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A Nardolillo J, DiLucia A, Kerwin T, Ramirez SR, Vazquez MC, Murry LT, Medlin CG. An exploratory mixed-methods evaluation of continuing education opportunities related to the care of sexual and gender minority patients from ACPE-accredited providers. Am J Health Syst Pharm 2024; 81:306-315. [PMID: 38150575 DOI: 10.1093/ajhp/zxad331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 12/29/2023] Open
Abstract
PURPOSE The objective of this analysis was to describe trends in continuing education opportunities for pharmacy professionals across the US related to the care of sexual and gender minority (SGM) patients. METHODS Continuing education programs offered by Accreditation Council for Pharmacy Education (ACPE)-accredited providers from 2012 through 2022 were identified by searching the ACPE database for titles containing SGM terminology. Data including ACPE provider classification, activity type, format, audience, ACPE topic designator, interprofessional accreditation, contact hours, and learning objectives were collected. Content analysis was used to categorize activities. RESULTS Following removal of duplicates and non-SGM-focused programming, 726 programs were identified. The most commonly observed program characteristics included a live format (67.6%, n = 491), a pharmacist audience (77.1%, n = 560), knowledge-based activities (90.8%, n = 656), a college or school of pharmacy provider (21.6%, n = 157), an ACPE topic of pharmacy administration (50.6%, n = 367), and a focus on pharmacy rather than interprofessional audiences (87.1%, n = 632). The median program length was 1 hour (interquartile range, 1-1.25 hours). The qualitative analysis identified programs focused on topics of gender-affirming care (pharmacotherapy) (32.1%, n = 233), general SGM (26.7%, n = 194), gender-affirming care (nonpharmacotherapy), sexually transmitted infections (7.2%, n = 52), and health disparities (3.9%, n = 28). CONCLUSION Advancement has occurred in the number of available continuing pharmacy education programs focused on the care of SGM patients. Further information regarding specific content and effectiveness of continuing education is necessary to determine strategies to better prepare pharmacy professionals to care for this growing patient population.
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Affiliation(s)
- Joseph A Nardolillo
- Department of Pharmacy Practice and Clinical Research, University of Rhode Island College of Pharmacy, Kingston, RI, and Rhode Island Primary Care Physicians Corporation, Cranston, RI, USA
| | - Alex DiLucia
- Department of Pharmacy Practice and Clinical Research, University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Taya Kerwin
- Department of Pharmacy Practice and Clinical Research, University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Samantha R Ramirez
- Department of Pharmacy Practice and Clinical Sciences, The University of Texas at El Paso School of Pharmacy, El Paso, TX, USA
| | - Maria C Vazquez
- Department of Pharmacy Practice and Clinical Sciences, The University of Texas at El Paso School of Pharmacy, El Paso, TX, USA
| | - Logan T Murry
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | - Christopher G Medlin
- Department of Pharmacy Practice and Clinical Sciences, The University of Texas at El Paso School of Pharmacy, El Paso, TX, USA
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Yang T, Linn BS, Bennis J. Incorporating diversity, equity, and inclusion concepts in pharmacy education and experiential training. Am J Health Syst Pharm 2024; 81:275-278. [PMID: 37966508 DOI: 10.1093/ajhp/zxad279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
| | - Becky S Linn
- University of Wyoming School of Pharmacy Laramie, WY, USA
| | - Jane Bennis
- University of Wyoming School of Pharmacy Laramie, WY, USA
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Murry LT, Whittington B, Travlos DV. Continuing Professional Development Activities Provided by Continuing Pharmacy Education Providers. Am J Pharm Educ 2024; 88:100685. [PMID: 38490562 DOI: 10.1016/j.ajpe.2024.100685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To describe continuing professional development (CPD)-related continuing pharmacy education (CPE) activities from 2018 through 2023. METHODS This was an exploratory study using CPE activities offered by US-based accredited providers from the Accreditation Council for Pharmacy Education Provider Web Tool. Activities were selected based on submission and expiration date, which included activities active from January 1, 2018 to December 31, 2023. The words "professional development" were used to search for CPE activities based on titles. Frequencies were calculated for provider type, delivery method, and activity types. Content analysis was used to identify categories, subcategories, and elements or components of the CPD cycle from activity titles and learning objectives. RESULTS A total of 204 activities were identified, with the most common provider type being college or school which provided 41% (n = 83) of the activities. Most activities were designed for pharmacists 76% (n = 156) and primarily delivered in a live seminar format (68%, n = 138) and used a single delivery method (92%, n = 187). Content analysis identified 7 categories and 23 subcategories of activities. Of the 7 activity categories, only 3 had subcategories which reflected elements or components of CPD: precepting and teaching; diversity, equity, and inclusion; and CPD process and principles. CONCLUSION This study identified that most CPE activities and learning objectives reflected educational interventions without the inclusion or use of the CPD cycle or process, suggesting that additional provider education on the implementation of CPD and differentiation between CPE and CPD may be necessary.
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Affiliation(s)
- Logan T Murry
- Accreditation Council for Pharmacy Education, Chicago, IL, USA.
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Stanciu CN, Ahmed S, Sarfraz Z, Nimavat N, Healey CJ, Grundmann O, Ballard JR, Henningfield J. Prevalence, Characteristics, and Reasons for Kratom Use among Psychiatrically Ill Inpatients Who Use Substances. J Dual Diagn 2024; 20:87-97. [PMID: 38153407 DOI: 10.1080/15504263.2023.2289456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE Despite kratom impacting neurobiological systems involved in psychiatric disorders, little is known about the prevalence of use among patients with severe psychopathologies. Here, we investigated the prevalence of kratom use, motives for use, and the clinical associations among inpatients with severe psychiatric disorders. METHODS A total of 578 patients, aged 18 to 65, were evaluated by New Hampshire Hospital's Addiction Services from January 1, 2020, to February 28, 2022. The study collected demographic information and used chi-square tests, multivariable logistic regression, and subgroup analyses with 95% confidence intervals to examine trends among kratom users. A receiver operating characteristic curve analysis was also conducted. All statistical tests were performed using IBM SPSS Version 28.0.1. RESULTS Of the patients assessed, 2.2% (n = 13) reported using kratom. The reasons for kratom use were managing withdrawal symptoms (15.4%), maintaining sobriety and reducing cravings for opioids (53.8%), improving focus and concentration (30.8%), alleviating low moods (38.5%), and managing pain (15.4%). Compared to non-kratom users, the only factor with a fair to good association with kratom use is postsecondary education (Area Under Curve, AUC = 0.77). CONCLUSIONS Prevalence of kratom use among patients with serious mental illness at our site aligns with that reported in the general population. Users often cite self-management of cravings and sobriety from opioids, as well as treatment of low mood states, as motivations for consumption. While observations suggest a possible association between kratom use and individuals with post-secondary education, multiple substance use, and experience of substance-induced psychosis or mood disorders, it is essential to interpret these links cautiously until further rigorous studies are carried out to substantiate these findings.
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Affiliation(s)
- Cornel N Stanciu
- Director of Addiction Services, New Hampshire Hospital, Concord, New Hampshire, USA
| | - Saeed Ahmed
- Department of Psychiatry, Rutland Regional Medical Center, Rutland, Vermont, USA
| | - Zouina Sarfraz
- Department of Research and Publications, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Nirav Nimavat
- Community Medicine Department, B.K. Shah Medical Institute & Research Centre, Vadodara, India
| | | | - Oliver Grundmann
- Entrepreneurial Programs in Medicinal Chemistry, University of Florida, Gainesville, Florida, USA
| | - Jonathan R Ballard
- Chief Medical Officer, New Hampshire Department of Health and Human Services, Concord, New Hampshire, USA
| | - Jack Henningfield
- Pinney Associates, Inc., Bethesda, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kim HY, Kim CE, Oh DR, Kim Y, Choi CY, Kim J. Development and Validation of a High-Performance Liquid Chromatography Method to Quantify Marker Compounds in Lysimachia vulgaris var. davurica and Its Effects in Diarrhea-Predominant Irritable Bowel Syndrome. Molecules 2024; 29:1489. [PMID: 38611770 PMCID: PMC11013019 DOI: 10.3390/molecules29071489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Irritable bowel syndrome (IBS), a common gastrointestinal disorder worldwide, is characterized by chronic abdominal pain, bloating, and disordered defecation. IBS is associated with several factors, including visceral hypersensitivity, gut motility, and gut-brain interaction disorders. Because currently available pharmacological treatments cannot adequately improve symptoms and may cause adverse effects, the use of herbal therapies for managing IBS is increasing. Lysimachia vulgaris var. davurica (LV) is a medicinal plant used in traditional medicine to treat diarrhea. However, information on whether LV can effectively improve diarrhea-predominant IBS (IBS-D) remains limited. In this study, using an experimental mouse model of IBS-D, we elucidated the effects of the LV extract. The methanol extract of LV decreased fecal pellet output in the restraint stress- or 5-hydroxytryptamine (5-HT)-induced IBS mouse model and inhibited 5-HT-mediated [Ca2+]i increase in a dose-dependent manner. Furthermore, we developed and validated a high-performance liquid chromatography method using two marker compounds, namely, chlorogenic acid and rutin, for quality control analysis. Our study results suggest the feasibility of the methanol extract of LV for developing therapeutic agents to treat IBS-D by acting as a 5-HT3 receptor antagonist.
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Affiliation(s)
- Hye-Youn Kim
- Jeonnam Institute of Natural Resources Research (JINR), Jeonnam Bio Foundation, Jangheung-gun 59338, Republic of Korea; (H.-Y.K.); (C.-E.K.); (D.-R.O.); (Y.K.)
| | - Cho-Een Kim
- Jeonnam Institute of Natural Resources Research (JINR), Jeonnam Bio Foundation, Jangheung-gun 59338, Republic of Korea; (H.-Y.K.); (C.-E.K.); (D.-R.O.); (Y.K.)
| | - Dool-Ri Oh
- Jeonnam Institute of Natural Resources Research (JINR), Jeonnam Bio Foundation, Jangheung-gun 59338, Republic of Korea; (H.-Y.K.); (C.-E.K.); (D.-R.O.); (Y.K.)
| | - Yonguk Kim
- Jeonnam Institute of Natural Resources Research (JINR), Jeonnam Bio Foundation, Jangheung-gun 59338, Republic of Korea; (H.-Y.K.); (C.-E.K.); (D.-R.O.); (Y.K.)
| | - Chul-Yung Choi
- BK21 FOUR Educational Research Group for Age-Associated Disorder Control Technology, Institute of Well-Aging Medicare, Department of Integrative Biological Sciences, Chosun University, Gwangju 61452, Republic of Korea;
| | - Jaeyong Kim
- Jeonnam Institute of Natural Resources Research (JINR), Jeonnam Bio Foundation, Jangheung-gun 59338, Republic of Korea; (H.-Y.K.); (C.-E.K.); (D.-R.O.); (Y.K.)
