Various traditional and current uses of kratom in South Asia and the Western world show that the impact of leaves and their extracts is multidimensional complexity, including socio-cultural, economic, legal, and medical problems that are often individual in nature.
Throughout the history of its use, Kratom has been known to provide stimulant and opioid effects that raise concerns with regulators and produce planning actions in various countries.
Although knowledge from clinical studies is limited, epidemiological data obtained from Southeast Asia, Europe, and the United States show that kratom has a separate user profile and the effect that exists distinguishes other stimulants or opioids.
The user’s opioid dependency substance is not the product of choice from other opioids but will use kratom as a hazard reduction or mitigation agent. This is the conclusion of research in Malaysia and the United States, although current information is preliminary in scope based on small sample sizes and limited regional investigations.
The results are consistent with preclinical observations in mice that show a reduction in the administration of morphine independently with the use of mitragynine. Potential points for developing current knowledge from mitragynine or using kratom as a reducing agent similar to methadone or buprenorphine are similar. This must be further studied in controlled clinical conditions.
Kratom toxicity in various animal species varies and has not been determined for acute and chronic exposure. The only clinical pharmacokinetic study in humans that provides mitragynine concentration in the blood does not correlate with postmortem blood mitragynine concentration and does not allow determination of toxic or lethal levels. Also, at this stage, only the concentration of mitragynine is reported to indicate the presence of Kratom, so we do not know that mitragynine is actually a toxic compound.
The report and the potential for study dependence on kratom are serious concerns about the current opioid crisis in the US and the increasing abuse of opiates in other countries. It seems that most kratom-dependent users have an abnormality or substance use before seeking help from chronic pain, but want to avoid using opioids.
The severity of Kratom’s dependency symptoms appears to be milder compared to opioid use disorders and can be treated in the same way as buprenorphine or methadone and subsequent shrinkage. The incidence of kratom addiction is unknown and to date, there is no information system on a national scale in the United States such as the National Narcotics and Health Use Survey (NSDUH) and future monitoring reports on kratom use in their reports.
Given the diversity of kratom usage patterns, additional research is very important to support and develop current results. Labeling products of kratom for sale according to consumer requirements to comply with appropriate regulatory standards and good manufacturing practices to ensure that consumers who see kratom are not exposed or polluted. Health care providers must be trained in kratom science and its clinical implications to help consumers make the right choices and avoid the interaction of medicinal herbs.