Mitragyna speciosa: Difference between revisions - Wikipedia

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'''''Mitragyna speciosa''''' is a tropical [[evergreen]] tree of the [[Rubiaceae]] family (coffee family) native to [[Southeast Asia]].~~<ref>{{cite web|url=https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/rubiaceae |title=Rubiaceae - an overview|publisher=Sciencedirect|date=2016-01-01}}</ref>~~<ref name="GRIN">{{GRIN | access-date = 2013-12-26}}</ref> It is indigenous to [[Cambodia]], [[Thailand]], [[Indonesia]], [[Malaysia]], [[Myanmar]], and [[Papua New Guinea]],<ref name=Rech2015>{{cite journal|last1=Rech|first1=MA|last2=Donahey|first2=E|last3=Cappiello Dziedzic|first3=JM|last4=Oh|first4=L|last5=Greenhalgh|first5=E|title=New drugs of abuse|journal=Pharmacotherapy|date=February 2015|volume=35|issue=2|pages=189–97|pmid=25471045|doi=10.1002/phar.1522|s2cid=206358469|doi-access=free}}</ref> where its leaves, known as "kratom" have been used in [[herbal medicine]] since at least the 19th century.<ref name="Hassan2013">{{cite journal | last1=Hassan | first1=Z | last2=Muzaimi | first2=M | last3=Navaratnam | first3=V | last4=Yusoff | first4=NHM | last5=Suhaimi | first5=FW | last6=Vadivelu | first6=R | last7=Vicknasingam | first7=BK | last8=Amato | first8=D | last9=von Hörsten | first9=S | last10=Ismail | first10=NIW | last11=Jayabalan | first11=N | last12=Hazim | first12=AI| last13=Mansor | first13=SM | last14=Müller|first14=CP|year=2013|title=From Kratom to mitragynine and its derivatives: Physiological and behavioural effects related to use, abuse, and addiction|journal=Neurosci Biobehav Rev | volume=37 | issue=2 | pages=138–151 | doi=10.1016/j.neubiorev.2012.11.012 | issn=0149-7634 | pmid=23206666 | s2cid=8463133 }}</ref> They have also historically been consumed via chewing, smoking, and as a tea.<ref name="Julien's Primer">{{cite book |last1=Advokat |first1=Claire D. |last2=Comaty |first2=Joseph E. |last3=Julien |first3=Robert M. |title=Julien's Primer of Drug Action: a comprehensive guide to the actions, uses, and side effects of psychoactive drugs |date=2019 |publisher=Worth Publishers |location=New York |isbn=978-1-319-20054-1 |page=570 |edition=14th}}</ref> Kratom has [[opioid]]-like properties and some [[stimulant]]-like effects.<ref name=FDA2018>{{cite web|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm595622.htm|title=Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency's scientific evidence on the presence of opioid compounds in kratom, underscoring its potential for abuse|author=Gottlieb, Scott|date=6 February 2018|publisher=US Food and Drug Administration|access-date=6 February 2018}}</ref><ref name=Cin2015>{{cite journal|pmc=4657101|year=2015|last1=Cinosi|first1=E|title=Following "the Roots" of Kratom (''Mitragyna speciosa''): The Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries|journal=BioMed Research International|volume=2015|pages=1–11|last2=Martinotti|first2=G|last3=Simonato|first3=P|last4=Singh|first4=D|last5=Demetrovics|first5=Z|last6=Roman-Urrestarazu|first6=A|last7=Bersani|first7=F. S|last8=Vicknasingam|first8=B|last9=Piazzon|first9=G|last10=Li|first10=J. H|last11=Yu|first11=W. J|last12=Kapitány-Fövény|first12=M|last13=Farkas|first13=J|last14=Di Giannantonio|first14=M|last15=Corazza|first15=O|doi=10.1155/2015/968786|pmid=26640804|doi-access=free}}</ref>