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Smith KE, Rogers JM, Sharma A, McCurdy CR, Weiss ST, Dunn KE, Feldman JD, Kuntz MA, Mukhopadhyay S, Raju KSR, Taylor RC, Epstein DH. Responses to a "Typical" Morning Dose of Kratom in People Who Use Kratom Regularly: A Direct-Observation Study. J Addict Med 2024; 18:144-152. [PMID: 38174871 PMCID: PMC10939942 DOI: 10.1097/adm.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Use of kratom has outpaced systematic study of its effects, with most studies reliant on retrospective self-report. METHODS We aimed to assess acute effects following kratom use in adults who use regularly, and quantify alkaloids in the products, urine, and plasma. Between July and November 2022, 10 adults came to our clinic and orally self-administered their typical kratom dose; blinding procedures were not used. Physiological measures included blood pressure, respiratory rate, heart rate, pulse oximetry, temperature, and pupil diameter. Subjective outcomes included Subjective Opioid Withdrawal Scale, Addiction Research Center Inventory, and Drug Effects Questionnaire. Psychomotor performance was also assessed. RESULTS Participants were 6 men and 4 women, mean age 41.2 years. Nine were non-Hispanic White; 1 was biracial. They had used kratom for 6.6 years (SD, 3.8 years) on average (2.0-14.1). Sessions were 190.89 minutes on average (SD, 15.10 minutes). Mean session dose was 5.16 g (median, 4.38 g; range, 1.1-10.9 g) leaf powder. Relative to baseline, physiological changes were minor. However, pupil diameter decreased (right, b = -0.70, P < 0.01; left, b = -0.73, P < 0.01) 40-80 minutes postdose and remained below baseline >160 minutes. Subjective Opioid Withdrawal Scale pre-dosing was mild (5.5 ± 3.3) and decreased postdose (b = [-4.0, -2.9], P < 0.01). Drug Effects Questionnaire "feeling effects" increased to 40/100 (SD, 30.5) within 40 minutes and remained above baseline 80 to 120 minutes (b = 19.0, P = 0.04), peaking at 72.7/100; 6 participants rated euphoria as mild on the Addiction Research Center Inventory Morphine-Benzedrine-scale. Psychomotor performance did not reliably improve or deteriorate postdosing. CONCLUSIONS Among regular consumers, we found few clinically significant differences pre- and post-kratom dosing. Alkaloidal contents in products were within expected ranges.
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Affiliation(s)
- Kirsten E. Smith
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeffrey M. Rogers
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Abhisheak Sharma
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Christopher R. McCurdy
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Stephanie T. Weiss
- Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States
| | - Kelly E. Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeffrey D. Feldman
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States
| | - Michelle A. Kuntz
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Sushobhan Mukhopadhyay
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Kanumuri Siva Rama Raju
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Richard C. Taylor
- Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States
| | - David H. Epstein
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States
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Hu J, Zhang J, Li D, Hu X, Li Q, Wang W, Su J, Wu D, Kang H, Zhou F. Predicting hypovitaminosis C with LASSO algorithm in adult critically ill patients in surgical intensive care units: a bi-center prospective cohort study. Sci Rep 2024; 14:5073. [PMID: 38429378 PMCID: PMC10907613 DOI: 10.1038/s41598-024-54826-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/16/2024] [Indexed: 03/03/2024] Open
Abstract
Vitamin C played pleiotropic roles in critical illness and vitamin C insufficiency was predictive of the development of multiple organ failure. Currently, the prevalence of vitamin C insufficiency in Chinese critically ill patients is rarely determined and there are no established bedside tools to predict hypovitaminosis C. To develop a nomogram to identify patients with high risk of hypovitaminosis C, we performed a bi-center prospective cohort study at two ICUs of the first and sixth medical center in PLA General Hospital, Beijing, China from May 6th to July 31st, 2021 We identified 322 eligible patients. 62.4% patients were hypovitaminosis C. 7 features, including source of infection, the level of serum albumin, age, male gender, sepsis, vascular disease, and wasting of vitamin C by the kidney, were selected using LASSO algorithm and therefore included in the nomogram. In the testing set, our model showed moderate discrimination ability with areas under the curve of 0.75 [0.64-0.84]. Variable importance evaluated by SHAP value highlighted two novel important predictors, i.e., abdominal infection and the level of serum albumin. In conclusion, we first reported a high burden of vitamin C insufficiency in Chinese adult patient in the ICU. We also constructed a prediction model to timely identify patients with high risk of hypovitaminosis C, which allows the clinicians to choose appropriate candidates for Vitamin C repletion in clinical practice or clinical trials.
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Affiliation(s)
- Jie Hu
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
- National Key Laboratory of Kidney Diseases, Beijing, 100853, People's Republic of China
| | - Jingwen Zhang
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Dawei Li
- Department of Critical Care Medicine, The Sixth Medical Centre, Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Xin Hu
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Qi Li
- Department of Critical Care Medicine, The Sixth Medical Centre, Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Wenwen Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Cheeloo Medical College, Shandong University, Jinan, 250013, People's Republic of China
| | - Jianguo Su
- Department of Critical Care Medicine, NingXia Chinese Medicine Research Center, Yinchuan, 750021, People's Republic of China
| | - Di Wu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, People's Republic of China
| | - Hongjun Kang
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Feihu Zhou
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
- Medical Engineering Laboratory of Chinese, PLA General Hospital, Beijing, 100853, People's Republic of China.
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Wheibe E, Dalkin BH, Meltzer HC, Russ-Sellers R, Grier JT. The Multisystem effects of Long COVID Syndrome and Potential Benefits of Massage Therapy in Long COVID Care. Int J Ther Massage Bodywork 2024; 17:19-42. [PMID: 38486840 PMCID: PMC10911825 DOI: 10.3822/ijtmb.v17i1.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Background A major complication of infection with Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, is the potential for Long COVID Syndrome. While the pathophysiology of Long COVID Syndrome has yet to be described, the disease presentation is characterized by long-term symptoms with debilitating effects on human health. A better understanding of Long COVID symptomology may open up new avenues for patient treatment such as massage therapy. Methods From the PubMed database, cohort studies that examined post-infection COVID sequelae published between January 1st, 2021 and April 30th, 2021 were selected to investigate patient demographics and symptoms. A review of massage therapy literature since 2000 in conjunction with identified Long COVID symptoms was performed. Results This systematic review identified 17 cohort studies across the world that investigated the symptomatology of patients suffering from post-COVID sequelae in multiple organ systems. We identified the pulmonary and nervous systems to be the organ systems most affected with post-COVID sequelae, with PTSD, fatigue, dyspnea, cough, sleep disturbances, loss of smell, abdominal pain, and decreased appetite as the most common symptoms reported by >20% of Long COVID patients. Massage therapy was historically found to provide benefits to patients experiencing similar symptoms to those identified in Long COVID. Conclusions Recognizing the need for new approaches to treatment for Long COVID Syndrome, we identify massage therapy as a potential therapeutic treatment to positively impact the organ systems affected by Long COVID, especially the high-incident symptoms, and improve patient quality of life.
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Affiliation(s)
- Elias Wheibe
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Benjamin H. Dalkin
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Haley C. Meltzer
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC
| | | | - Jennifer T. Grier
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC
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Wood ME, Brown GJ, Karschner EL, Seither JZ, Brown JT, Knittel JL, Walterscheid JP. Screening and confirmation of psilocin, mitragynine, phencyclidine, ketamine and ketamine metabolites by liquid chromatography-tandem mass spectrometry. J Anal Toxicol 2024; 48:111-118. [PMID: 38287693 DOI: 10.1093/jat/bkae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
A safe and productive workplace requires a sober workforce, free from substances that impair judgment and concentration. Although drug monitoring programs already exist, the scope and loopholes of standard workplace testing panels are well known, allowing other substances to remain a source of risk. Therefore, a high-throughput urine screening method for psilocin, mitragynine, phencyclidine, ketamine, norketamine and dehydronorketamine was developed and validated in conjunction with a urine and blood confirmation method. There are analytical challenges to overcome with psilocin and mitragynine, particularly when it comes to drug stability and unambiguous identification in authentic specimens. Screening and confirmation methods were validated according to the American National Standards Institute/Academy Standards Board (ANSI/ASB) Standard 036, Standard Practices for Method Validation in Forensic Toxicology. An automated liquid handling system equipped with dispersive pipette extraction tips was utilized for preparing screening samples, whereas an offline solid-phase extraction method was used for confirmation sample preparation. Both methods utilized liquid chromatography-tandem mass spectrometry to achieve limits of detection between 1-5 ng/mL for the screening method and 1 ng/mL for the confirmation method. Automation allows for faster throughput and enhanced quality assurance, which improves turnaround time. Compared to previous in-house methods, specimen volumes were substantially decreased for both blood and urine, which is an advantage when volume is limited. This screening technique is well suited for evaluating large numbers of specimens from those employed in safety-sensitive workforce positions. This method can be utilized by workplace drug testing, human performance and postmortem laboratories seeking robust qualitative screening and confirmation methods for analytes that have traditionally been challenging to routinely analyze.
