Kratom policy: The challenge of balancing therapeutic potential with public safety
Kratom (Mitragyna speciosa) is a tree-like plant indigenous to Southeast Asia. Its leaves, and the teas brewed from them have long been used by people in that region to stave off fatigue and to manage pain and opioid withdrawal. Evidence suggests kratom is being increasingly used by people in the Un...
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| Published in | The International journal of drug policy Vol. 70; pp. 70 - 77 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Netherlands
Elsevier B.V
01.08.2019
Elsevier Science Ltd |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0955-3959 1873-4758 1873-4758 |
| DOI | 10.1016/j.drugpo.2019.05.003 |
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| Abstract | Kratom (Mitragyna speciosa) is a tree-like plant indigenous to Southeast Asia. Its leaves, and the teas brewed from them have long been used by people in that region to stave off fatigue and to manage pain and opioid withdrawal. Evidence suggests kratom is being increasingly used by people in the United States and Europe for the self-management of opioid withdrawal and treatment of pain. Recent studies have confirmed that kratom and its chemical constituents have potentially useful pharmacological actions. However, there have also been increasing numbers of reports of adverse effects resulting from use of kratom products. In August 2016, the US Drug Enforcement Administration announced plans to classify kratom and its mitragynine constituents as Schedule I Controlled Substances, a move that triggered a massive response from pro-kratom advocates. The debate regarding the risks, and benefits and safety of kratom continues to intensify. Kratom proponents tout kratom as a safer and less addictive alternative to opioids for the management of pain and opioid addiction. The anti-kratom faction argues that kratom, itself, is a dangerous and addictive drug that ought to be banned. Given the widespread use of kratom and the extensive media attention it is receiving, it is important for physicians, scientists and policy makers to be knowledgeable about the subject. The purpose of this commentary is to update readers about recent developments and controversies in this rapidly evolving area. All of the authors are engaged in various aspects of kratom research and it is our intention to provide a fair and balanced overview that can form the basis for informed decisions on kratom policy. Our conclusions from these analyses are: (a) User reports and results of preclinical studies in animals strongly suggest that kratom and its main constituent alkaloid, mitragynine may have useful activity in alleviating pain and managing symptoms of opioid withdrawal, even though well-controlled clinical trials have yet to be done. (b) Even though kratom lacks many of the toxicities of classic opioids, there are legitimate concerns about the safety and lack of quality control of purported “kratom” products that are being sold in the US. (c) The issues regarding the safety and efficacy of kratom and its mitragynine constituent can only be resolved by additional research. Classification of the Mitragyna alkaloids as Schedule I controlled substances would substantially impede this important research on kratom. |
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| AbstractList | Kratom (
Mitragyna speciosa
) is a tree-like plant indigenous to Southeast Asia. Its leaves, and the teas brewed from them have long been used by people in that region to stave off fatigue and to manage pain and opioid withdrawal. Evidence suggests kratom is being increasingly used by people in the United States and Europe for the self-management of opioid withdrawal and treatment of pain. Recent studies have confirmed that kratom and its chemical constituents have potentially useful pharmacological actions. However, there have also been increasing numbers of reports of adverse effects resulting from use of kratom products. In August 2016, the US Drug Enforcement Administration announced plans to classify kratom and its mitragynine constituents as Schedule I Controlled Substances, a move that triggered a massive response from pro-kratom advocates. The debate regarding the risks, and benefits and safety of kratom continues to intensify. Kratom proponents tout kratom as a safer and less addictive alternative to opioids for the management of pain and opioid addiction. The anti-kratom faction argues that kratom, itself, is a dangerous and addictive drug that ought to be banned. Given the widespread use of kratom and the extensive media attention it is receiving, it is important for physicians, scientists and policy makers to be knowledgeable about the subject. The purpose of this commentary is to update readers about recent developments and controversies in this rapidly evolving area. All of the authors are engaged in various aspects of kratom research and it is our intention