{{As of|2018}}, the efficacy and safety of kratom are unclear.<ref name="white">{{cite journal|vauthors=White CM|year=2018|title=Pharmacologic and clinical assessment of kratom|journal=Am J Health Syst Pharm|type=Review|volume=75|issue=5|pages=261–267|doi=10.2146/ajhp161035|pmid=29255059}}</ref> In 2019, the United States [[Food and Drug Administration]] (FDA) stated that there is no evidence that kratom is safe or effective for treating any condition.<ref name="fda4-3-19" /> Some people take it for managing [[chronic pain]], for treating [[opioid withdrawal]] symptoms, or for [[recreational drug use|recreational purposes]].<ref name=Rech2015/><ref name="warner">{{cite journal |vauthors=Warner ML, Kaufman NC, Grundmann O |year=2016 |title=The pharmacology and toxicology of kratom: from traditional herb to drug of abuse |journal=Int. J. Legal Med. |type=Review |volume=130 |issue=1 |pages=127–38 |doi=10.1007/s00414-015-1279-y |pmid=26511390 |s2cid=2009878}}</ref> The onset of effects typically begins within five to ten minutes and lasts for two to five hours.<ref name="Rech2015" />

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|legal_BR = E

|legal_BR_comment = <ref>{{Cite web |author=Anvisa |author-link=Brazilian Health Regulatory Agency |date=2023-09-15 |title=RDC Nº 816 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial |trans-title=Collegiate Board Resolution No. 816 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control|url=https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-816-de-15-de-setembro-de-2023-510390164 |url-status=live |archive-url=https://web.archive.org/web/20231019120956/https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-816-de-15-de-setembro-de-2023-510390164 |archive-date=2023-10-19 |access-date=2023-10-19 |publisher=[[Diário Oficial da União]] |language=pt-BR |publication-date=2023-09-18}}</ref>

|legal_CA = Unscheduled (Not authorized for sale or use), legal for religious use, ~~like~~such as incense <ref>{{cite web |title=Unauthorized "Sāj" kratom products seized from two Edmonton stores may pose serious health risks |url=http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2018/66710a-eng.php |website=Health Canada |publisher=Canada |access-date=8 August 2018 |date=4 May 2018}}</ref>

|legal_US = Unscheduled (Drug of concern),<ref name=Hassan2013 /> subject to import bans,<ref name=FDAImportAlert /> ~~and sale for consumption is illegal~~<ref name=FDAImportAlert /><ref name=Tave>{{cite web|url=https://www.fda.gov/downloads/AboutFDA/CentersOffices/OfficeofFoods/CFSAN/CFSANFOIAElectronicReadingRoom/UCM598251.pdf|title=FDA warning letter to Industrial Chemicals, LLC, and INI Botanicals|publisher=Office of Dietary Supplement Programs, Center for Food Safety and Applied Nutrition, US Food and Drug Administration| last=Tave |first=Steven J.|date=26 February 2018|access-date=7 March 2018}}</ref><ref name="fda4-3-19">{{cite web |title=FDA and kratom |url=https://www.fda.gov/news-events/public-health-focus/fda-and-kratom |publisher=US Food and Drug Administration |access-date=8 August 2019 |date=3 April 2019}}</ref>

|legal_UN = Unscheduled

|legal_status = Illegal in [[Malaysia]], [[Myanmar]], [[Indonesia]] and [[New Zealand]]<ref name=EMCDDA /><ref name=Hassan2013 />