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Affiliation(s)
- Madeleine E Wood
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Dr., Dover AFB, DE 19902, USA
| | - Glenna J Brown
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Dr., Dover AFB, DE 19902, USA
| | - Erin L Karschner
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Dr., Dover AFB, DE 19902, USA
| | - Joshua Z Seither
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Dr., Dover AFB, DE 19902, USA
| | - Jordan T Brown
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Dr., Dover AFB, DE 19902, USA
| | - Jessica L Knittel
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Dr., Dover AFB, DE 19902, USA
| | - Jeffrey P Walterscheid
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Dr., Dover AFB, DE 19902, USA
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Huestis MA, Brett MA, Bothmer J, Atallah R. Human Mitragynine and 7-Hydroxymitragynine Pharmacokinetics after Single and Multiple Daily Doses of Oral Encapsulated Dried Kratom Leaf Powder. Molecules 2024; 29:984. [PMID: 38474495 DOI: 10.3390/molecules29050984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 03/14/2024] Open
Abstract
Kratom leaves, consumed by millions worldwide as tea or ground leaf powder, contain multiple alkaloids, with mitragynine being the most abundant and responsible for most effects. Mitragynine is a partial µ-opioid receptor agonist and competitive antagonist at κ- and δ-opioid receptors; however, unlike morphine, it does not activate the β-arrestin-2 respiratory depression pathway. Due to few human mitragynine data, the largest randomized, between-subject, double-blind, placebo-controlled, dose-escalation study of 500-4000 mg dried kratom leaf powder (6.65-53.2 mg mitragynine) was conducted. LC-MS/MS mitragynine and 7-hydroxymitragynine plasma concentrations were obtained after single and 15 daily doses. Mitragynine and 7-hydroxymitragynine Cmax increased dose proportionally, and AUC was slightly more than dose proportional. The median mitragynine Tmax was 1.0-1.3 h after single and 1.0-1.7 h after multiple doses; for 7-hydroxymitragynine Tmax, it was 1.2-1.8 h and 1.3-2.0 h. Steady-state mitragynine concentrations were reached in 8-9 days and 7-hydroxymitragynine within 7 days. The highest mean mitragynine T1/2 was 43.4 h after one and 67.9 h after multiple doses, and, for 7-hydroxymitragynine, it was 4.7 and 24.7 h. The mean 7-hydroxy-mitragynine/mitragynine concentration ratios were 0.20-0.31 after a single dose and decreased (0.15-0.21) after multiple doses. These mitragynine and 7-hydroxymitragynine data provide guidance for future clinical kratom dosing studies and an interpretation of clinical and forensic mitragynine and 7-hydroxymitragynine concentrations.
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Affiliation(s)
- Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | - John Bothmer
- JB Pharma Consulting, 6418PR Heerlen, The Netherlands
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Annuar NAK, Azlan UK, Mediani A, Tong X, Han R, Al-Olayan E, Baharum SN, Bunawan H, Sarian MN, Hamezah HS, Jantan I. An insight review on the neuropharmacological effects, mechanisms of action, pharmacokinetics and toxicity of mitragynine. Biomed Pharmacother 2024; 171:116134. [PMID: 38219389 DOI: 10.1016/j.biopha.2024.116134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024] Open
Abstract
Mitragynine is one of the main psychoactive alkaloids in Mitragyna speciosa Korth. (kratom). It has opium-like effects by acting on μ-, δ-, and κ-opioid receptors in the brain. The compound also interacts with other receptors, such as adrenergic and serotonergic receptors and neuronal Ca2+ channels in the central nervous system to have its neuropharmacological effects. Mitragynine has the potential to treat diseases related to neurodegeneration such as Alzheimer's disease and Parkinson's disease, as its modulation on the opioid receptors has been reported extensively. This review aimed to provide an up-to-date and critical overview on the neuropharmacological effects, mechanisms of action, pharmacokinetics and safety of mitragynine as a prospective psychotropic agent. Its multiple neuropharmacological effects on the brain include antinociceptive, anti-inflammatory, antidepressant, sedative, stimulant, cognitive, and anxiolytic activities. The potential of mitragynine to manage opioid withdrawal symptoms related to opioid dependence, its pharmacokinetics and toxic effects were also discussed. The interaction of mitragynine with various receptors in the brain produce diverse neuropharmacological effects, which have beneficial properties in neurological disorders. However, further studies need to be carried out on mitragynine to uncover its complex mechanisms of action, pharmacokinetics, pharmacodynamic profiles, addictive potential, and safe dosage to prevent harmful side effects.
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Affiliation(s)
- Nur Aisyah Khairul Annuar
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Ummi Kalthum Azlan
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Ahmed Mediani
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Xiaohui Tong
- School of Life Sciences, Anhui University of Chinese Medicine, Hefei, China
| | - Rongchun Han
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Ebtesam Al-Olayan
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Syarul Nataqain Baharum
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Hamidun Bunawan
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Murni Nazira Sarian
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| | - Hamizah Shahirah Hamezah
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia.
| | - Ibrahim Jantan
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
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Roth-Walter F, Berni Canani R, O'Mahony L, Peroni D, Sokolowska M, Vassilopoulou E, Venter C. Nutrition in chronic inflammatory conditions: Bypassing the mucosal block for micronutrients. Allergy 2024; 79:353-383. [PMID: 38084827 DOI: 10.1111/all.15972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024]
Abstract
Nutritional Immunity is one of the most ancient innate immune responses, during which the body can restrict nutrients availability to pathogens and restricts their uptake by the gut mucosa (mucosal block). Though this can be a beneficial strategy during infection, it also is associated with non-communicable diseases-where the pathogen is missing; leading to increased morbidity and mortality as micronutritional uptake and distribution in the body is hindered. Here, we discuss the acute immune response in respect to nutrients, the opposing nutritional demands of regulatory and inflammatory cells and particularly focus on some nutrients linked with inflammation such as iron, vitamins A, Bs, C, and other antioxidants. We propose that while the absorption of certain micronutrients is hindered during inflammation, the dietary lymph path remains available. As such, several clinical trials investigated the role of the lymphatic system during protein absorption, following a ketogenic diet and an increased intake of antioxidants, vitamins, and minerals, in reducing inflammation and ameliorating disease.
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Affiliation(s)
- Franziska Roth-Walter
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Roberto Berni Canani
- Department of Translational Medical Science and ImmunoNutritionLab at CEINGE-Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Liam O'Mahony
- Department of Medicine, School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Diego Peroni
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland
- Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Emilia Vassilopoulou
- Pediatric Area, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Carina Venter
- Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
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Wollen J, El-Desoky R, Stroud A, Abdelhakiem AK. Developing and Validating the Diversity, Equity, Inclusion, and Antiracism Faculty Perceptions of College Climate (DEIA FPCC) Scale in Pharmacy Faculty. Am J Pharm Educ 2024; 88:100647. [PMID: 38237685 DOI: 10.1016/j.ajpe.2024.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/21/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE This work's objective was to demonstrate acceptable reliability and consistency within and across each domain of the survey tool. METHODS A survey with 16 questions was distributed to faculty from the AACP membership list and contained 4 domains: DEIA. The survey responses were analyzed using factor analysis and reliability analysis. RESULTS A total of 877 subjects' responses met inclusion criteria and were used in the analysis. The results demonstrated that the survey had high reliability and discriminating validity within each domain and overall as a scale. CONCLUSION The finalized tool provides a practical, standardized measure to evaluate faculty perceptions of DEIA efforts in institutions of pharmacy education. This tool can help identify areas of improvement and guide the advancement of DEIA initiatives in colleges of pharmacy. Further research is needed to validate the survey in other populations. Future efforts will also explore predictors of survey scores.
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Affiliation(s)
- Joshua Wollen
- University of Houston College of Pharmacy, Houston, TX, USA.
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Erfan A, Aghaei A, Golparvar M. Effectiveness of Group Emotional Schema Therapy on Psychological Distress, Severity and Frequency of Symptoms in Women with Irritable Bowel Syndrome. Adv Biomed Res 2024; 13:11. [PMID: 38525387 PMCID: PMC10958722 DOI: 10.4103/abr.abr_85_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 03/26/2024] Open
Abstract
Background This study aimed to evaluate the effectiveness of emotional schema therapy on psychological distress, severity and frequency of symptoms in women with irritable bowel syndrome (IBS). Materials and Methods This semi-experimental two-group three-stage (pre and post-test and two-month follow-up) study was done on 30 women of 18-50 years old with IBS. They were randomly assigned to two groups (experimental and control). Psychological distress and Bowel symptoms severity and frequency in the three stages were measured. The emotional schema therapy group was treated for 8 sessions and the control group remained on the waiting list. Results The mean score of pre-test, post-test and follow-up of emotional therapy schema group in psychological distress were 21.23 ± 8.18, 16.08 ± 6.05 and 14.69 ± 4.05; in symptom intensity 7.46 ± 1.98, 5.23 ± 1.30 and 6.46 ± 1.33 and in symptom frequency 7.46 ± 1.98, 6.08 ± 1.66 and 7.54 ± 2.18 respectively. In the control group, there was no difference between the scores of different tests; in the pre-test, post-test and follow-up, the scores of psychological distress were 20.23 ± 5.39, 20.08 ± 5.59, and 20.38 ± 4.75, in the symptoms severity 7.69 ± 1.49, 7.62 ± 1.33, and 7.69 ± 1.80, and in the symptoms frequency 6.92 ± 2.75, 6.54 ± 2.40 and 6.62 ± 2.63 respectively. In the control group, there was no difference between the scores in different tests. In the pre-test, post-test and follow-up, in psychological distress, the scores were 20.23 ± 5.39, 20.08 ± 5.59, and 20.38 ± 4.75 in the symptom severity 7.69 ± 1.49, 7.62 ± 1.33, and 7.69. ±1.80 and in the symptoms frequency 6.92 ± 2.75, 6.54 ± 2.40 and 6.92 ± 2.75 respectively (P < 0.05). Conclusion Emotional schema therapy can be used as a complementary psychological treatment to reduce psychological distress and severity and frequency of symptoms in women with IBS.