to provide a fair and balanced overview that can form the basis for informed decisions on kratom policy. Our conclusions from these analyses are: (a) User reports and results of preclinical studies in animals strongly suggest that kratom and its main constituent alkaloid, mitragynine may have useful activity in alleviating pain and managing symptoms of opioid withdrawal, even though well-controlled clinical trials have yet to be done. (b) Even though kratom lacks many of the toxicities of classic opioids, there are legitimate concerns about the safety and lack of quality control of purported “kratom” products that are being sold in the US. (c) The issues regarding the safety and efficacy of kratom and its mitragynine constituent can only be resolved by additional research. Classification of the Mitragyna alkaloids as Schedule I controlled substances would substantially impede this important research on kratom. Kratom (Mitragyna speciosa) is a tree-like plant indigenous to Southeast Asia. Its leaves, and the teas brewed from them have long been used by people in that region to stave off fatigue and to manage pain and opioid withdrawal. Evidence suggests kratom is being increasingly used by people in the United States and Europe for the self-management of opioid withdrawal and treatment of pain. Recent studies have confirmed that kratom and its chemical constituents have potentially useful pharmacological actions. However, there have also been increasing numbers of reports of adverse effects resulting from use of kratom products. In August 2016, the US Drug Enforcement Administration announced plans to classify kratom and its mitragynine constituents as Schedule I Controlled Substances, a move that triggered a massive response from pro-kratom advocates. The debate regarding the risks, and benefits and safety of kratom continues to intensify. Kratom proponents tout kratom as a safer and less addictive alternative to opioids for the management of pain and opioid addiction. The anti-kratom faction argues that kratom, itself, is a dangerous and addictive drug that ought to be banned. Given the widespread use of kratom and the extensive media attention it is receiving, it is important for physicians, scientists and policy makers to be knowledgeable about the subject. The purpose of this commentary is to update readers about recent developments and controversies in this rapidly evolving area. All of the authors are engaged in various aspects of kratom research and it is our intention to provide a fair and balanced overview that can form the basis for informed decisions on kratom policy. Our conclusions from these analyses are: (a) User reports and results of preclinical studies in animals strongly suggest that kratom and its main constituent alkaloid, mitragynine may have useful activity in alleviating pain and managing symptoms of opioid withdrawal, even though well-controlled clinical trials have yet to be done. (b) Even though kratom lacks many of the toxicities of classic opioids, there are legitimate concerns about the safety and lack of quality control of purported "kratom" products that are being sold in the US. (c) The issues regarding the safety and efficacy of kratom and its mitragynine constituent can only be resolved by additional research. Classification of the Mitragyna alkaloids as Schedule I controlled substances would substantially impede this important research on kratom. Kratom (Mitragyna speciosa) is a tree-like plant indigenous to Southeast Asia. Its leaves, and the teas brewed from them have long been used by people in that region to stave off fatigue and to manage pain and opioid withdrawal. Evidence suggests kratom is being increasingly used by people in the United States and Europe for the self-management of opioid withdrawal and treatment of pain. Recent studies have confirmed that kratom and its chemical constituents have potentially useful pharmacological actions. However, there have also been increasing numbers of reports of adverse effects resulting from use of kratom products. In August 2016, the US Drug Enforcement Administration announced plans to classify kratom and its mitragynine constituents as Schedule I Controlled Substances, a move that triggered a massive response from pro-kratom advocates. The debate regarding the risks, and benefits and safety of kratom continues to intensify. Kratom proponents tout kratom as a safer and less addictive alternative to opioids for the management of pain and opioid addiction. The anti-kratom faction argues that kratom, itself, is a dangerous and addictive drug that ought to be banned. Given the widespread use of kratom and the extensive media attention it is receiving, it is important for physicians, scientists and policy makers to be knowledgeable about the subject. The purpose of this commentary is to update readers about recent developments and controversies in this rapidly evolving area. All of the authors are engaged in various aspects of kratom