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===Opioid withdrawal===

Because the withdrawal effects of kratom are often reported to be less severe than those associated with traditional opioids,<ref name="warner" /> some people use kratom in the attempt to manage [[opioid use disorder]],<ref name=":2">{{Cite journal|last1=Swogger|first1=Marc T.|last2=Walsh|first2=Zach|date=2018-02-01|title=Kratom use and mental health: A systematic review|url=https://pubmed.ncbi.nlm.nih.gov/29248691/|journal=Drug and Alcohol Dependence|volume=183|pages=134–140|doi=10.1016/j.drugalcdep.2017.10.012|issn=1879-0046|pmid=29248691}}</ref> though no clinical trials have been done supporting this use. {{As of|2018}}, there have been no formal trials to study the efficacy or safety of kratom to treat opioid addiction.<ref name="FDA2018" /> Kratom is not approved for this or any other medical use.<ref name="EMCDDA" /> Stanciu et al. conducted a review of all literature and found insufficient evidence for any conclusions concerning whether kratom is harmful or whether can serve as harm reduction for those with opioid addiction.<ref>{{Cite journal |last1=Stanciu |first1=Cornel |last2=Ahmed |first2=Saeed |last3=Gnanasegaram |first3=Samantha |last4=Gibson |first4=Stephen |last5=Penders |first5=Thomas |last6=Grundmann |first6=Oliver |last7=McCurdy |first7=Christopher |date=2022-09-03 |title=Kratom as an opioid alternative: harm, or harm reduction? A systematic review of literature |url=https://pubmed.ncbi.nlm.nih.gov/36001875/ |journal=The American Journal of Drug and Alcohol Abuse |volume=48 |issue=5 |pages=509–528 |doi=10.1080/00952990.2022.2111685 |issn=1097-9891 |pmid=36001875|s2cid=251810402 }}</ref> While some [[literature review]]s claim that kratom has less potential for [[Substance dependence|dependence]] or [[Drug overdose|overdose]] than traditional opioids,<ref>{{Cite journal|last1=Henningfield|first1=Jack E.|last2=Fant|first2=Reginald V.|last3=Wang|first3=Daniel W.|date=2018|title=The abuse potential of kratom according the 8 factors of the controlled substances act: implications for regulation and research|journal=Psychopharmacology|volume=235|issue=2|pages=573–589|doi=10.1007/s00213-017-4813-4|issn=1432-2072|pmc=5813050|pmid=29273821}}</ref><ref name=":3">{{Cite journal|last1=Eastlack|first1=Steven C.|last2=Cornett|first2=Elyse M.|last3=Kaye|first3=Alan D.|date=2020|title=Kratom—Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review|journal=Pain and Therapy|volume=9|issue=1|pages=55–69|doi=10.1007/s40122-020-00151-x|issn=2193-8237|pmc=7203303|pmid=31994019}}</ref> other reviews note that kratom withdrawal itself can still be quite severe.<ref name="Stan2019" />

Data on how widely it is used worldwide are lacking, as it is not detected by typical drug-screening tests.<ref name="Adkins 2011-05-01"/> Rates of kratom use appear to be increasing among those who have been self-managing chronic pain with opioids purchased without a prescription and are cycling (but not quitting) their opioid use.<ref name="Adkins 2011-05-01"/>

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==Adverse effects==

''Mitragyna speciosa'' may cause many adverse effects, and in November 2017 the FDA issued a public health advisory for the drug.<ref name=white/> The side effects of kratom appear to be [[Dose–response relationship|dose-dependent]] and are more common with doses that exceed 8 g.<ref name=":3" /> While the [[Incidence (epidemiology)|incidence]] of adverse effects in people who use kratom is unknown, a 2019 review of 935 kratom exposures reported to U.S. [[poison control center]]s over a seven-year period listed the following signs and symptoms: agitation (18.6%), [[tachycardia]] (16.9%), [[Somnolence|drowsiness]] (13.6%), [[vomiting]] (11.2%), [[confusion]] (8.1%), [[seizure|seizures]] (6.1%), [[Drug withdrawal|withdrawal symptoms]] (6.1%), [[hallucination]]s (4.8%), [[Hypoventilation|respiratory depression]] (2.8%), [[coma]] (2.3%), and [[Cardiac arrest|cardiac]] or [[respiratory arrest]] (0.6%).<ref name=":5">{{Cite journal|last1=Eggleston|first1=William|last2=Stoppacher|first2=Robert|last3=Suen|first3=Kyle|last4=Marraffa|first4=Jeanna M.|last5=Nelson|first5=Lewis S.|date=2019|title=Kratom Use and Toxicities in the United States|url=https://pubmed.ncbi.nlm.nih.gov/31099038/|journal=Pharmacotherapy|volume=39|issue=7|pages=775–777|doi=10.1002/phar.2280|issn=1875-9114|pmid=31099038|s2cid=157058636}}</ref><ref name=":3" /> The study also reported two deaths and four cases of [[Neonatal withdrawal|neonatal abstinence syndrome]].<ref name=":5" /> A different 2019 review listed as common side effects: [[decreased appetite]], ~~anorexia,~~ [[weight loss]], ~~temporary~~ [[erectile dysfunction]], [[insomnia]], [[sweating]], [[hyperpigmentation]], [[hair loss]], [[tremor]], and [[constipation]].<ref name=corkery/>