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Affiliation(s)
- Arefeh Erfan
- Department of Psychology, Esfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Asghar Aghaei
- Department of Educational Science and Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Mohsen Golparvar
- Psychology Faculty, College of Education and Psychology, Esfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
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Torrico T, Patel K, Nikolov N, Salam MT, Padhy R, Weinstein D. Presence of kratom in opioid overdose deaths: findings from coroner postmortem toxicological report. Front Psychiatry 2024; 14:1332999. [PMID: 38268564 PMCID: PMC10806006 DOI: 10.3389/fpsyt.2023.1332999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024] Open
Abstract
Background Kratom (Mitragyna speciosa) use in the United States is becoming increasingly popular and its legal status varies widely from state to state. Multiple reports of adverse events associated with kratom use have ranged from liver injury, seizures, psychiatric disturbance, and rarely death. Methods This study investigated coroner autopsy reports from Kern County in California for the year 2020 which included qualitative data on substances from blood toxicological reports. Of the 214 opioid-associated accidental overdoses reported, 4 subjects (1.9%) had mitragynine (kratom) exposure on the autopsy report and were included in the study. We reported available demographic information and comorbid substance findings from the associated autopsy reports. Results All 4 individuals with mitragynine (kratom) toxicology had accidental opioid overdose deaths noted in autopsy reports. Each subject also had toxicology positive for at least one other substance. Fentanyl was found in 3 (75%) of the cases and suspected to be the primary contributor to opioid-related deaths in those cases. However, one fatality was without fentanyl, but instead had tested positive for benzodiazepines, cannabis, and other psychiatric medications. Discussion The findings of this brief report provide insight into the role that mitragynine (kratom) may have in modulating risk of opioid-related deaths. The combined use of kratom with opioids such as fentanyl appears most likely to increase the risk of a fatal overdose, but it may also occur with other medications such as benzodiazepines and psychiatric medications. It is a serious concern that in the midst of the opioid overdose epidemic there is a growing presence of kratom use in the U.S. population with a largely unregulated status.
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Affiliation(s)
- Tyler Torrico
- Department of Psychiatry, Kern Medical, Bakersfield, CA, United States
| | - Kajal Patel
- Ross University School of Medicine, Miramar, FL, United States
| | - Nicole Nikolov
- Ross University School of Medicine, Miramar, FL, United States
| | - Md Towhid Salam
- Department of Psychiatry, Kern Medical, Bakersfield, CA, United States
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Ranjit Padhy
- Department of Psychiatry, Kern Medical, Bakersfield, CA, United States
| | - David Weinstein
- Department of Psychiatry, Kern Medical, Bakersfield, CA, United States
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Smith KE, Panlilio LV, Feldman JD, Grundmann O, Dunn KE, McCurdy CR, Garcia-Romeu A, Epstein DH. Ecological Momentary Assessment of Self-Reported Kratom Use, Effects, and Motivations Among US Adults. JAMA Netw Open 2024; 7:e2353401. [PMID: 38277146 PMCID: PMC10818224 DOI: 10.1001/jamanetworkopen.2023.53401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024] Open
Abstract
Importance Kratom products, which are sold legally in most of the US, contain alkaloids with opioidergic, adrenergic, and serotonergic activity. Millions of people use kratom to relieve pain, improve mood, or self-manage substance use disorders (SUDs). Kratom use has primarily been examined via surveys, in which recall biases among satisfied users may lead to minimization of transient negative outcomes. Further prospective study of kratom use, such as with ecological momentary assessment (EMA), is needed. Objective To characterize proximal motivators, effects, and patterns of kratom use and to assess whether use frequency is associated with motivations, effects, past-year criteria for SUD for kratom (KUD), or other substance use. Design, Setting, and Participants For this prospective cross-sectional study, an intensive longitudinal smartphone-based EMA in which participants' current behaviors and experiences were repeatedly sampled in real time was conducted between July 1 and October 31, 2022. Participants comprised a convenience sample of US adults who used kratom at least 3 days per week for at least 4 weeks at the time of online screening. Criteria for past-year KUD were based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Data analysis was performed between November 2022 and November 2023. Exposure The exposure was 13 401 kratom-use events across 15 days. Main Outcomes and Measures A baseline survey covering demographics, health, kratom attitudes and behaviors, use motivations, other substance use, and KUD was administered before EMA. Data for the following EMA entries were then collected: event-contingent entries for kratom use (product, dose, and proximal motivations), follow-up entries (short-term effects and consequences of use events), random-prompt entries (mood), beginning-of-day entries (effects of kratom on sleep), and end-of-day entries (daily subjective descriptions of kratom effects). Bayesian regression was used to estimate means and credible intervals. Results A total of 357 participants completed the EMA. Their mean (SD) age was 38.0 (11.1) years; more than half were men (198 [55.5%]). Participants reported overall motivators of use on the baseline survey that involved managing psychiatric and SUD problems, but proximal motivators evaluated during the EMA involved situation-specific needs such as increasing energy and productivity and decreasing pain. Acute effects were considered congruent with daily obligations. Use patterns, despite having some distinguishing features, were generally similar in their motivators and effects; participants used kratom predominantly during the daytime and seemed to find use frequencies that suited their needs. Higher use patterns were associated with symptoms of physical dependence (eg, withdrawal or tolerance). Co-used substances included caffeine, nicotine, vitamins, and cannabis. Conclusions and Relevance Most participants in this study reported using kratom in a seemingly nonproblematic way. When such use appeared problematic, the key element was usually that withdrawal avoidance became a proximal motivator. Longitudinal studies examining changes in kratom use patterns and effects over time are needed.
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Affiliation(s)
- Kirsten E. Smith
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leigh V. Panlilio
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland
| | - Jeffrey D. Feldman
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville
| | - Kelly E. Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher R. McCurdy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David H. Epstein
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland
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17
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Phoong SW, Phoong SY, Yeoh YJ. Kratom: A Bibliometric Analysis of Scientific Publications. J Psychoactive Drugs 2024; 56:14-22. [PMID: 36560854 DOI: 10.1080/02791072.2022.2159591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 12/24/2022]
Abstract
Kratom has caught the attention of governments, policymakers, and academicians due to its unique characteristics. This paper explores the scholarly works related to the different aspects of Kratom to elucidate its research progress and identify future research agendas. We reviewed existing publications on Kratom using a bibliometric methodology. By analyzing 431 scientific publications, we identified publication sources, document analysis, countries analysis, and research keywords, which helped us understand the research locus on Kratom. After reviewing the publications, we discovered significant disagreements in categorizing and defining Kratom amongst authors based on their nationalities. We also showed the knowledge structure of existing publications via thematic analysis, illustrating that the studies focused on the opioid nature of Kratom. Also, drug abuse-related issues evolved as the motor theme of research, while other aspects are prevalent as niche or emerging research themes. This paper contributes to the literature by providing a broad idea of existing literature and offering a comprehensive outlook on Kratom, which could be helpful for policy formulation in the future.
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Affiliation(s)
- Seuk Wai Phoong
- Department of Management, Faculty of Business and Economics, Universiti Malaya, Kuala Lumpur
| | - Seuk Yen Phoong
- Department of Mathematics, Faculty of Science and Mathematics, Universiti Pendidikan Sultan Idris, Tanjong Malim, Malaysia
| | - Ying Jia Yeoh
- Institute of Advanced Studies, Universiti Malaya, Kuala Lumpur, Malaysia
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Faucher MA, Morillos S, Cordova P, McNeil-Santiel J, Onisko N, Adhikari EH, Nelson DB. Kratom (Mitragyna speciosa): A Case Review of Use Before and During Pregnancy. J Midwifery Womens Health 2024; 69:144-149. [PMID: 37679866 DOI: 10.1111/jmwh.13558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Kratom (Mitragyna speciosa) is a plant-based substance with psychoactive properties similar to opioids but is not currently classified as an opioid. One of its more prevalent uses is to treat opioid dependency and withdrawal symptoms. Opioid use disorder is a leading cause of pregnancy-associated maternal mortality, and pregnant women may be using kratom as a substitute or alternative to opioids. Prevalence of kratom use is increasing rapidly, but scientific evidence specific to therapeutic and adverse effects is lacking overall, and the implications of its use in pregnancy and on the fetus-newborn are limited to a few case reports. Kratom is a legal substance by federal law, although some states have banned its use. The lack of regulation is concerning. Significant illness and associated deaths have been reported with kratom use. Lack of disclosure by people using kratom and limited laboratory testing options are major challenges for health care providers and public health.
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Affiliation(s)
- Mary Ann Faucher
- Women & Infants Specialty Health, Parkland Health, Dallas, Texas
| | | | - Polly Cordova
- Women & Infants Specialty Health, Parkland Health, Dallas, Texas
| | | | - Nancy Onisko
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emily H Adhikari
- Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David B Nelson
- Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
- Division of Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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McCurdy CR, Sharma A, Smith KE, Veltri CA, Weiss ST, White CM, Grundmann O. An update on the clinical pharmacology of kratom: uses, abuse potential, and future considerations. Expert Rev Clin Pharmacol 2024; 17:131-142. [PMID: 38217374 PMCID: PMC10846393 DOI: 10.1080/17512433.2024.2305798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/11/2024] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Kratom (Mitragyna speciosa) has generated substantial clinical and scientific interest as a complex natural product. Its predominant alkaloid mitragynine and several stereoisomers have been studied for activity in opioid, adrenergic, and serotonin receptors. While awaiting clinical trial results, the pre-clinical evidence suggests a range of potential therapeutic applications for kratom with careful consideration of potential adverse effects. AREAS COVERED The focus of this review is on the pharmacology, pharmacokinetics, and potential drug-drug interactions of kratom and its individual alkaloids. A discussion on the clinical pharmacology and toxicology of kratom is followed by a summary of user surveys and the evolving concepts of tolerance, dependence, and withdrawal associated with kratom use disorder. EXPERT OPINION With the increasing use of kratom in clinical practice, clinicians should be aware of the potential benefits and adverse effects associated with kratom. While many patients may benefit from kratom use with few or no reported adverse effects, escalating dose and increased use frequency raise the risk for toxic events in the setting of polysubstance use or development of a use disorder.
