypertension, diarrhea, cough, and fever ( Tanguay, 2011 Cinosi et al., 2015 Singh et al., 2016). We conclude by making recommendations for best practices in working with people who use kratom. ![]() With these caveats in mind we provide a comprehensive overview of the available science on kratom that has the potential to i clarity for healthcare providers and patients. An especially important gap in safety-related science is the use of kratom in combination with physiologically active substances and medicines. There is, however, a growing literature of peer-reviewed science that can inform healthcare providers so that they are better equipped to discuss kratom use with consumers and people considering kratom use within the context of their overall health and safety, while recognizing that neither kratom nor any of its constituent substances or metabolites have been approved as safe and effective for any disease. Some of these safety concerns have echoed across media and broad-based health websites and, in the absence of clinical trials to test kratom’s efficacy and safety, considerable confusion has arisen among healthcare providers. More recently, as kratom has gained popularity in the West, United States federal agencies have raised concerns over its safety leading to criminalization in some states and cities. ![]() Kratom ( Mitragyna speciosa Korth., Rubiaceae) is a plant native to Southeast Asia, where it has been used for centuries as a mild stimulant and as medicine for various ailments. ![]()
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