Kratom products in the U.S. are commonly used in doses of 2–6 g of dried leaf, and doses exceeding 8 g are relatively uncommon.<ref>{{Cite journal|last=Grundmann|first=Oliver|date=2017-07-01|title=Patterns of Kratom use and health impact in the US-Results from an online survey|url=https://pubmed.ncbi.nlm.nih.gov/28521200/|journal=Drug and Alcohol Dependence|volume=176|pages=63–70|doi=10.1016/j.drugalcdep.2017.03.007|issn=1879-0046|pmid=28521200}}</ref> Given that kratom products may vary greatly in potency, there is no standard dosing system. At relatively low doses (1–5 g of raw leaves), at which there are mostly stimulant effects, side effects include contracted pupils and blushing; adverse effects related to stimulation include anxiety and agitation, and opioid-related effects ~~like~~such as itching, nausea, loss of appetite, and increased urination begin to appear.<ref name=Rech2015/><ref name=warner/> At moderate to high doses (5–15 g of raw leaves), at which opioid effects generally appear, additional adverse effects include [[tachycardia]] (an increased stimulant effect) as well as the opioid side effects of constipation, dizziness, hypotension, dry mouth, and sweating.<ref name="warner" /><ref name="Rosen" /><ref name=":4">{{Cite journal|last1=Meireles|first1=Vânia|last2=Rosado|first2=Tiago|last3=Barroso|first3=Mário|last4=Soares|first4=Sofia|last5=Gonçalves|first5=Joana|last6=Luís|first6=Ângelo|last7=Caramelo|first7=Débora|last8=Simão|first8=Ana Y.|last9=Fernández|first9=Nicolás|last10=Duarte|first10=Ana Paula|last11=Gallardo|first11=Eugenia|date=2019-03-04|title=''Mitragyna speciosa'': Clinical, Toxicological Aspects and Analysis in Biological and Non-Biological Samples|journal=Medicines|volume=6|issue=1|page=35|doi=10.3390/medicines6010035|issn=2305-6320|pmc=6473843|pmid=30836609|doi-access=free}}</ref>

Long-term use of high doses of kratom may lead to development of tolerance, dependence, and withdrawal symptoms, including loss of appetite, weight loss, decreased ~~sexual drive~~[[libido]], ~~trouble sleeping~~insomnia, muscle spasms, muscle and bone pain, [[myoclonus]], [[lacrimation|watery eyes]], [[Hot flash|hot ~~flushes~~flashes]], [[fever]], [[diarrhea]], restlessness, anger, and sadness.<ref name=Cin2015/> This may lead to resumption of use.<ref name=Cin2015/><ref name=warner/><ref name=Stan2019>{{Cite journal|last1=Stanciu|first1=Cornel N.|last2=Gnanasegaram|first2=Samantha A.|last3=Ahmed|first3=Saeed|last4=Penders|first4=Thomas|date=January 2019|title=Kratom Withdrawal: A Systematic Review with Case Series|journal=Journal of Psychoactive Drugs|volume=51|issue=1|pages=12–18|doi=10.1080/02791072.2018.1562133|issn=2159-9777|pmid=30614408|s2cid=58643707}}</ref>