research and it is our intention to provide a fair and balanced overview that can form the basis for informed decisions on kratom policy. Our conclusions from these analyses are: (a) User reports and results of preclinical studies in animals strongly suggest that kratom and its main constituent alkaloid, mitragynine may have useful activity in alleviating pain and managing symptoms of opioid withdrawal, even though well-controlled clinical trials have yet to be done. (b) Even though kratom lacks many of the toxicities of classic opioids, there are legitimate concerns about the safety and lack of quality control of purported "kratom" products that are being sold in the US. (c) The issues regarding the safety and efficacy of kratom and its mitragynine constituent can only be resolved by additional research. Classification of the Mitragyna alkaloids as Schedule I controlled substances would substantially impede this important research on kratom.Kratom (Mitragyna speciosa) is a tree-like plant indigenous to Southeast Asia. Its leaves, and the teas brewed from them have long been used by people in that region to stave off fatigue and to manage pain and opioid withdrawal. Evidence suggests kratom is being increasingly used by people in the United States and Europe for the self-management of opioid withdrawal and treatment of pain. Recent studies have confirmed that kratom and its chemical constituents have potentially useful pharmacological actions. However, there have also been increasing numbers of reports of adverse effects resulting from use of kratom products. In August 2016, the US Drug Enforcement Administration announced plans to classify kratom and its mitragynine constituents as Schedule I Controlled Substances, a move that triggered a massive response from pro-kratom advocates. The debate regarding the risks, and benefits and safety of kratom continues to intensify. Kratom proponents tout kratom as a safer and less addictive alternative to opioids for the management of pain and opioid addiction. The anti-kratom faction argues that kratom, itself, is a dangerous and addictive drug that ought to be banned. Given the widespread use of kratom and the extensive media attention it is receiving, it is important for physicians, scientists and policy makers to be knowledgeable about the subject. The purpose of this commentary is to update readers about recent developments and controversies in this rapidly evolving area. All of the authors are engaged in various aspects of kratom research and it is our intention to provide a fair and balanced overview that can form the basis for informed decisions on kratom policy. Our conclusions from these analyses are: (a) User reports and results of preclinical studies in animals strongly suggest that kratom and its main constituent alkaloid, mitragynine may have useful activity in alleviating pain and managing symptoms of opioid withdrawal, even though well-controlled clinical trials have yet to be done. (b) Even though kratom lacks many of the toxicities of classic opioids, there are legitimate concerns about the safety and lack of quality control of purported "kratom" products that are being sold in the US. (c) The issues regarding the safety and efficacy of kratom and its mitragynine constituent can only be resolved by additional research. Classification of the Mitragyna alkaloids as Schedule I controlled substances would substantially impede this important research on kratom. |
| Author | Avery, Bonnie A. Veltri, Charles A. Henningfield, Jack E. McCurdy, Christopher R. McMahon, Lance R. Prozialeck, Walter C. Boyer, Edward W. Kruegel, Andrew C. Grundmann, Oliver Singh, Darshan Swogger, Marc T. |
| AuthorAffiliation | j Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia f Department of Chemistry, Columbia University, 3000 Broadway, New York, NY 10027, USA i Department of Pharmaceutical Sciences, Midwestern University, 19555 N. 59th Avenue, Glendale, AZ 85308, USA c Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA h Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14682, USA b Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA g Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA a Department of Pharmacology, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA d Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA e Research, Health Policy and Abuse, Liability, Pinney Associates And Department of Psychiatry and |
| AuthorAffiliation_xml | – name: d Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA – name: i Department of Pharmaceutical Sciences, Midwestern University, 19555 N. 59th Avenue, Glendale, AZ 85308, USA – name: a Department of Pharmacology, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA – name: e Research, Health Policy and Abuse, Liability, Pinney Associates And Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 4800 Montgomery Lane, Suite 400, Bethesda, MD 20814, USA – name: b Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA – name: g Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA – name: h Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14682, USA – name: f Department of Chemistry, Columbia University, 3000 Broadway, New York, NY 10027, USA – name: j Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia – name: c Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA |