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Affiliation(s)
- Christopher R McCurdy
- College of Pharmacy, Department of Pharmaceutics, University of Florida, FL, 32610, U.S.A
- College of Pharmacy, Department of Medicinal Chemistry, University of Florida, FL, 32610, U.S.A
| | - Abhisheak Sharma
- College of Pharmacy, Department of Pharmaceutics, University of Florida, FL, 32610, U.S.A
| | - Kirsten E. Smith
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, MD, 21205, U.S.A
| | - Charles A. Veltri
- Midwestern University, College of Pharmacy, Department of Pharmaceutical Sciences, Glendale, AZ, 85308, U.S.A
| | - Stephanie T. Weiss
- Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, U.S.A
| | - Charles M. White
- University of Connecticut School of Pharmacy, Storrs, CT, and Department of Pharmacy, Hartford Hospital, Hartford, CT, U.S.A
| | - Oliver Grundmann
- College of Pharmacy, Department of Medicinal Chemistry, University of Florida, FL, 32610, U.S.A
- Midwestern University, College of Pharmacy, Department of Pharmaceutical Sciences, Glendale, AZ, 85308, U.S.A
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20
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Shi T, Shea JL. A case of fatal overdose involving both hydromorphone and kratom. J Forensic Sci 2024; 69:355-358. [PMID: 37753815 DOI: 10.1111/1556-4029.15394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
Kratom is a plant originating in Southeast Asia that has been used for its dose-dependent stimulant and opioid effects. The main active compound in kratom is mitragynine, an alkaloid with affinity for the mu-opioid receptor. Toxicity and fatalities related to kratom use have increased substantially in recent years. In this case report, we describe a 44-year-old man who was found deceased in bed. The only significant finding at autopsy was abdominal distension with >4 L of ascites. Toxicology testing was performed on femoral blood which showed 79 ng/mL of hydromorphone, 560 ng/mL of mitragynine, and 240 ng/mL of olanzapine. In addition, creatinine and urea in vitreous humor were significantly elevated, consistent with renal impairment. Death was attributed to hydromorphone toxicity with mitragynine being a contributing factor.
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Affiliation(s)
- Thomas Shi
- Department of Laboratory Medicine, Dr. Everett Chalmers Hospital, Horizon Health Network, Fredericton, New Brunswick, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer L Shea
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, New Brunswick, Canada
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21
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Penzak SR, Durham SH, Phillippe HM, Fox BI. Knowledge of Kratom among Alabama Pharmacists. Pharmacy (Basel) 2023; 12:6. [PMID: 38251400 PMCID: PMC10801507 DOI: 10.3390/pharmacy12010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Kratom (Mitragyna speciosa) is a botanical substance whose leaves produce stimulant- and opioid-like effects. Kratom use has increased precipitously in the United States (U.S.) over the last decade, yet, in our experience, many pharmacists are unfamiliar with this herb. The purpose of this study was to assess pharmacists' awareness and knowledge of kratom. This cross-sectional study used an online questionnaire to preferentially solicit community pharmacists' knowledge of kratom and collect demographic information. The survey was sent via email to approximately 10,000 pharmacists, targeting those in the state of Alabama, U.S. Data were analyzed using descriptive statistics, and the Chi Square test was used to compare nominal data. A total of 257 participants responded to the survey. Almost 50% of participants had heard of kratom, and 50% had not. Compared to females, males were more likely to have heard of kratom (64% vs. 42%; p = 0.0015), as were pharmacists who worked for an independent pharmacy vs. a chain (61% vs. 41%; p = 0.025). Of the participants who had heard of kratom, only 14% considered themselves knowledgeable or very knowledgeable about the herb, and only 44% knew it was illegal in Alabama. These data indicate a need to further kratom education among community pharmacists in Alabama.
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Affiliation(s)
- Scott R. Penzak
- Department of Pharmacy Practice, Harrison College of Pharmacy, Auburn University, Auburn, AL 36849-5502, USA; (S.H.D.); (H.M.P.)
| | - Spencer H. Durham
- Department of Pharmacy Practice, Harrison College of Pharmacy, Auburn University, Auburn, AL 36849-5502, USA; (S.H.D.); (H.M.P.)
| | - Haley M. Phillippe
- Department of Pharmacy Practice, Harrison College of Pharmacy, Auburn University, Auburn, AL 36849-5502, USA; (S.H.D.); (H.M.P.)
| | - Brent I. Fox
- Department of Health Outcomes and Research Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL 36849-5502, USA;
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22
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Lykkesfeldt J, Carr AC. Vitamin C - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2023; 67:10300. [PMID: 38187788 PMCID: PMC10770653 DOI: 10.29219/fnr.v67.10300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/29/2022] [Accepted: 10/16/2023] [Indexed: 01/09/2024] Open
Abstract
Vitamin C has multiple metabolic functions in the body, but the available information on the exact relationship between these functions and the intake necessary to maintain them is very limited. However, most attempts to objectively measure adequacy of vitamin C status, including, for example, replacement of metabolic turnover, chronic disease prevention, urinary excretion, and saturation of immune cells and body compartment, currently point toward 50 µmol/L as a reasonable target plasma concentration. As a strong correlation between body weight and vitamin C status exists, recommended intakes (RIs) for other age groups may be extrapolated from the adult RI based on weight. However, as body weights above 70 kg are becoming increasingly common - also in the Nordic region - an RI of 140 mg/day for individuals weighing 100 kg or more should be considered to compensate for the larger volume of distribution. Finally, smoking continues to be a common contributor to poor vitamin C status; therefore, it is proposed that people who smoke increase their daily vitamin C intake by 40 mg/day to compensate for the increased metabolic turnover induced by smoking.
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Affiliation(s)
- Jens Lykkesfeldt
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anitra C. Carr
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
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23
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Singh D, Azuan MA, Narayanan S. Kratom ( Mitragyna speciosa) use in a sample of drug-dependent adolescents in rehabilitation for drug use in Malaysia. J Ethn Subst Abuse 2023:1-16. [PMID: 38142274 DOI: 10.1080/15332640.2023.2293941] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
BACKGROUND Leaves derived from the Kratom (Mitragyna speciosa) tree have been traditionally ingested for their curative properties by diverse groups of the population including people who use drugs (PWUDs) in Southeast Asia. This study investigated the motives for using kratom among drug-dependent adolescents. METHODS Eighty adolescents who were undergoing mandatory drug rehabilitation volunteered to participate in this mixed-method, cross-sectional study. All respondents answered a semi-structured questionnaire while a few were interviewed in-depth. RESULTS The majority were males (70%, n = 56/80). The respondents' mean age at admission was 18.2 years (SD = 1.40), and 65% were between 14 and 18 years old. Sixty-three percent (n = 50/80) had used crystal methamphetamine alone, while the rest had co-used crystal methamphetamine with heroin. About three-fifths (60%, n = 48/80) had a history of kratom use. Kratom was commonly used for many perceived benefits such as increasing energy, reducing crystal methamphetamine intake, intensifying euphoria, easing heroin withdrawal, as a heroin substitute and reducing heroin use. In addition, the multivariate analysis indicated that higher odds of kratom use were associated with those who were employed, used only crystal methamphetamine, were recent drug users, and had no prior incarceration history. CONCLUSION While kratom was being used for its multifold perceived benefits, it also functions as a means to self-treat withdrawal from illicit drug use among drug-dependent adolescents.
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Settle JR, Smith A, Rausch P. A social media analysis of kratom use to discontinue stimulants. J Addict Dis 2023:1-7. [PMID: 38105430 DOI: 10.1080/10550887.2023.2292304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND While FDA-approved treatments exist for opioid use disorder, none are available for stimulant use disorder. Kratom (Mitragyna speciosa), an unregulated plant-derived substance with known opioid- and stimulant-like effects, has been used to self-treat opioid use disorder; however, its use in relation to stimulant use disorder has not been described. OBJECTIVE To understand whether and how individuals use kratom to self-treat stimulant use disorder. METHODS Using a commercially available social listening platform, 3,820 publicly available social media posts published between January 1, 2020, and June 21, 2021, were reviewed for relevance to kratom and stimulant discontinuation. Manual qualitative thematic analysis was conducted on relevant data. RESULTS Among the 398 relevant posts that discussed using kratom to discontinue stimulants, motivations and methods varied considerably. Posts predominantly identified benefits but also negative outcomes of kratom use. Some justified it as necessary despite consequences, while others reported a desire to quit. CONCLUSIONS Although there is some awareness that kratom is used to self-treat opioid use disorder, its use to treat stimulant use disorder is more novel. In the absence of approved treatments, kratom was viewed as a natural and safe way to quit stimulants. Despite some reported success, this study shows self-treatment may pose significant risks, including kratom addiction and physical dependence. Healthcare practitioners, researchers, and public health professionals may benefit from understanding motivations for kratom use, associated benefits and risks, and the importance of discussing kratom use with patients/clients who have stimulant use disorder.
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Affiliation(s)
- Jill R Settle
- U.S. Food & Drug Administration Center for Drug Evaluation and Research Office of Communications, Silver Spring, MD, USA
| | - Alexandria Smith
- U.S. Food & Drug Administration Center for Drug Evaluation and Research Office of Communications, Silver Spring, MD, USA
| | - Paula Rausch
- U.S. Food & Drug Administration Center for Drug Evaluation and Research Office of Communications, Silver Spring, MD, USA
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25
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Ding N, Zeng Z, Luo J, Li K. The cross-sectional relationship between vitamin C and high-sensitivity C-reactive protein levels: insights from NHANES database. Front Nutr 2023; 10:1290749. [PMID: 38024382 PMCID: PMC10675847 DOI: 10.3389/fnut.2023.1290749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Background Ascorbic acid or vitamin C has antioxidant and anti-inflammatory properties that may impact markers of inflammation like C-reactive protein (CRP). However, studies specifically on vitamin C and high-sensitivity CRP (hs-CRP) have been scarce. Methods We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey 2017-2018 dataset including 5,380 U.S. adults aged ≥20 years. Multiple regression models examined the relationship between plasma vitamin C and serum hs-CRP while adjusting for potential confounders. Stratified analyses and curve fitting assessed effect modification and nonlinearity. Results An inverse association was found between plasma vitamin C and serum hs-CRP overall (β = -0.025, 95% CI: -0.033 to -0.017, p < 0.00001) and in subgroups except for the "other Hispanic" subgroup in model II (β = -0.009, 95% CI: (-0.040, 0.023), p = 0.5885). The relationship was nonlinear, with the greatest hs-CRP reduction observed up to a plasma vitamin C level of 53.1 μmol/L. Conclusion The results showed a non-linear negative correlation between vitamin C levels and hs-CRP in adults. These results suggest vitamin C intake may reduce inflammation and cardiovascular risk, but only up to 53.1 μmol/L plasma vitamin C.