Frequent use of high doses of kratom may cause tremors, anorexia, weight loss, [[seizure]]s, psychosis and other mental health conditions.<ref name=bachu>{{cite journal |vauthors=Bachu AK, Singal P, Griffin B, Harbaugh L, Prasad S, Jain L, Mohiuddin S, Papudesi BN, Nagi T, Youssef NA, Chopra A, Ahmed S |title=Kratom use and mental health: A systematic literature review and case example |journal=J Addict Dis |volume= |issue= |pages=1–12 |date=November 2023 |pmid=37942896 |doi=10.1080/10550887.2023.2273192 |s2cid=265064749 |url=}}</ref><ref name=warner/> Kratom use may worsen existing mental health conditions.<ref name=bachu/> In case reports associating kratom use with psychosis, it remains unclear whether kratom use directly caused psychosis or simply unmasked the condition.<ref>{{Cite book|last1=Dye|first1=Leslie R.|url=https://books.google.com/books?id=cEFEDwAAQBAJ&q=kratom+psychosis&pg=PA238|title=Case Studies in Medical Toxicology: From the American College of Medical Toxicology|last2=Murphy|first2=Christine|last3=Calello|first3=Diane P.|last4=Levine|first4=Michael D.|last5=Skolnik|first5=Aaron|date=2017-12-22|publisher=Springer|isbn=978-3-319-56449-4|language=en}}</ref> Serious toxicity is relatively rare and generally appears at high doses or when kratom is used with other substances.<ref name=Rech2015/><ref name=warner/> [[Drug interaction|Herb–drug interactions]] may result when kratom is combined with [[Alcoholic drink|alcohol]], [[sedative]]s, [[benzodiazepine]]s, [[opioid]]s, [[caffeine]], [[cocaine]], [[yohimbine]], or [[monoamine oxidase inhibitor]]s (MAOIs).<ref name=":4" /> [[Rhabdomyolysis]] is one of the rare and serious complications of this herb at high dosage.<ref name="pmid34430176">{{cite journal |vauthors=Patel P, Aknouk M, Keating S, Richard I, Kata P, Ali RY, Cheriyath P |title=Cheating Death: A Rare Case Presentation of Kratom Toxicity |journal=[[Cureus]] |volume=13 |issue=7 |pages=e16582 |date=July 2021 |pmid=34430176 |pmc=8378318 |doi=10.7759/cureus.16582 |doi-access=free |url= |issn=}}</ref>

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===Respiratory depression===

[[Respiratory depression]] is the leading cause of death from opioid use.<ref name= Beckett2014>{{cite book| first= Jaclyn R. | last= Beckett|editor1-last=Raffa|editor1-first= Robert B.|title=Kratom and other mitragynines : the chemistry & pharmacology of opioids from|date= 2014| publisher= CRC Press|isbn= 978-1-4822-2518-1|pages= 195–204|chapter= Non-Analgesic CNS Effects}}</ref> Although evidence is sparse, the risk of respiratory depression caused by taking kratom appears to be low, but, {{as of|lc=yes|2016}}, the Food and Drug Administration listed respiratory depression as a concern.<ref name=white/><ref name="FDAImportAlert">{{cite web |date=20 December 2016 |title=Import Alert 54-15; Detention without physical examination of dietary supplements and bulk dietary ingredients that are or contain ''Mitragyna speciosa'' or kratom |url=http://www.accessdata.fda.gov/cms_ia/importalert_1137.html |access-date=7 March 2018 |publisher=U.S. Food and Drug Administration}}</ref> Confusingly, a 2018 review found that the alkaloids in kratom do not induce respiratory depression.<ref name="Kruegel">{{Cite journal|last1=Kruegel|first1=Andrew C.|last2=Grundmann|first2=Oliver|date=2018|title=The medicinal chemistry and neuropharmacology of kratom: A preliminary discussion of a promising medicinal plant and analysis of its potential for abuse|url=http://dx.doi.org/10.1016/j.neuropharm.2017.08.026|journal=Neuropharmacology|volume=134|issue=Pt A|pages=108–120|doi=10.1016/j.neuropharm.2017.08.026|pmid=28830758|s2cid=24009429|issn=0028-3908}}</ref>