| Author_xml | – sequence: 1 givenname: Walter C. surname: Prozialeck fullname: Prozialeck, Walter C. email: wprozi@midwestern.edu organization: Department of Pharmacology, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA – sequence: 2 givenname: Bonnie A. surname: Avery fullname: Avery, Bonnie A. organization: Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA – sequence: 3 givenname: Edward W. surname: Boyer fullname: Boyer, Edward W. email: edward.boyer@childrens.harvard.edu organization: Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA – sequence: 4 givenname: Oliver orcidid: 0000-0003-2302-8949 surname: Grundmann fullname: Grundmann, Oliver email: grundman@ufl.edu organization: Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA – sequence: 5 givenname: Jack E. surname: Henningfield fullname: Henningfield, Jack E. email: jhenning@pinneyassociates.com organization: Research, Health Policy and Abuse, Liability, Pinney Associates And Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 4800 Montgomery Lane, Suite 400, Bethesda, MD 20814, USA – sequence: 6 givenname: Andrew C. surname: Kruegel fullname: Kruegel, Andrew C. email: ack2137@columbia.edu organization: Department of Chemistry, Columbia University, 3000 Broadway, New York, NY 10027, USA – sequence: 7 givenname: Lance R. surname: McMahon fullname: McMahon, Lance R. email: lance.mcmahon@cop.ufl.edu organization: Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA – sequence: 8 givenname: Christopher R. surname: McCurdy fullname: McCurdy, Christopher R. email: cmccurdy@cop.ufl.edu organization: Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA – sequence: 9 givenname: Marc T. surname: Swogger fullname: Swogger, Marc T. email: marc_swogger@urmc.rochester.edu organization: Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14682, USA – sequence: 10 givenname: Charles A. orcidid: 0000-0001-7626-1555 surname: Veltri fullname: Veltri, Charles A. email: cveltr@midwestern.edu organization: Department of Pharmaceutical Sciences, Midwestern University, 19555 N. 59th Avenue, Glendale, AZ 85308, USA – sequence: 11 givenname: Darshan surname: Singh fullname: Singh, Darshan email: darshan@usm.my organization: Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31103778$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | 2019 The Authors Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved. Copyright Elsevier Science Ltd. Aug 2019 |
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| ISSN | 0955-3959 1873-4758 |
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| Keywords | Ketum Drug policy Opioid use disorder (OUD) Mitragynine Kratom Pain management |
| Language | English |
| License | This is an open access article under the CC BY-NC-ND license. Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/). |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Authors’ roles in writing manuscript Drs. Walter Prozialeck and Darshan Singh conceived the manuscript and wrote the first draft. All of the authors provided significant input into the writing and editing of the manuscript. All authors have approved the final version of the manuscript. |
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| PublicationTitle | The International journal of drug policy |
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| Snippet | Kratom (Mitragyna speciosa) is a tree-like plant indigenous to Southeast Asia. Its leaves, and the teas brewed from them have long been used by people in that... Kratom ( Mitragyna speciosa ) is a tree-like plant indigenous to Southeast Asia. Its leaves, and the teas brewed from them have long been used by people in... |
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| SubjectTerms | Addictions Animals Classification Clinical research Clinical trials Drug and Narcotic Control - legislation & jurisprudence Drug policy Efficacy Enforcement Fatigue Humans Ketum Kratom Mass media Mitragyna - adverse effects Mitragynine Narcotics Opioid use disorder (OUD) Opioids Pain Pain management Physicians Plant Extracts - adverse effects Plant Extracts - pharmacology Plant Extracts - therapeutic use Plant Leaves - adverse effects Policy making Public safety Quality Quality control Scientists Secologanin Tryptamine Alkaloids - adverse effects Secologanin Tryptamine Alkaloids - pharmacology Secologanin Tryptamine Alkaloids - therapeutic use Selfmanagement Side effects Substance Withdrawal Syndrome - drug therapy Symptom management Withdrawal symptoms |
| Title | Kratom policy: The challenge of balancing therapeutic potential with public safety |
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