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Kratom is a traditional drug from Southeast Asia that has been an emerging new substance in the United States. On August 30, 2016, the DEA announced the intention to emergency schedule kratom into Schedule I. To support this decision, the DEA cited an increase in drug seizures of kratom and an increase in calls to poison control concerning kratom....
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Context 1
... illustrate the findings of the Google News search and the LexisNexis news search, Table 3 and Figure 1 were created. When looking at the table and figure, four dates are important to keep in mind: (1) July 29, when the CDC report was disseminated; (2) August 30, when the DEA made the announcement of their intent to emergency schedule kratom; (3) September 30, when kratom was originally supposed to be placed into Schedule I of the CSA; and (4) October 12, when the DEA withdrew the notice of emergency scheduling. ...
Citations
... Participants selected their own aliases, which we use throughout.5 Kratom is derived from the leaves of the Korth tree (Mitragyna speciosa). It contains psychoactive properties and is used among people in Southeast Asian as a stimulant and to treat numerous maladies(Griffin and Webb 2018). It has gained popularity within the United States as means to reduce opioid dependence(Smith and Lawson 2017). ...
The concept of cultural appropriation has drawn increasing attention from academic disciplines and nonacademic circles. Yet, there is no consensus on what constitutes cultural appropriation nor whether it is harmful. The contested nature of the concept suggests that it is important to understand how people respond to such accusations. Indeed, understanding how people resist accusations of cultural appropriation (i.e., how they account for their actions) can provide insights into defining cultural appropriation and understanding its impact. Accordingly, we rely on data from an ethnography of people who attended peyote ceremonies (a sacred Native American practice) in a Southern U.S. state to understand how they account for accusations of cultural appropriation when they are presented. Findings suggest that participants delegitimized accusations in one of two ways: saying that cultural appropriation does not exist (e.g., peyote is for everyone) or that appropriation exists but they are not appropriators (e.g., they were respectful of the ceremonies). Regardless of which approach they used, participants drew on broader narratives that allowed them to maintain a positive identity while minimizing the potential stigma of being appropriators.
... 3,4 Kratom's mu-opioid agonist activity provides analgesic and euphoric effects to individuals and may lead to misuse. 2 Additional effects at dopamine, serotonin, and alpha receptors can also result in stimulatory effects of kratom use, including hallucinations, aggression, and delirium. 5 Reports of seizures, liver damage, respiratory depression, severe withdrawal, and even death have also been associated with kratom consumption. ...
... The FDA issued its first official warning against consumption of kratom in 2014. 2 In 2016, the drug enforcement agency attempted to place kratom and its active constituents of mitragynine and 7-hydroxymitragynine as a Schedule 1 under the Controlled Substance Act; however, the proposal was withdrawn after strong opposition from kratom support groups. 2 Within the United States, kratom is currently illegal in 6 states (Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin), and legislation is pending to ban sales in several other states. 9 Doses recommended by facilities that sell kratom differ based on dosage form but widely range from 1 to 8 g per day. 3 This case is unique in that naltrexone was used for an offlabel use of weight loss. ...
... The FDA issued its first official warning against consumption of kratom in 2014. 2 In 2016, the drug enforcement agency attempted to place kratom and its active constituents of mitragynine and 7-hydroxymitragynine as a Schedule 1 under the Controlled Substance Act; however, the proposal was withdrawn after strong opposition from kratom support groups. 2 Within the United States, kratom is currently illegal in 6 states (Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin), and legislation is pending to ban sales in several other states. 9 Doses recommended by facilities that sell kratom differ based on dosage form but widely range from 1 to 8 g per day. 3 This case is unique in that naltrexone was used for an offlabel use of weight loss. ...
Kratom is an herbal supplement with reports of use for natural pain relief or treatment of opioid withdrawal symptoms. Kratom has metabolites that bind to and agonize mu-opioid receptors similar to opiate medications. There have been reports of serious adverse reactions, with a potential for dependence with long-term use and withdrawal that may occur upon discontinuation. Naltrexone can result in abrupt withdrawal symptoms when used with opioids or opioid-like supplements such as kratom. This case report describes withdrawal precipitated by naltrexone administration in a patient with undisclosed chronic kratom use. This case highlights the importance of thorough assessment of all self-administered herbal and over-the-counter supplements as they may have serious interactions with other prescribed medications and affect therapeutic outcomes.
... Indigenous to Southeast Asia, Kratom contains alkaloids used to treat addictions. In the United States, the Drug Enforcement Administration (DEA) had planned to add Kratom to Schedule 1 of banned substances thought to have high potential for abuse and no medical use, although due to protests from the American Kratom Association and other groups the DEA backed away from making Kratom a Schedule 1 substance (Griffin and Webb 2018). Webb and Griffin (2020) find there was a "mild moral panic" regarding Kratom in the US as the media started to report "bad trips" regarding Kratom use, and for that reason the DEA attempted to schedule Kratom as a Schedule 1 drug. ...