===Liver toxicity===

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{{As of|2011}}, the plant was controlled in Denmark, Latvia, Lithuania, Poland, Romania and Sweden.<ref name=EMCDDA/>

Kratom is a controlled substance in Bulgaria.<ref>{{Cite web ~~|last=OnlineMarketing.bg~~ |title=Какво е кратом? |url=https://www.drugsinfo-bg.org/azbuka-na-narkoticite/kratom/kakvo-e-kratom/ |access-date=2023-11-28 |website=Национална информационна линия за наркотиците, алкохола и хазарта}}</ref>

The sale, import, and export of kratom have been prohibited in the UK since 2016 under the [[Psychoactive Substances Act 2016|Psychoactive Substances Act]].<ref>{{cite web |url=http://www.legislation.gov.uk/ukpga/2016/2/contents |title=Psychoactive Substances Act 2016 |publisher=The National Archives, HM Government Publishing |date=9 September 2016}}</ref>

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=== Indonesia ===

Kratom iswas previously scheduled to become an illegal substance in Indonesia in 2024 once new regulations from the Indonesian National Narcotics Agency (BNN) go into effect.<ref>{{cite web|date=December 22, 2020|title=Mulai 2024, Pemerintah Larang Penggunaan dan Ekspor Kratom|url=https://www.beritasatu.com/nasional/811035/mulai-2024-pemerintah-larang-penggunaan-dan-ekspor-kratom|access-date=2022-06-12|website=beritasatu.com|language=id}}</ref> However, in 2024, a revision to a regulation by [[Ministry of Trade (Indonesia)|Ministry of Trade]] legalized production and export of kratom leaves.<ref name=":9">{{Cite web |last=adminkalbaronline |date=2024-09-04 |title=Bupati Kapuas Hulu: Sudah Terbit Permendag RI Nomor 21 Tahun 2024 Tentang Ekspor Komoditi Kratom - KalbarOnline.Com |url=https://kalbaronline.com/2024/09/04/bupati-kapuas-hulusudah-terbit-permendag-ri-nomor-21-tahun-2024-tentang-ekspor-komoditi-kratom/ |access-date=2024-09-04 |website=kalbaronline.com/ |language=en-US}}</ref> Later in September 2024, Indonesia's Ministry of Cooperatives and Small Medium Business stated that Indonesia will start building downstream industries for kratom exports.<ref>{{Cite web |title=Teten Masduki Akan Wariskan Program Hilirisasi Kratom untuk Prabowo |url=https://kumparan.com/kumparanbisnis/teten-masduki-akan-wariskan-program-hilirisasi-kratom-untuk-prabowo-23XfQMRRM7n |access-date=2024-09-18 |website=kumparan |language=id-ID}}</ref><ref name=":10">{{Cite web |title=Menkop Teten Dorong Hilirisasi Produk Kratom, Bisa Dijual Rp90 Juta per Kilogram |url=https://www.merdeka.com/uang/menkop-teten-dorong-hilirisasi-produk-kratom-bisa-dijual-rp90-juta-per-kilogram-198673-mvk.html |access-date=2024-09-18 |website=merdeka.com |language=en}}</ref> These developments made kratom legal to export and manufacture in Indonesia.<ref name=":9" /><ref name=":10" />

