Kratom: Substance of Abuse or Therapeutic Plant?

David A Gorelick

doi:10.1016/j.psc.2022.04.002

Kratom: Substance of Abuse or Therapeutic Plant?

Psychiatr Clin North Am. 2022 Sep;45(3):415-430. doi: 10.1016/j.psc.2022.04.002. Epub 2022 Jul 31.

Author

David A Gorelick¹

Affiliation

¹ Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, MPRC-Tawes Building, Baltimore, MD 21228, USA. Electronic address: dgorelick@som.umaryland.edu.

PMID: 36055730
DOI: 10.1016/j.psc.2022.04.002

Abstract

Kratom is the common term for Mitragyna speciosa and its products. Its major active compounds are mitragynine and 7-hydroxymitragynine. An estimated 2.1 million US residents used kratom in 2020, as a "legal high" and self-medication for pain, opioid withdrawal, and other conditions. Up to 20% of US kratom users report symptoms consistent with kratom use disorder. Kratom use is associated with medical toxicity and death. Causality is difficult to prove as almost all cases involve other psychoactive substances. Daily, high-dose use may result in kratom use disorder and opioid-like withdrawal on cessation of use. These are best treated with buprenorphine.

Keywords: 7-Hydroxymitragynine; Analgesia; Biased agonist; Kratom; Mitragynine; Opioid receptor; Withdrawal.

Publication types

Review

MeSH terms

Analgesics, Opioid
Humans
Mitragyna*
Plant Extracts / therapeutic use
Substance Withdrawal Syndrome* / drug therapy

Substances

Analgesics, Opioid
Plant Extracts