2024 15th Annual NUBE Conference

In Malaysia, Dutch botanist Pieter Korthals in 1831 first discovered Kratom or Mitragyna speciosia. Kratom is derived from the Nitragyna speciose korth, a tropical forest tree found in Malaysia, Thailand and Myanmar. The trees’ leaves contain psychoactive opioid compounds, that have been consumed for thousands of years. Kratom contains alkaloids that bind to opioid receptors, with an opioid drug structure.

Kratom can be ingested in various routes, traditionally chewed but also smoked or strained in teas. The leaves have a very bitter taste that can be masked by adding sugar or honey in juices or teas. As an alternative, lemon juice can be added to facilitate the extraction of the plant alkaloids.

Kratom induces euphoria, and in lower doses acts as a stimulant, increasing energy, alertness, while in higher doses it induces sedation. Kratom is purportedly used for anxiety, depression, inflammation, libido. Importantly, given opioid activity, it suppresses opioid withdrawal. With regular use, Kratom is associated with dependence and addiction.
Kratom’s pharmacological properties are similar to those of opioids but unlike opioids it is not a federally regulated substance. There are increasing number of case reports with Kratom intoxications and withdrawals that are challenging for the physicians. Kratom is not a very commonly known substance and is also difficult to detect as it does not cause positive findings in urine drug screens. The assessment relies on the history from the patient or specific immune-assay tests. The treatment can consist of symptomatic treatment with Clonidine but also with Suboxone. There are several cases reported of Kratom withdrawal.

Kratom is gaining increasingly popularity and about 40 million Americans are current using Kratom recreationally. However, there are currently very limited clinical studies available that demonstrate safety and efficacy in humans. The FDA has not approved Kratom for any medical use, and publishes warnings regarding its toxicity. Available information is mostly based on reports from users or animal models. Case reports involving the use of Kratom are concerning and alarming. The use of Kratom is associated with increasing numbers of ER visits, calls to poison control centers and even deaths related to multiple causes.

This presentation is based on a systematic review of literature of the current available data on Kratom and will be providing physician and clinician education about Kratom as a substance.

Utilized sources were Pubmed, Ovid, Medline, PsychInfo, EMBASE.

Learning objectives:

Kratom use- Clinical presentations, toxicity, risks.

Pharmacology of Kratom.

Kratom use- Diagnosis and Treatment