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Affiliation(s)
- Ning Ding
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Zhao Zeng
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Ju Luo
- Department of Geriatrics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Keng Li
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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26
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Bachu AK, Singal P, Griffin B, Harbaugh L, Prasad S, Jain L, Mohiuddin S, Papudesi BN, Nagi T, Youssef NA, Chopra A, Ahmed S. Kratom use and mental health: A systematic literature review and case example. J Addict Dis 2023:1-12. [PMID: 37942896 DOI: 10.1080/10550887.2023.2273192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This review aims to synthesize and critically evaluate the existing literature on kratom use and its possible association with induction of psychotic and manic symptoms, in order to identify potential areas for future research that would improve our understanding of the risks of kratom consumption. METHODS An electronic search was performed using five major databases: including PubMed, Scopus, Google Scholar, Web of Science, and PsycINFO. keywords such as kratom, Mitragyna speciosa, mania, psychosis, bipolar disorder, schizophrenia, schizoaffective, case report, and case series. The retrieved articles on initial search were screened based on predefined inclusion and exclusion criteria for this study, and then data synthesis was performed to analyze relevant information from the included studies. RESULTS Six prior papers were found using (1 case series and 5 case reports). These included 10 cases, involving kratom use association with mania and psychosis. The ages of patients ranged from 28 to 55 years mean age was 38, and (SD 13.74), the majority were males (8 out of 11). Patients had durations of kratom use ranging from 2 wk to 15 years. Significant association was found between kratom use and the worsening of psychotic and manic symptoms in individuals with psychiatric conditions. CONCLUSIONS Our research highlights the possibility of worsening preexisting psychiatric conditions in the context of kratom use. This study emphasizes the need for clinical evaluation of patients for kratom use. Additional research is required to gain a deeper understanding of the potential mental health implications of kratom use, especially among vulnerable populations.
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Affiliation(s)
- Anil K Bachu
- Baptist Health - UAMS Psychiatry Residency Program, North Little Rock, AR, USA
- AHN Psychiatry and Behavioral Health Institute, Pittsburgh, PA, USA
| | - Prakamya Singal
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Brittany Griffin
- Baptist Health - UAMS Psychiatry Residency Program, North Little Rock, AR, USA
| | - Lauren Harbaugh
- Arkansas College of Osteopathic Medicine, Fort Smith, AR, USA
| | - Sakshi Prasad
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Lakshit Jain
- Department of Psychiatry, University of Connecticut, Farmington, CT, USA
| | - Syed Mohiuddin
- Arkansas College of Osteopathic Medicine, Fort Smith, AR, USA
| | | | - Tarika Nagi
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, NY, USA
| | - Nagy A Youssef
- Department of Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Amit Chopra
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Saeed Ahmed
- Rutland Regional Medical Center, Rutland, VT, USA
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27
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Robinson JD, Petrelli H, Adams ML, Baker LB, Cone C, Dhing C, Grant A, Hardy Y, Parker D. PharmD Education Program Diversity, Equity, & Inclusion: Aligning Accreditation, Curricula, and the Oath. Am J Pharm Educ 2023; 87:100565. [PMID: 37399899 DOI: 10.1016/j.ajpe.2023.100565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023]
Abstract
In November 2021, the Oath of a Pharmacist was updated to include the following statement, "I will promote inclusion, embrace diversity, and advocate for justice to advance health equity." These words underscore the responsibility of Doctor of Pharmacy (PharmD) programs and the Accreditation Council for Pharmacy Education to reconsider how diversity, equity, inclusion, and antiracism are integrated within curricula and programmatic processes. To fully embrace the new Oath, the Accreditation Council for Pharmacy Education and PharmD programs should consider the incorporation of diversity, equity, inclusion, and antiracism concepts utilizing the recommendations of external expert bodies with overlapping and complementary frameworks. The intent is not to add more to the accreditation standards or curricula, but rather to intentionally integrate inclusive approaches into programmatic processes and delivery. This can be accomplished through the alignment of our accreditation standards, PharmD programs, and the Oath that is the foundation of the pharmacy profession.
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Affiliation(s)
- Jennifer D Robinson
- Washington State University, College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA.
| | - Heather Petrelli
- University of South Florida, Taneja College of Pharmacy, Tampa, FL, USA
| | - Michael L Adams
- Campbell University, College of Pharmacy & Health Sciences, Buies Creek, NC, USA
| | | | - Catherine Cone
- Touro University California, College of Pharmacy, Vallejo, CA, USA
| | - Conrad Dhing
- Husson University, School of Pharmacy, Bangor, ME USA
| | - Amy Grant
- University of South Carolina, School of Pharmacy, Columbia, SC, USA
| | - Yolanda Hardy
- Palm Beach Atlantic University, Lloyd L. Gregory School of Pharmacy, West Palm Beach, FL, USA
| | - Debra Parker
- University of Findlay, College of Pharmacy, Findlay, OH, USA
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28
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Gahr M. [Kratom (Mitragyna Speciosa): a Psychoactive Plant with Opportunities and Risks]. Fortschr Neurol Psychiatr 2023; 91:455-465. [PMID: 35613937 DOI: 10.1055/a-1826-2766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Kratom is an evergreen tree that is native to Southeast Asia. Its leafs are traditionally used as a stimulant, a remedy for various health problems and for religious purposes. Especially in the US (in a lesser extent also in Europe) kratom use is significantly prevalent. In Western countries, kratom is used predominantly as an analgesic and stimulant, for the treatment of opioid use disorders, and for improving mental health (e. g., in depression, anxiety disorders). Main molecular constituents of kratom are alkaloids of which mitragynine and 7-hydroxymitragynine appear to be most important. Pharmacodynamics and -kinetics of kratom are complex and insufficiently studied. It is known that mitragynine and 7-hydroxymitragynine are partial agonist at human μ-opioid receptors and antagonists at κ- and δ-opioid receptors with additional effects at other central receptors. Tolerability of kratom is presumably better than that of classical opioids; this is probably due to missing effects of kratom on β-arrestin and discussed as a starting point for the development of opioids with improved tolerability. Some alkaloids of kratom are inhibitors of CYP26 and to a somewhat lesser degree of CYP2C19 and CYP3A4. The addictive potential of kratom appears to be lower than that of classical opioids; however, corresponding data is limited and kratom use disorders appear to occur primarily in Western countries. Several cases of severe health-related problems and deaths are known in the US; in these cases, however, polysubstance use was usually present. Kratom use is likely associated with hepatotoxicity and cardiotoxicity. Kratom-associated mortality and morbidity in Western countries are quantitatively significantly different from Southeast Asia, where kratom use is no public health problem. The reasons for this may be the combined use of substances (which is more prevalent in Western countries), higher dosages of consumed kratom, adulterations and contaminations of commercially available kratom in Western countries, pharmacokinetic interactions, and higher concentrations of 7-hydroxymitragynine in dried kratom leafs (that are typically consumed in Western countries) in comparison to fresh leafs (that are typically consumed in Southeast Asia).
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Affiliation(s)
- Maximilian Gahr
- Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm, Ulm, Germany
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29
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Burgess A, Craig J, Miller EN, Clear B, Weiner SG. Treatment of poppy seed tea misuse with buprenorphine in a telehealth practice: a case series. J Addict Dis 2023:1-6. [PMID: 37909343 DOI: 10.1080/10550887.2023.2273191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Poppy seed tea (PST) is a legally obtainable source of opiates made from the seeds of the opium poppy. Our large telehealth opioid use disorder (OUD) provider group has treated several patients with PST misuse. METHODS We retrospectively identified patients with primary PST use disorder treated with buprenorphine in a telehealth-only practice with first visits between January 2021 and December 2022. Patients were identified by having the word "poppy" in their enrollment note, and then charts were reviewed to determine which patients had primary PST misuse. Demographics, buprenorphine doses, and retention in treatment were recorded. RESULTS We identified 18 patients treated for PST use disorder. Fifteen (83.3%) identified as male, mean age was 40.4 (standard deviation 8.8) years, and patients resided in 10 different U.S. states. Median starting buprenorphine dose was 2 mg (interquartile range (IQR) 2-2.5 mg). Median stabilizing dose of buprenorphine was 16 mg daily (IQR 15-20.5 mg). As of June 2023, 5 patients (27.8%) were still in active treatment. Two patients (11.1%) had completed a planned, elective taper. Ten patients (55.6%) had unplanned discontinuation from treatment, and 3 patients (16.7%) discontinued for other reasons. CONCLUSIONS To our knowledge, this is the largest case series describing PST misuse in the U.S., and the first to demonstrate its treatment in the telehealth setting. PST use disorder is treatable with buprenorphine with doses similar to treatment of other opioid use disorders. Clinicians who treat patients with OUD should be aware of PST use disorder and its treatment.
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Affiliation(s)
- Amelia Burgess
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Julie Craig
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily N Miller
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian Clear
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott G Weiner
- Bicycle Health Medical Group, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
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30
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Hossain R, Sultana A, Nuinoon M, Noonong K, Tangpong J, Hossain KH, Rahman MA. A Critical Review of the Neuropharmacological Effects of Kratom: An Insight from the Functional Array of Identified Natural Compounds. Molecules 2023; 28:7372. [PMID: 37959790 PMCID: PMC10648626 DOI: 10.3390/molecules28217372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Kratom (Mitragyna speciosa Korth. Havil) has been considered a narcotic drug for years, barred by the law in many parts of the world, while extensive research over the past few decades proves its several beneficial effects, some of which are still in ambiguity. In many countries, including Thailand, the indiscriminate use and abuse of kratom have led to the loss of life. Nonetheless, researchers have isolated almost fifty pure compounds from kratom, most of which are alkaloids. The most prevalent compounds, mitragynine and 7-hydroxy mitragynine, are reported to display agonist morphine-like effects on human μ-opioid receptors and antagonists at κ- and δ-opioid receptors with multimodal effects at other central receptors. Mitragynine is also credited to be one of the modulatory molecules for the Keap1-Nrf2 pathway and SOD, CAT, GST, and associated genes' upregulatory cascades, leading it to play a pivotal role in neuroprotective actions while evidently causing neuronal disorders at high doses. Additionally, its anti-inflammatory, antioxidative, antibacterial, and gastroprotective effects are well-cited. In this context, this review focuses on the research gap to resolve ambiguities about the neuronal effects of kratom and demonstrate its prospects as a therapeutic target for neurological disorders associated with other pharmacological effects.
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Affiliation(s)
- Rahni Hossain
- School of Allied Health Sciences, College of Graduate Studies, Walailak University, Nakhon Si Thammarat 80160, Thailand; (R.H.); (M.N.); (K.N.)