===Malaysia===

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The FDA's arguments for the federal [[Prohibition of drugs|prohibition]] of kratom have drawn both criticism and support.<ref name=":8">{{cite web|title=The U.S. May Ban Kratom. But Are its Effects Deadly or Lifesaving?|url=https://www.discovermagazine.com/health/the-us-may-ban-kratom-but-are-its-effects-deadly-or-lifesaving|access-date=2021-06-22|website=Discover Magazine|language=en}}</ref><ref name=":6">{{Cite magazine|last1=Garber-Paul|first1=Elisabeth|last2=Garber-Paul|first2=Elisabeth|date=2018-08-15|title=Kratom Association Calls FDA Review of Drug 'Junk Science' in Scathing Report|url=https://www.rollingstone.com/culture/culture-news/kratom-drug-industry-fda-opioid-711169/|access-date=2021-06-22|magazine=Rolling Stone|language=en-US}}</ref><ref name=":7">{{cite web|last=Marlan|first=Dustin|date=2021-06-08|title=A Sensible, Evidence-Based Proposal for Kratom Reform|url=https://blog.petrieflom.law.harvard.edu/2021/06/08/a-sensible-evidence-based-proposal-for-kratom-reform/|access-date=2021-06-22|website=Bill of Health|language=en-US}}</ref> FDA commissioner Gottlieb responded to criticism in 2018 by stating that “The FDA has done an exhaustive review of adverse event reports, clinical literature and other sources of information related to kratom."<ref name=":6" /> However, in 2021, former Acting [[Commissioner of Food and Drugs]] [[Brett Giroir]] claimed that the FDA's recommendation to schedule kratom was rejected because of "embarrassingly poor evidence [and] data."<ref name=":7" /> The FDA's position on kratom has also been criticized by the [[American Kratom Association]] and researchers including [[Walter Prozialeck]].<ref name=":8" /><ref name=":6" /><ref>{{Cite journal|last1=Prozialeck|first1=Walter C.|last2=Avery|first2=Bonnie A.|last3=Boyer|first3=Edward W.|last4=Grundmann|first4=Oliver|last5=Henningfield|first5=Jack E.|last6=Kruegel|first6=Andrew C.|last7=McMahon|first7=Lance R.|last8=McCurdy|first8=Christopher R.|last9=Swogger|first9=Marc T.|last10=Veltri|first10=Charles A.|last11=Singh|first11=Darshan|date=2019|title=Kratom policy: The challenge of balancing therapeutic potential with public safety|journal=The International Journal on Drug Policy|volume=70|pages=70–77|doi=10.1016/j.drugpo.2019.05.003|issn=1873-4758|pmc=7881941|pmid=31103778}}</ref> Former commissioner Gottlieb continued to defend the agency's position in 2021, stating that he was convinced that kratom was fueling the U.S. [[opioid epidemic]], though Gottlieb's partiality has been called into question as he has since gone on to become a member of the board of directors of [[Pfizer Inc.]], a company that has been heavily criticized for its sale and marketing of opioid drugs.<ref name=":7" />

