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Current Psychopharmacology

Editor-in-Chief

ISSN (Print): 2211-5560
ISSN (Online): 2211-5579

Research Article

Substance Use Disorder Related to Kratom (Mitragyna speciosa) Use in Malaysia

Author(s): Darshan Singh, Mohammad F.I.L. Abdullah, Balasingam K. Vicknasingam and Christian P. Müller*

Volume 8, Issue 1, 2019

Page: [64 - 71] Pages: 8

DOI: 10.2174/2405461503666180420120649

Price: $65

Abstract

Background: Kratom is a traditional medicinal herb with mild addictive properties. Nevertheless, current available data on substance use disorder related to kratom use is scarce. This study aims to clinically evaluate and identify factors that are associated with kratom use disorder among regular kratom tea/juice users in traditional settings in Malaysia.

Method: 150 regular kratom users were recruited through convenient sampling for this crosssectional study. They were interviewed with Mini International Neuropsychiatric Interview (M.I.N.I.) to diagnose substance use disorder related to kratom use, while the Ketum Dependence Scale (KDS) and Clinical Opioid Withdrawal Scale (COWS) were administered to evaluate kratom dependence and withdrawal severity.

Results: All subjects were males with the majority being Malays (99%, n=148/150). More than half were single (n=84/150), had secondary education (91%, n=136/150), and were employed (93%, n=139/150). Almost all (99%) fulfilled the criteria for substance use disorder related to kratom use, 95% reported withdrawal symptoms on abstinence, 87% reported tolerance, and 93% craving for kratom. Results from Chi-square analysis indicated that higher quantity (>3 glasses) of daily kratom tea/juice consumption was significantly associated with severe kratom dependence (OR: 2.1: 1.0-4.5: p<.041) and moderate withdrawal (OR: 3.1: 1.5-6.3: p<.002). Similarly, those who consumed >3 glasses of brewed kratom tea daily had higher odds of reporting longer kratom use history (>7 years) (OR: 4.4: 2.2-8.8: p<.001) and higher frequency of daily kratom use (>5 times) (p<.001), compared to those who consumed less than three glasses of kratom daily.

Conclusion: Our findings indicated that regular and chronic (>3 glasses daily) kratom tea/juice consumption was associated with kratom use disorder, severe kratom dependence and moderate withdrawal.

Keywords: Dependence, kratom, withdrawal, Mitragyna speciosa, Malaysia, herb.