- Research Excellence Center for Innovation and Health Product (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Abida Sultana
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chittagong 4331, Bangladesh;
| | - Manit Nuinoon
- School of Allied Health Sciences, College of Graduate Studies, Walailak University, Nakhon Si Thammarat 80160, Thailand; (R.H.); (M.N.); (K.N.)
- Hematology and Transfusion Science Research Center, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Kunwadee Noonong
- School of Allied Health Sciences, College of Graduate Studies, Walailak University, Nakhon Si Thammarat 80160, Thailand; (R.H.); (M.N.); (K.N.)
- Research Excellence Center for Innovation and Health Product (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Jitbanjong Tangpong
- School of Allied Health Sciences, College of Graduate Studies, Walailak University, Nakhon Si Thammarat 80160, Thailand; (R.H.); (M.N.); (K.N.)
- Research Excellence Center for Innovation and Health Product (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Kazi Helal Hossain
- Angiogenesis and Brain Development Laboratory, Department of Neurosciences, Huntington Medical Research Institutes (HMRI), Pasadena, CA 91105, USA;
| | - Md Atiar Rahman
- School of Allied Health Sciences, College of Graduate Studies, Walailak University, Nakhon Si Thammarat 80160, Thailand; (R.H.); (M.N.); (K.N.)
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chittagong 4331, Bangladesh;
- Research Excellence Center for Innovation and Health Product (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand
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Ebenuwa I, Violet PC, Michel K, Padayatty SJ, Wang Y, Tu H, Wilkins KJ, Kassaye S, Levine M. Vitamin C Urinary Loss and Deficiency in Human Immunodeficiency Virus (HIV): Cross-sectional Study of Vitamin C Renal Leak in Women With HIV. Clin Infect Dis 2023; 77:1157-1165. [PMID: 37264998 PMCID: PMC10573720 DOI: 10.1093/cid/ciad333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Reduced plasma vitamin C (vitC) concentrations in human immunodeficiency virus (HIV) may result from abnormal urinary excretion: a renal leak. VitC renal leak indicates underlying nutritional dysregulation independent of diet. We hypothesized that increased renal leak prevalence in HIV would be associated with deficient vitC concentrations. METHODS We conducted an outpatient cross-sectional study of 96 women (40 HIV [PWH] and 56 without HIV [PWOH]) at the National Institutes of Health and Georgetown University. Renal leak was defined as abnormal urinary vitC excretion at fasting plasma concentrations <43.2µM, 2 SDs below vitC renal threshold in healthy women. To determine the primary outcome of renal leak prevalence, matched urine and plasma samples were collected the morning after overnight fast. Secondary outcomes assessed group differences in mean plasma vitC concentrations and prevalence of vitC deficiency. Exploratory outcomes assessed clinical parameters associated with renal leak. VitC was measured by high-performance liquid chromatography with coulometric electrochemical detection. RESULTS PWH had significantly higher renal leak prevalence (73%vs14%; OR (odds ratio):16; P<.001), lower mean plasma vitC concentrations (14µMvs50µM; P<.001), and higher prevalence of vitC deficiency (43%vs7%; OR:10; P<.001) compared with PWOH, unchanged by adjustments for confounding factors. Significant predictors of renal leak included antiretroviral therapy (ART), Black race, older age, and metabolic comorbidities but not viral load or CD4 count. When compared with other chronic disease cohorts, PWH had the highest prevalence of renal leak and vitC deficiency (P<.001). CONCLUSIONS High prevalence of vitC renal leak in HIV was associated with vitC deficiency, ART use, and race/ethnicity differences.
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Affiliation(s)
- Ifechukwude Ebenuwa
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Pierre-Christian Violet
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Kate Michel
- Department of Medicine, Division of Infectious Disease, Georgetown University School of Medicine, Washington D.C., USA
| | - Sebastian J Padayatty
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Yaohui Wang
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Hongbin Tu
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Kenneth J Wilkins
- Office of Clinical Research Support, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Seble Kassaye
- Department of Medicine, Division of Infectious Disease, Georgetown University School of Medicine, Washington D.C., USA
| | - Mark Levine
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Ashraf MU, Akhouri D, Bhardwaj D, Siddiqui B. A Study to Evaluate the Effectiveness of "Mindfulness-Based Stress Reduction Therapy(MBSRT)" in Reducing Symptom Severity and Improving Quality of Life in Patients Suffering From Irritable Bowel Syndrome. J Clin Gastroenterol 2023; 57:945-950. [PMID: 36374952 DOI: 10.1097/mcg.0000000000001800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high prevalence. IBS is considered a disorder of brain-gut interaction. Mindfulness-Based Stress Reduction Therapy (MBSRT) is a form of treatment that uses meditation and relaxation to foster awareness and acceptance of the present moment. This kind of therapy requires individuals to practice noticing and observing details about their surroundings without passing judgment or reacting to triggers in the environment. MATERIAL AND METHODS After making the diagnosis of IBS, 30 patients were subjected to concomitant MBSRT in addition to pharmacological therapy(Case Group) while the remaining were given only pharmacotherapy (Control Group). MBSRT was performed by a Clinical Psychologist. Seventeen patients were given only pharmacological therapy (Control Group). Scores were assessed using the IBS Symptom Severity Scale (IBS-SSS), Five Facets of Mindfulness Questionnaire(FFMQ), and World Health Organisation Quality Of Life-BREF (WHO-QOL-BREF) before and after the completion of MBSRT sessions. RESULTS The study included 47 patients (30 in the case group and 17 in the control group) who presented to Medicine OPD and were diagnosed with IBS. Kendall tau correlation test was applied for IBS-SSS scores, which showed significant improvement in IBS-SSS scores postmindfulness therapy in the case group with P value of <0.001. McNemar test was applied for FFMQ scores, which showed significant improvement in FFMQ scores postmindfulness therapy in the case group with a P value of <0.001. A logistic regression model was also generated, which showed a significant change in QOL scores after MBSRT. CONCLUSION IBS patients who received MBSRT had a greater improvement in the quality of life and mindfulness components and reduced IBS symptoms as compared with the control group.
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Ding Y, Wang C, Yu J, Lu M, Mu P, Liu X, Liu T. Low levels of serum vitamin C in children with limb fractures: a case-control study. Front Pediatr 2023; 11:1226508. [PMID: 37780044 PMCID: PMC10539904 DOI: 10.3389/fped.2023.1226508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction The role of vitamin C in pediatric fractures has not received much attention, although it is known to be a factor in osteoporotic fractures in the elderly. This case-control study aimed to investigate the changes in serum vitamin C levels among children with limb fractures. Methods We recruited 325 children with and 316 children without limb fractures hospitalized between January 2021 and December 2021. Following admission, basic demographic data of all participants were collected, and fasting serum vitamin C levels were determined using ultra-high-performance liquid chromatography-tandem mass spectrometry. Results The mean age of the fracture group was 5.1 years (95% CI, 4.83-5.33). The serum vitamin C levels in the fracture group (4.48 µg/ml) were significantly lower than those in the control group (8.38 µg/ml) (p < 0.0001). Further subgroup analysis of the fracture group revealed that serum vitamin C levels decreased significantly after 4 years of age and there was a significant difference in the duration after injury between <6 and >6 h (p = 0.0224). Spearman's rank correlation coefficient suggested that age and vitamin C levels were negatively correlated in the fracture group. Conclusion In general, children with limb fractures had lower serum vitamin C levels, especially those aged 4 years and over.
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Affiliation(s)
| | | | | | | | | | | | - Tao Liu
- Department of Pediatric Orthopedics, Jinan Children’s Hospital, Jinan, China
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Hassan Z, Singh D, Suhaimi FW, Chear NJY, Harun N, See CP, Kaur G, Mat NH, Bakar SNS, Yusof NSM, Kasinather VB, Chawarski MC, Murugaiyah V, Ramanathan S. Evaluation of toxicity profile of kratom (Mitragyna speciosa Korth) decoction in rats. Regul Toxicol Pharmacol 2023; 143:105466. [PMID: 37536550 DOI: 10.1016/j.yrtph.2023.105466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/22/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
Mitragyna speciosa Korth also known as kratom, is an herbal drug preparation for its therapeutic properties and opioid-replacement therapy. Kratom is consumed in a brewed decoction form in Malaysia and to date, no studies have characterized its chemical and toxicity profile. Thus, this study aims to evaluate kratom decoction's safety and toxicity profile after 28 days of treatment. Mitragynine content was quantified in kratom decoction and used as a marker to determine the concentration. Male and female Sprague Dawley rats were orally treated with vehicle or kratom decoction (10, 50 or 150 mg/kg) and two satellite groups were treated with vehicle and kratom decoction (150 mg/kg). Blood and organs were collected for hematology, biochemical and histopathology analysis at the end of treatment. No mortality was found after 28 days of treatment and no significant changes in body weight and hematology profile, except for low platelet count. High amounts of uric acid, AST, ALT and alkaline phosphatase were found in the biochemical analysis. Histological investigation of the heart and lungs detected no alterations except for the kidney, liver and brain tissues. In conclusion, repeated administration of kratom decoction provided some evidence of toxicity in the kidney and liver with no occurrence of mortality.
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Affiliation(s)
- Zurina Hassan
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Penang, Malaysia.
