Kratom Botanical that at low doses produce stimulation and at - - PowerPoint PPT Presentation
Kratom Botanical that at low doses produce stimulation and at higher doses produce opioid effects Potential for physical dependence and opioid-type effects/toxicities Marketed in Western countries and increasing use/toxicities being reported
Botanical that at low doses produce stimulation and at higher doses produce opioid effects Potential for physical dependence and opioid-type effects/toxicities Marketed in Western countries and increasing use/toxicities being reported
Jean J. Schensul, Ph.D. Institute for Community Research and WHPP
Adapted from Elinore F. McCance-Katz, Presentation on urgent and emerging issues, SAMHSA, 2019
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used traditionally to combat fatigue and improve work productivity among farm populations in Southeast Asia
Western countries (Cinosi et al, 2015).
receptors as morphine, appears to have properties that expose users to the risks of addiction, abuse, and dependence
has received concerning reports about its safety
stimulant.
how they affect behavior in rats. The results are preliminary, but suggest the drug could hold promise for people dealing with addiction. (Business insider, 2018)
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pharmacological and toxicological evaluation unique and difficult.
identified in the laboratory.
receptor agonist and is roughly 13 times more potent than morphine.
responsible for the opioid-like effects.
Source: Cinosi E.; Martinotti; et all. 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; Biomed Res Int. 2015; 2015: 968786
Red Thai
Red Bali- Native to Bali, Indonesia Red Vietnam- Native to Vietnam Red Maeng Da- Native to Thailand Red Borneo- Native to South Borneo Red Dampar- Native to Indonesia Red Indo- Native to Indonesia Red Sumatra- Native to Sumatra, Indonesia Red Malay- Native to Malaysia Red Gold- Native to Indonesia Red Bantuagie- Native to Indonesia Red Dragon- Native to Malaysia Red Horned Maeng Da- Native To Thailand Rain Forests Yellow Borneo- Native to North Borneo Yellow Kapuas- Native to Malaysia Yellow Gold- Native to Indonesia Chocolate Borneo- Native to South Borneo Dark Brown Bantuagie- Native to Indonesia
https://www.shopcbdkratom.com/pages/kratom-menu
Green Maeng Da- Native to Thailand Green Malay- Native to Malaysia Green Vietnam- Native to Vietnam Green Dampar- Native to Indonesia Green Cambodian- Native to Cambodia Green Borneo- Native to North Borneo Green Sumatra- Native to Thailand Green Indo- Native to Indonesia Green Dragon- Native to Malaysia Green Bali- Native to Bali, Indonesia Green Kapuas- Native to Malaysia Dark Green Borneo- Native to Borneo Green Bantuagie- Native to Indonesia Green Horned Maeng Da- Native To Thailand Rain Forests Super Indo- Native To Indonesia White Bali- Native to Bali, Indonesia White Borneo- Native to North Borneo White Maeng Da- Native to Thailand White Dampar- Native to Indonesia White Kapuas- Native to Malaysia White Sumatra- Native to Thailand White Bantuagie- Native to Indonesia
All Kratom strains effects vary. Kratom affects different people differently, and larger doses tend to be more sedative than
recommended to change the Kratom strains and veins you take frequently
The effects of kratom in humans are dose- dependent:
resembling the stimulant effect of drugs such as cocaine or amphetamines.
narcotic, pain reducing effects that resemble drugs such as opiates.
addictive disorders, as evidenced by craving and compulsive use. Opioid withdrawal symptoms upon cessation.
SOURCE: Prozialeck W. C., Jivan J. K., Andurkar S. V. Pharmacology of Kratom: an emerging botanical agent with stimulant, analgesic and opioid-like effects. Journal of the American Osteopathic Association. 2012;112(12):792–799; Singh, 2014; Suwanlert, 1975; Ahmad and Aziz, 2012; Vicknasingam et al., 2010; Singh et al., 2014
10,000 current kratom users through available social media and from the American Kratom Association (https://speciosa.org/home/ )
males (56.91%) with income $35,000 or higher with private insurance (61.31%).
mental conditions (66%) and for withdrawal symptoms associated with prescription opioid use.
with high doses (5g) and with and frequent dosing (Q22 doses/wk).
SOURCE: Grundmann O.; Patterns of kratom use and health impact in the USVresults from an online survey. Drug Alcohol Depend. 2017; 175(5):63Y70.
National Poison Data System - United States and Puerto Rico January 2010–December 2015
SOURCE: Anwar M, Law R, Schier J. Notes from the Field. Kratom (Mitragyna speciosa) Exposures Reported to Poison Centers — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:748–
Source: CDC SUDORS Overdose Death Data
From July 2016 to June 2017, 25 fatal
SUDORS states were identified
In 2017, the Food and Drug Administration (FDA) began issuing a series of warnings about kratom and has now identified at least 44 deaths related to its use. Most kratom associated deaths appeared to have resulted from adulterated products or taking kratom along with other potent substances.
popularized as a safe herbal product capable of giving a “legal” high (Swogger et al., 2015), and as an alternative to other sedative and stimulant type drugs (Warner et al., 2016).
emerge from case reports from the UK (Boyer et al., 2008, McWhirter and
Morris, 2010), Germany (Kapp et al., 2011) and the US (Dorman et al., 2014, Nelsen et al., 2010, Forrester, 2013, Sheleg and Collins, 2011).
internet purchase sites for kratom (cited in Cinosi et al., 2015), addiction to kratom is also likely to be growing in the Western countries.
and who responded to opioid treatment.