Graphical Abstract
[1]
Singh D, Narayanan S, Vicknasingam B. Traditional and non-traditional uses of Mitragynine (Kratom): A survey of the literature. Brain Res Bull 2016; 126: 41-6.
[2]
Hassan Z, Muzaimi M, Navaratnam V, et al. From Kratom to mitragynine and its derivatives: Physiological and behavioural effects related to use, abuse and addiction. Neurosci Biobehav Rev 2013; 37: 138-51.
[3]
Suwanlert S. A study of kratom eaters in Thailand. Bull Narc 1975; 27(3): 21-7.
[4]
Saingam D, Assanangkornchai S, Geater AF, Balthip Q. Pattern and consequences of krathom (Mitragyna speciosa Korth.) use among male villagers in southern Thailand: A qualitative study. Int J Drug Policy 2012; 24(4): 351-8.
[5]
Vicknasingam B, Narayanan S, Goh TB, Mansor SM. The informal use of Ketum (Mitragyna speciosa) for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy. Int J Drug Policy 2010; 21: 283-8.
[6]
Cinosi E, Martinotti G, Simonato P, et al. Following the roots of Kratom (Mitragynine speciosa): The evolution of an enhancer from traditional use to increase work and productivity in Southeast Asia to a recreational psychoactive drug in western countries. BioMed Res Int; Article ID 968786.
[7]
Grundmann O. Patterns of Kratom use and health impact in the US-Results from an online survey. Drug Alcohol Depend 2017; 176: 63-70.
[8]
Prozialeck WC. Update on the pharmacology and legal status of kratom. J Am Osteopath Assoc 2016; 116(12): 802-9.
[9]
Adkins JE, Boyer EW, McCurdy CR. Mitragyna speciosa, a psychoactive tree from Southeast Asia with opioid activity. Curr Top Med Chem 2011; 11: 1165-75.
[10]
Ahmad K, Aziz Z. Mitragyna speciosa use in the northern states of Malaysia: A cross-sectional study. J Ethnopharmacol 2012; 141: 446-50.
[11]
Singh D, Müller CP, Vicknasingam BK. Kratom (Mitragyna speciosa) Dependence, withdrawal symptoms and craving in regular users. Drug Alcohol Depend 2014; 139: 132-7.
[12]
Boyer EW, Babu KM, Adkins JE, McCurdy CR, Halpern JH. Self-treatment of opioid withdrawal using kratom (Mitragyna speciosa Korth). Addict 2018; 103: 1048-50.
[13]
Kapp FG, Maurer HH, Auwarter V, Winkelmann M, Hermanns-Clausen M. Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa). J Med Toxicol 2011; 7(3): 227-31.
[14]
Dorman C, Wong M, Khan A. Cholestatic hepatitis from prolonged kratom use. A case report Hepatol 2015; 61(3): 1086-7.
[15]
Abdullah MFI, Singh D, Kasinather BV, Azman N. Validation of the Malay version of the Kratom Dependence Scale (KDS) among Malaysian kratom (Mitragyna speciosa Korth) users. ASEAN J Psychiatry 2017; 19(1): 276-8.
[16]
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59(20): 22-33.
[17]
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini- International Neuropsychiatric Interview (M.I.N.I.): 5.0.0. Malay version/DSM-IV/current. Floria: University of South Florida-Tampa Press 1998.
[18]
Saingam D, Assanangkornchai S, Geater AF, Lerkiatbundit S. Validation of Krathom (Mitragyna speciosa Korth.) Dependence Scale (KDS): A dependence screen for international emerging psychoactive substance. Subst Abuse 2014; 35: 276-83.
[19]
Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs 2003; 35: 253-9.
[20]
Utar Z, Majid MIA, Adenan MI, Jamil MFA, Lan TM. Mitragynine inhibits the COX-2 mRNA expression and prostaglandin E2 production induced by lipopolysaccharide in RAW264.7 macrophage cells. J Ethnopharmacol 2011; 136: 75-82.
[21]
Yusoff NHM, Mansor SM, Müller CP, Hassan Z. Opioid receptors mediate the acquisition, but not the expression of mitragynine-induced conditioned place preference in rats. Behav Brain Res 2017; 332: 1-6.
[22]
Ismail NIW, Jayabalan N, Mansor SM, Müller CP, Muzaimi M. Chronic mitragynine (kratom) enhances punishment resistance in natural reward seeking and impairs place learning in mice. Addict Biol 2017; 22(4): 967-76.
[23]
Singh D, Müller CP, Vicknasingam BK, Mansor SM. Social functioning of Kratom (Mitragyna speciosa) users in Malaysia. J Psychoactive Drugs 2015; 47(2): 125-31.
[24]
Swogger MT, Walsh Z. Kratom use and mental health: A systematic review. Drug Alcohol Depend 2018; 183: 134-40.
[25]
Swift RM, Stout R. The relationship between craving, anxiety, and other symptoms in opioid withdrawal. J Subst Abuse 1992; 4: 19-26.
[26]
Strain EC, Lofwall MR, Jaffe JH. Opioid-related disorders. In: Saddock BJ, Saddock, Ruiz P, Eds. Comprehensive Textbook of Psychiatry. Philadelphia: Lippincott Williams & Wilkins 2009; pp. 1360-87.
[27]
Yamamoto LT, Horie S, Takayama H, et al. Opioid receptor agonistic characteristics of mitragynine pseudoindoxyl in comparison with mitragynine derived from Thai medicinal plant Mitragyna speciosa. Gen Pharmacol 1999; 33(1): 73-81.
[28]
Suhaimi FW, Yusoff NHM, Hassan R. Neurobiology of kratom and its main alkaloid mitragynine. Brain Res Bull 2016; 126: 29-40.
[29]
Matsumoto K, Horie S, Takayama H, et al. Antinociception, tolerance and withdrawal symptoms induced by 7-hydroxymitragynine, an alkaloid from the Thai medicinal herb Mitragyna speciosa. Life Sci 2017; 78: 2-7.
[30]
Matsumoto K, Takayama H, Narita M, et al. MGM-9 [(E)-Methyl 2-(3-ethyl-7a,12a-(epoxyethanoxy)-9-fluoro-1,2,3, 4,6,7,12,12b-octahydro-8-methoxyindolo [2,3-a]quinolizin-2-yl)-3-methoxyacrylate], a derivative of the indole alkaloid mitragynine: A novel dual-acting mu- and kappa-opioid agonist with potent antinociceptive and weak rewarding effects in mice. Neuropharmacology 2008; 55: 154-65.

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