... Webb and Griffin (2020) find there was a "mild moral panic" regarding Kratom in the US as the media started to report "bad trips" regarding Kratom use, and for that reason the DEA attempted to schedule Kratom as a Schedule 1 drug. Public backlash caused the DEA to withdraw these plans (Griffin and Webb 2018). The findings reveal the influence the media has on politicians and in turn how claims made by politicians in the media can prompt legal changes. ...
Smoking a potent concentration of salvia divinorum (hereafter salvia) has the capacity to dissolve one’s ego and sense of self. Due to the catatonic state a strong dose of salvia produces, the substance has been considered alarming by claims-makers including politicians, media officials, police, and citizen groups. This paper examines news media accounts of salvia use in Canada and salvia’s regulation by the Canadian federal government. Providing a qualitative content analysis of newspaper articles spanning 1991–2019 regarding claims made about salvia, we draw from literature on moral panics and drugs to conceptualize the police and political response to salvia in Canada. We trace the shifting claims made by an array of claims-makers, showing how the focus changed from curiosity to claims about risk. The banning of salvia in Canada displays the hallmarks of a moral panic, though in this case the claims-making about the harm and risk of salvia went on for years before the substance was made illegal. We apply the notions of slow panic and panic policy to salvia regulation in Canada and reflect on the implications for literatures regarding drug panics and the new psychedelic renaissance.
... recognized medicinal value and a significant potential for misuse [14]. ...
... While consumers believe these goods are harmless, experts have raised concerns about their toxicity and interaction with medicinal medicines [21]. Due to a lack of evidence on potential bad effects on users, prior attempts to categorize kratom as a controlled substance rather than a herbal supplement have met with overwhelming popular opposition [14]. Growing data shows that recreational usage of kratom may be associated with negative clinical symptoms [20,22,23]. ...
... Several US states have banned kratom preparations citing concerns of public health whereas others require labeling and GMP (Good Manufacturing Practice) testing in order to meet quality standards. 29 Given the ongoing global coronavirus (COVID-19) pandemic, availability of kratom from its sources in Southeast Asia (primarily Indonesia, Thailand, and Malaysia) may contribute to supply shortages or disruptions in kratom leaves reaching distributors and, ultimately, consumers. ...
... 47 Likewise, despite increasing self-regulation among kratom vendors, some kratom products purchased in the US have been associated with adulteration, contamination, and insufficient regulation of the alkaloid content to ensure consumer safety and product quality and consistency. 29,[48][49][50] Even if kratom users are able to obtain their preferred products, they may not always receive consistent product quality and content, which could contribute to experimentation in dose escalation and concomitant use with other drugs/substances. Kratom may often serve the purpose of mitigating the withdrawal effects of other drugs that were initially taken concomitantly, especially opioids and stimulants, based on its own central stimulant and depressant effects. ...
Background: Kratom, a tree native to Southeast Asia, is increasingly used in Western countries for self-treatment of pain, psychiatric disorders, and mitigation of withdrawal symptoms from drugs of abuse. Because kratom is solely supplied from its native locations, supply shortages during the COVID-19 pandemic may impact the availability of preparations and hence force consumers to change their patterns of use. The aim of this study was to understand if and how COVID-19 was influencing kratom purchasing and use. Methods: Additional questions specific to kratom availability and changes in use during COVID-19 were added to an international online survey with responses collected between January and July 2020. During the same period, kratom-related social media posts to Twitter, Reddit, and Bluelight were analyzed for themes similar to the survey questions. Results: The survey results indicated no changes in kratom use patterns although the sample size was relatively small (n = 70) with younger consumers reporting a potential issue in obtaining their desired products from their usual sources. The survey respondents identified primarily as non-Hispanic whites (87.1%). Social media themes revolved primarily around quitting kratom during COVID-19, misinformation about the effects of kratom on COVID-19, and other non-COVID-related discussions. While some consumers may increase their kratom dose because of additional stress, a majority of discussions centered around reducing or rationing kratom due to COVID-19 or a perceived dependence. Access to quality kratom products was also a major discussion topic on social media. Conclusions: Kratom use patterns did not change due to COVID-19 but consumers were concerned about potential product shortages and resulting quality issues. Clinicians and public health officials need to be informed and educated about kratom use as a potential mitigation strategy for substance use disorders and for self-treatment of pain.
... Due to its numerous side effects, sales of kratom are prohibited in many Asian countries and Australia (Schimmel and Dart, 2020). In the U.S., the initial attempt by the U.S. Drug Enforcement Administration in 2016 to list kratom as schedule I drug was postponed due to strong opposition from kratom lobbyists (Griffin and Webb, 2018). This delay resulted in uncontrolled sales of kratom in the U.S. and a spike of reported side effects associated with kratom use recorded in the last several years (Post et al., 2019;Ahmad et al., 2021). ...