== Research directions==

Kratom is under preliminary research for ~~its~~ possible [[antipsychotic]] and [[antidepressant]] properties.<ref>{{Cite journal|last1=Johnson|first1=Lindsay E.|last2=Balyan|first2=Lilian|last3=Magdalany|first3=Amy|last4=Saeed|first4=Fizza|last5=Salinas|first5=Robert|last6=Wallace|first6=Starla|last7=Veltri|first7=Charles A.|last8=Swogger|first8=Marc T.|last9=Walsh|first9=Zach|last10=Grundmann|first10=Oliver|date=2020-06-29|title=The Potential for Kratom as an Antidepressant and Antipsychotic|journal=The Yale Journal of Biology and Medicine|volume=93|issue=2|pages=283–289|issn=0044-0086|pmc=7309668|pmid=32607089}}</ref><ref>{{Cite journal|last1=Taylor Levine|first1=M.|last2=Gao|first2=Jin|last3=Satyanarayanan|first3=Senthil Kumaran|last4=Berman|first4=Sarah|last5=Rogers|first5=Jack T.|last6=Mischoulon|first6=David|date=2020|title=S-adenosyl-l-methionine (SAMe), cannabidiol (CBD), and kratom in psychiatric disorders: Clinical and mechanistic considerations|journal=Brain, Behavior, and Immunity|volume=85|pages=152–161|doi=10.1016/j.bbi.2019.07.013|issn=1090-2139|pmid=31301401|s2cid=195848995}}</ref> A study has shown that high doses of Kratom have antipsychotic-effects similar to that of [[haloperidol]],<ref>{{Cite journal |title=Mitragyna speciosa Leaf Extract Exhibits Antipsychotic-Like Effect with the Potential to Alleviate Positive and Negative Symptoms of Psychosis in Mice |date=2016 |pmc=5138496 |last1=Vijeepallam |first1=K. |last2=Pandy |first2=V. |last3=Kunasegaran |first3=T. |last4=Murugan |first4=D. D. |last5=Naidu |first5=M. |journal=Frontiers in Pharmacology |volume=7 |page=464 |doi=10.3389/fphar.2016.00464 |pmid=27999544 |doi-access=free }}</ref> however Kratom affects everyone differently. Survey studies found that some people use kratom as a self-treatment strategy for conditions such as [[opioid use disorder]], [[Pain|acute pain]], [[chronic pain]], and various mental health conditions, including [[anxiety]], [[ADHD]] and [[Depression (mood)|depression]].<ref name=":1" /><ref>{{Cite journal|last1=Covvey|first1=Jordan R.|last2=Vogel|first2=Samantha M.|last3=Peckham|first3=Alyssa M.|last4=Evoy|first4=Kirk E.|date=2020|title=Prevalence and characteristics of self-reported kratom use in a representative US general population sample|journal=Journal of Addictive Diseases|volume=38|issue=4|pages=506–513|doi=10.1080/10550887.2020.1788914|issn=1545-0848|pmid=32657217|s2cid=220499407}}</ref><ref name=":2">{{Cite journal|last1=Swogger|first1=Marc T.|last2=Walsh|first2=Zach|date=2018-02-01|title=Kratom use and mental health: A systematic review|url=https://pubmed.ncbi.nlm.nih.gov/29248691/|journal=Drug and Alcohol Dependence|volume=183|pages=134–140|doi=10.1016/j.drugalcdep.2017.10.012|issn=1879-0046|pmid=29248691}}</ref>

Kratom is being studied in order to [[Drug design|design]] novel drugs for treating [[pain]], [[opioid use disorder]], and [[Alcoholism|alcohol use disorder]].<ref>{{Cite journal|last1=Kudla|first1=Lucja|last2=Przewlocki|first2=Ryszard|date=2021-04-09|title=Influence of G protein-biased agonists of μ-opioid receptor on addiction-related behaviors|journal=Pharmacological Reports |volume=73|issue=4|pages=1033–1051|doi=10.1007/s43440-021-00251-1|issn=1734-1140|pmid=33835467|pmc=8413226|doi-access=free}}</ref> Further clinical research is necessary to corroborate anecdotal reports of kratom as an effective treatment for chronic pain, and to determine whether it is a safe or effective treatment for illness.<ref>{{cite web|publisher=National Institute on Drug Abuse, US National Institutes of Health|title=Kratom DrugFacts|url=https://www.drugabuse.gov/publications/drugfacts/kratom|access-date=17 June 2021|date=1 April 2019}}</ref><ref>{{Cite journal|last1=Prevete|first1=Elisabeth|last2=Kuypers|first2=Kim Paula Colette|last3=Theunissen|first3=Eef Lien|last4=Corazza|first4=Ornella|last5=Bersani|first5=Giuseppe|last6=Ramaekers|first6=Johannes Gerardus|date=2021-07-26|title=A systematic review of (pre)clinical studies on the therapeutic potential and safety profile of kratom in humans|journal=Human Psychopharmacology|volume=37|issue=1|pages=e2805|doi=10.1002/hup.2805|issn=1099-1077|pmid=34309900|pmc=9285932 |doi-access=free}}</ref>

== See also ==

Line 223 ⟶ 221:

== References ==

~~[https://topextracts.com/kratom-plant/ Kratom Plant]~~

== External links ==

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[[Category:Trees of Malesia]]

[[Category:Trees of New Guinea]]

[[Category:Herbal and fungal stimulants]]

[[Category:Herbal teas]]