Kratom is restricted or illegal in: Australia Lithuania Romania Denmark Myanmar South Korea Finland Malaysia Sweden Israel Poland Thailand United Kingdom
variety of sources to determine if they contain heavy metals. The analysis found significant levels of lead and nickel at concentrations that exceed safe exposure for oral daily drug intake.
exposed to levels of lead and nickel many times greater than the safe daily exposure, as referenced in Appendix 2 of the Q3D Elemental Impurities Guidance for Industry.
potentially develop heavy metal poisoning, which could include nervous system or kidney damage, anemia, high blood pressure, and/or increased risk of certain cancers.
On April 6, 2018, in response to FDA's mandatory recall order of April 2, 2018, Triangle Pharmanaturals, LLC of Las Vegas, Nevada initiated a recall for its products containing powdered kratom. ... This recall now includes at least 26 different products.
tom&commit=Search (for multiple warnings and statements about Kraton
Darshan Singh, PhD Centre for Drug Research Universiti Sains Malaysia (USM)
National Institute on Drug Abuse (NIDA) International Symposium at College on Problems of Drug Dependence (CPDD) San Diego, June 9 2018
Chewing
leaves & consump tion of kratom decoctio n.
(Singh et al. Drug and Alcohol Dependence, 2014).
Self-report surveys in Malaysia found that regular consumption was associated with kratom dependence. Kratom dependence was associated with higher frequency & heavy kratom consumption. Being dependent on kratom was not affiliated with impaired social functioning, though users had difficulty abstaining from kratom use. Regular users were more likely to increase their kratom intake overtime.
(Singh et al., Journal of Psychoactive Drugs, 2015 & )
Kratom withdrawal symptoms are claimed to resemble opioid-like withdrawal symptoms. Kratom produces dose- dependent withdrawal effects during abrupt cessation. Kratom users with long-term (>1 year) & chronic kratom use history (daily ingestion of >1 litter of brewed kratom tea) have difficulty ceasing from kratom use. However, users have their own ways to overcome (e.g. shower, sleep, sweat profusely, etc.) kratom withdrawal symptoms. Most users have never sought treatment for kratom withdrawal symptoms.
(Kronstrand et al., Journal of Analytical Toxicology, 2011; Singh et al., Brain Research Bulletin,
2016; Lydeker et al., 2016; Anwar et al., CDC, 2016; Grundmann, Drug and Alcohol Dependence,
201 )
Long-term kratom effects are poorly elucidated. Long-term users appeared thin, have darker skin & hepatic face, experience constipation, dehydration, psychological problems & experienced fatigue. So far, there have been no kratom toxicity incidents in Malaysia. Perhaps, consumption of brewed kratom tea could be less toxic than the ingestion of powdered kratom extracts. In the West, kratom use (regardless of duration & quantity) was associated with kratom exposure (poisoning & death). Current toxicity cases stem from the co-used of kratom with other substances & unresolved medical problems. Users have elevated risk
gastrointestinal (e.g. constipation, abdominal pain, etc.) & cardiovascular (e.g. tachycardia, hypertension, drowsiness, etc.) related effects. Despite the unpleasant effects, majority have not sought medical or mental health care treatment for kratom use.
Opioid Users Call Kratom a Godsend. The F.D.A. Says It’s a Menace
“The steep rise in the number of people suffering opioid addiction has helped spawn the widespread use of another substance: kratom, a green powdered herbal supplement that is widely available and virtually unregulated. It is also increasingly being used by those who swear by it as a curb for opioid addiction. Some veterans also say it helps control symptoms of post-traumatic stress. Several million Americans are now believedto use kratom.” (NY Times, April 18, 2019) .
July 29, 2016;65(29):748Y749)
the same as ‘‘safe.’’
to aid in managing opioid withdrawal. However, some of these individual attempts have resulted in cases of toxicity and fatalities.
potential toxicity or withdrawal effects in patients including in newborns which cannot be picked up by the standard toxicology screen (Davidson et al, 2018).
communities raising awareness, providing education about effects and risks.
Abuse (NIDA) affirmed that, "Kratom by itself is not associated with fatal
contaminated or "laced with other compounds" has it been associated with death
consumers who safely use kratom, as well as the healthcare professionals and government leaders who support kratom in its natural form, in calling upon the FDA to follow the science, to allow consumer access to the natural botanical, and to use its efforts and energy to go after those who lace it illegally," (The American Kratom Association (AKA)).
rights to possess and consume safe and natural kratom. AKA represents millions of Americans, each of whom has a unique story to tell about the virtues of kratom and its positive effects on their
research (December 2018)