Dietary supplements (DS) constitute a widely used group of products comprising vitamin, mineral, and botanical extract formulations. DS of botanical or herbal origins (HDS) comprise nearly 30% of all DS and are presented on the market either as single plant extracts or multi-extract-containing products. Despite generally safe toxicological profiles of most products currently present on the market, rising cases of liver injury caused by HDS – mostly by multi-ingredient and adulterated products – are of particular concern. Here we discuss the most prominent historical cases of HDS-induced hepatotoxicty – from Ephedra to Hydroxycut and OxyELITE Pro-NF, as well as products with suspected hepatotoxicity that are either currently on or are entering the market. We further provide discussion on overcoming the existing challenges with HDS-linked hepatotoxicity by introduction of advanced in silico, in vitro, in vivo, and microphysiological system approaches to address the matter of safety of those products before they reach the market.
... However, definitive proof that kratom was the cause of the toxicities and deaths was lacking. In addition, almost all cases involved the use of other drugs or the presence of serious health problems including seizure disorders and refractory depression [16,[25][26][27]. In some cases, the kratom products may have even been adulterated with exogenous substances including synthetic opioids [16,28,29]. ...
Kratom (Mitragyna speciosa) is a tropical tree that is indigenous to Southeast Asia. Kratom leaf products have been used in traditional folk medicine for their unique combination of stimulant and opioid-like effects. Kratom is being increasingly used in the West for its reputed benefits in the treatment of pain, depression, and opioid use disorder (OUD). Recent studies from the United States Food and Drug Administration (FDA, Silver Spring, MD, USA) and our laboratory have shown that many kratom products being sold in the United States are contaminated with potentially hazardous levels of lead (Pb). In this commentary, we discuss the public health implications of the presence of Pb in kratom products, particularly as they relate to the predicted levels of Pb exposure among kratom users. We also considered the specific toxic effects of Pb and how they might relate to the known physiologic and toxicologic effects of kratom. Finally, we consider the possible sources of Pb in kratom products and suggest several areas for research on this issue.
... Fresh leaves can be left in the sun to be dried, then the dried leaves rubbed between hands to be powder. The powder form can be filled into capsules or pills and ingested or made into a liquid form which can be injected (Griffin & Webb, 2018;Sharma et al., 2019). ...
... People who have decided to initiate kratom use should begin with a minute amount to test for adverse reactions before slowly increasing. It is important to convey that the potency of the plant can vary based on factors such as geographical source, the season, age of the sample, and post-harvest handling (Adkins et al., 2011;Griffin and Webb, 2018;Pearson et al., 2018;Zhang et al., 2020), as well as strain, which is commonly referred to as vein type (red, green, or white) and likely corresponds to the age of the leaf. Evidence suggests that the red vein variety may be more potent than the older, green vein (Braley and Hondrogiannis, 2020). ...
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. 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. 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. 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. An especially important gap in safety-related science is the use of kratom in combination with physiologically active substances and medicines. 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. We conclude by making recommendations for best practices in working with people who use kratom.
... This reduction in side effect profile was first attributed to G-protein-biased activity of the kratom alkaloids at the µOR (Kruegel et al., 2016;Váradi et al., 2016), but new research suggests that partial agonism at the µOR likely drives these effects (Gillis et al., 2020;Bhowmik et al., 2021;Uprety et al., 2021). Despite the reduced µOR-mediated side effects relative to traditional opioids, kratom use is not without risk, and this is reflected in controversial efforts to place 7-hydroxymitragynine and mitragynine under Schedule I regulation by the Drug Enforcement Agency (DEA, 2016;Griffin and Webb, 2018). ...
Background and Purpose: Mitragyna speciosa extract and kratom alkaloids decrease alcohol consumption in mice at least in part through actions at the δ-opioid receptor (δOR). However, the most potent opioidergic kratom alkaloid, 7-hydroxymitragynine, exhibits rewarding properties and hyperlocomotion presumably due to preferred affinity for the mu opioid receptor (µOR). We hypothesized that opioidergic kratom alkaloids like paynantheine and speciogynine with reduced µOR potency could provide a starting point for developing opioids with an improved therapeutic window to treat alcohol use disorder.
Experimental Approach: We characterized paynantheine, speciociliatine, and four novel kratom-derived analogs for their ability to bind and activate δOR, µOR, and κOR. Select opioids were assessed in behavioral assays in male C57BL/6N WT and δOR knockout mice.
Key Results: Paynantheine (10 mg∙kg⁻¹, i.p.) produced aversion in a limited conditioned place preference (CPP) paradigm but did not produce CPP with additional conditioning sessions. Paynantheine did not produce robust antinociception but did block morphine-induced antinociception and hyperlocomotion. Yet, at 10 and 30 mg∙kg⁻¹ doses (i.p.), paynantheine did not counteract morphine CPP. 7-hydroxypaynantheine and 7-hydroxyspeciogynine displayed potency at δOR but limited µOR potency relative to 7-hydroxymitragynine in vitro, and dose-dependently decreased voluntary alcohol consumption in WT but not δOR in KO mice. 7-hydroxyspeciogynine has a maximally tolerated dose of at least 10 mg∙kg⁻¹ (s.c.) at which it did not produce significant CPP neither alter general locomotion nor induce noticeable seizures.
Conclusion and Implications: Derivatizing kratom alkaloids with the goal of enhancing δOR potency and reducing off-target effects could provide a pathway to develop novel lead compounds to treat alcohol use disorder with an improved therapeutic window.
