Kratom Use Within the Context of the Evolving Opioid Crisis and the COVID-19 Pandemic in the United States.

Walter C Prozialeck,Michael Krupp,Oliver Grundmann,Laura E Phelps,Matthew Moon,Peter C Lamar

doi:10.3389/fphar.2021.729220

Walter C Prozialeck, Michael Krupp + Show 4 more

Open Access

https://doi.org/10.3389/fphar.2021.729220

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Abstract

Kratom (Mitragyna speciosa, Korth.) is an evergreen tree that is indigenous to Southeast Asia. When ingested, kratom leaves or decoctions from the leaves have been reported to produce complex stimulant and opioid-like effects. For generations, native populations in Southeast Asia have used kratom products to stave off fatigue, improve mood, alleviate pain and manage symptoms of opioid withdrawal. Despite the long history of kratom use in Asia, it is only within the past 10–20 years that kratom has emerged as an important herbal agent in the United States, where it is being used for the self-treatment of pain, opioid withdrawal symptoms, and mood disorders. The increase in the use of kratom in the United States has coincided with the serious epidemic of opioid abuse and dependence. Since 2015, efforts to restrict access to prescription opioids have resulted in a marked increase in the use of “street” opioids such as heroin and illicit fentanyl. At the same time, many patients with chronic pain conditions or opioid use disorder have been denied access to appropriate medical help. The lack of access to care for patients with chronic pain and opioid use disorder has been magnified by the emergence of the COVID-19 pandemic. In this report, we highlight how these converging factors have led to a surge in interest in kratom as a potential harm reduction agent in the treatment of pain and opioid use disorder.

Highlights

Kratom is a tree-like plant (Mitragyna speciosa, Korth) that is native to Thailand, Malaysia, Indonesia and other regions of Southeast Asia (Adkins et al, 2011; Prozialeck et al, 2012; Cinosi et al, 2015)
We suggest that the increase in opioid prescribing in the early 2000s can be traced to two factors; the policy changes that were instituted by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in the year 2000–2001 and the promotion by pharmaceutical companies of opioid products such as
As a result of these uncertainties, we focused our analyses on better-defined measures of kratom use such as the number of scientific publications and reports of toxicities associated with the use of purported kratom products

Summary

INTRODUCTION

Kratom ( known as ketum) is a tree-like plant (Mitragyna speciosa, Korth) that is native to Thailand, Malaysia, Indonesia and other regions of Southeast Asia (Adkins et al, 2011; Prozialeck et al, 2012; Cinosi et al, 2015). We trace the evolution of kratom use in the United states and highlight the likely associations among the development of the ongoing opioid crisis, the unintended consequences of efforts to restrict access to prescription opioids for pain management, and the possible impact of the COVID-19 pandemic on demand for kratom. Even though the CDC actions were intended to serve as “guidelines”, many clinicians, practice groups, healthcare systems, and even legal authorities, interpreted the “guidelines” as absolute requirements, and some local jurisdictions led by the state of Washington enacted laws to restrict the prescribing of opioids for many types of pain (Franklin et al, 2012; Stolbach and Nelson, 2016; Brookes, 2019) These interventions appeared to achieve the intended goal as evidenced by a marked decrease in the number of opioid prescriptions beginning in 2012 and continuing through 2019 (see Figure 1B). Based on the available data, we think it is highly likely that the COVID-19 pandemic may have triggered an increase in kratom usage, but additional studies are needed to either confirm or refute this possibility

General Perspective and Conclusions

DATA AVAILABILITY STATEMENT