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Penang, Malaysia
| | | | | | - Norsyifa Harun
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Penang, Malaysia
| | - Cheah Pike See
- Department of Human Anatomy, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Gurjeet Kaur
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, 11800, USM, Penang, Malaysia
| | - Noorul Hamizah Mat
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Penang, Malaysia
| | | | | | | | - Marek C Chawarski
- Departments of Psychiatry and Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Vikneswaran Murugaiyah
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Penang, Malaysia; Discipline of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia
| | - Surash Ramanathan
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Penang, Malaysia
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Farkas DJ, Inan S, Heydari LN, Johnson CT, Zhao P, Bradshaw HB, Ward SJ, Rawls SM. Cannabinoid mechanisms contribute to the therapeutic efficacy of the kratom alkaloid mitragynine against neuropathic, but not inflammatory pain. Life Sci 2023; 328:121878. [PMID: 37392779 PMCID: PMC10527577 DOI: 10.1016/j.lfs.2023.121878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Abstract
AIMS Mitragynine (MG) is an alkaloid found in Mitragyna speciosa (kratom), a plant used to self-treat symptoms of opioid withdrawal and pain. Kratom products are commonly used in combination with cannabis, with the self-treatment of pain being a primary motivator of use. Both cannabinoids and kratom alkaloids have been characterized to alleviate symptoms in preclinical models of neuropathic pain such as chemotherapy-induced peripheral neuropathy (CIPN). However, the potential involvement of cannabinoid mechanisms in MG's efficacy in a rodent model of CIPN have yet to be explored. MAIN METHODS Prevention of oxaliplatin-induced mechanical hypersensitivity and formalin-induced nociception were assessed following intraperitoneal administration of MG and CB1, CB2, or TRPV1 antagonists in wildtype and cannabinoid receptor knockout mice. The effects of oxaliplatin and MG exposure on the spinal cord endocannabinoid lipidome was assessed by HPLC-MS/MS. KEY FINDINGS The efficacy of MG on oxaliplatin-induced mechanical hypersensitivity was partially attenuated upon genetic deletion of cannabinoid receptors, and completely blocked upon pharmacological inhibition of CB1, CB2, and TRPV1 channels. This cannabinoid involvement was found to be selective to a model of neuropathic pain, with minimal effects on MG-induced antinociception in a model of formalin-induced pain. Oxaliplatin was found to selectively disrupt the endocannabinoid lipidome in the spinal cord, which was prevented by repeated MG exposure. SIGNIFICANCE Our findings suggest that cannabinoid mechanisms contribute to the therapeutic efficacy of the kratom alkaloid MG in a model of CIPN, which may result in increased therapeutic efficacy when co-administered with cannabinoids.
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Affiliation(s)
- Daniel J Farkas
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, USA.
| | - Saadet Inan
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, USA
| | - Laila N Heydari
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, USA
| | - Clare T Johnson
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Pingwei Zhao
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, USA
| | - Heather B Bradshaw
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Sara Jane Ward
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, USA; Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, USA
| | - Scott M Rawls
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, USA; Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, USA
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Krasnovsky L, Crowley AP, Naeem F, Wang LS, Wu GD, Chao AM. A Scoping Review of Nutritional Biomarkers Associated with Food Security. Nutrients 2023; 15:3576. [PMID: 37630766 PMCID: PMC10459650 DOI: 10.3390/nu15163576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Food insecurity affects more than 40 million individuals in the United States and is linked to negative health outcomes due, in part, to poor dietary quality. Despite the emergence of metabolomics as a modality to objectively characterize nutritional biomarkers, it is unclear whether food security is associated with any biomarkers of dietary quality. This scoping review aims to summarize studies that examined associations between nutritional biomarkers and food security, as well as studies that investigated metabolomic differences between people with and without food insecurity. PubMed, Embase, Scopus, and AGRICOLA were searched through August 2022 for studies describing food insecurity and metabolic markers in blood, urine, plasma, hair, or nails. The 78 studies included consisted of targeted assays quantifying lipids, dietary nutrients, heavy metals, and environmental xenobiotics as biochemical features associated with food insecurity. Among those biomarkers which were quantified in at least five studies, none showed a consistent association with food insecurity. Although three biomarkers of dietary quality have been assessed between food-insecure versus food-secure populations, no studies have utilized untargeted metabolomics to characterize patterns of small molecules that distinguish between these two populations. Further studies are needed to characterize the dietary quality profiles of individuals with and without food insecurity.
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Affiliation(s)
- Lev Krasnovsky
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.P.C.); (F.N.); (L.S.W.)
| | - Aidan P. Crowley
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.P.C.); (F.N.); (L.S.W.)
| | - Fawaz Naeem
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.P.C.); (F.N.); (L.S.W.)
| | - Lucy S. Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.P.C.); (F.N.); (L.S.W.)
| | - Gary D. Wu
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Ariana M. Chao
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA;
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Zainudin NAB, Zulkifli NN, Abdul Hamid K, Hashim H, Mansor S. A Pilot Study of the Striatal Dopamine Transporter Levels in Kratom-Dependent and Normal Subjects Using 99mTc-TRODAT-1 Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT). Cureus 2023; 15:e43251. [PMID: 37692587 PMCID: PMC10491945 DOI: 10.7759/cureus.43251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE The study aims to elucidate the effects of kratom addiction on dopamine transporter (DAT) using [2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo[3.2.1]oct-2-yl]methyl](2-mercaptoethyl)amino]ethyl]amino]ethanethiolato(3-)-N2,N20,S2,S20]oxo-[1R-(exo-exo)]-[99mTc] technetium (99mTc-TRODAT-1) brain single photon emission computed tomography-computed tomography (SPECT-CT) in kratom-dependent and healthy subjects. MATERIALS AND METHODS We recruited 12 kratom-dependent subjects and 13 healthy men to participate in this study. Addiction, craving, depression, and cognitive scores were assessed. All subjects received a single bolus injection of 99mTc-TRODAT-1 with 914.1 MBq ± 65.5 of activity (mean ± SD). The brain SPECT-CT images were reconstructed using 3D ordered subset expectation maximization (3D-OSEM) along with attenuation correction (AC), scatter correction (SC), and resolution recovery (RR) with an iteration number of four and a subset of 10. The Cohen's Kappa interrater-reliability between two raters, the standardized uptake value of body weight (SUVBW), and the asymmetrical index percentage (AI%) were evaluated. RESULTS Kappa statistics showed a fine agreement of abnormal 99mTc-TRODAT-1 uptake in the striatum region for the kratom-dependent group with the κ value of 0.69 (p = 0.0001), and the percentage of agreement for rater 1 and rater 2 was 56% and 64%, respectively. There was a reduction in average SUV in kratom-dependent subjects compared to healthy control subjects in the left caudate and left striatum (0.938 vs. 1.251, p = 0.014, and 1.055 vs. 1.29, p = 0.036, respectively). There was a significant difference in the AI% of the caudate region between the kratom-dependent group and the normal group (33% vs. 14%, p = 0.019). CONCLUSION Our findings signify that kratom addiction, may cause a change in DAT level and the results can be confirmed using 99mTc-TRODAT-1 SPECT-CT.
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Affiliation(s)
| | | | - Khadijah Abdul Hamid
- Biomedical Imaging, Universiti Sains Malaysia, Penang, MYS
- Nuclear Medicine Unit, Universiti Sains Malaysia, Penang, MYS
| | - Hazlin Hashim
- Biomedical Imaging, Universiti Sains Malaysia, Penang, MYS
- Nuclear Medicine Unit, Universiti Sains Malaysia, Penang, MYS
| | - Syahir Mansor
- Biomedical Imaging, Universiti Sains Malaysia, Penang, MYS
- Nuclear Medicine Unit, Universiti Sains Malaysia, Penang, MYS
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Ahmed S, Tran QV, McLean M. The Great Imitator: A Case of Accidental Kratom Overdose. Cureus 2023; 15:e43144. [PMID: 37560054 PMCID: PMC10408695 DOI: 10.7759/cureus.43144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 08/11/2023] Open
Abstract
Kratom (Mitragyna speciosa) is an herb that is sold over the counter in both pill and liquid forms. It contains opioid and stimulant properties and is used for relaxation as well as for weaning off opioid addictions. While a few adverse effects of kratom have been already reported, mainly with concerns around its toxicity, very little is known about it. We report a case of a female in her 40s presenting with signs of hypoxia reversed with naloxone administration, initially suspected to be a case of opioid overdose. Upon becoming alert and oriented, the patient and her husband reported that she consumed a large amount of kratom bought from the local gas station, and he later noticed that her lips were turning blue and she was becoming increasingly altered. Her urine toxicology was noted to be negative for opioids or any other substance use. The patient survived this accidental overdose due to the quick action of her husband, who rushed her to the emergency department (ED) upon realizing she appeared altered and very ill. It is important for emergency medicine practitioners to be aware of kratom overdose as a possible item on the differential diagnosis. This paper focuses on kratom overdose presentation and treatment.
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Affiliation(s)
- Shajeda Ahmed
- Emergency Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - Quoc Vinh Tran
- Emergency Medicine, AdventHealth East Orlando, Orlando, USA
| | - Mary McLean
- Emergency Medicine, AdventHealth East Orlando, Orlando, USA
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Rockich-Winston N, Robinson A, Arif SA, Steenhof N, Kellar J. The Influence of Intersectionality on Professional Identity Formation among Underrepresented Pharmacy Students. Am J Pharm Educ 2023; 87:100108. [PMID: 37597916 DOI: 10.1016/j.ajpe.2023.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/18/2023] [Accepted: 02/15/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE The objective of this study is to explore professional identity formation (PIF) among student pharmacists from underrepresented groups (URGs). METHODS In this qualitative study, 15 student pharmacists from the University of Georgia and Midwestern University Colleges of Pharmacy were recruited for interviews to explore the influence of intersectionality of race, ethnicity, and gender on PIF. Interview data were analyzed using constructivist grounded theory to identify themes and then further analyzed using Crenshaw's theory of intersectionality, namely structural, political, and representational intersectionality. RESULTS Intersectionality of identities created situations where participants expressed advantages belonging to certain social categories, while simultaneously being disadvantaged belonging to other social categories. This awareness led to strategies to overcome these collective obstacles for themselves and their communities. Participants then described ways to shift perceptions of how society depicts pharmacists and the pharmacy profession. The results depict these processes and how intersectionality influences PIF for URG student pharmacists. CONCLUSION The sociocultural aspects of race, ethnicity, and gender influence the PIF of student pharmacists who belong to URGs. Intersectionality helps us better understand the ways in which inequality compounds itself, and this results in URG student pharmacists creating opportunities for belongingness and representation. Resultantly, URGs create opportunities for inclusivity and representation. To continue to facilitate this it is essential for educators and university systems to promote ways to foster and incorporate PIF in student pharmacists.
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Affiliation(s)
| | | | - Sally A Arif
- Midwestern University College of Pharmacy, Downers Grove, IL, USA
| | - Naomi Steenhof
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada
| | - Jamie Kellar
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada
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Mehta B, Smith MG, Bacci J, Brooks A, Dopp A, Groves B, Hritcko P, Kebodeaux C, Law AV, Marciniak MW, McGivney MA, Steinkopf M, Traylor C, Bradley-Baker LR. The Report of the 2022-2023 AACP Professional Affairs Standing Committee: Focused Integration of Community-Based Pharmacy Practice Within the AACP Transformation Center. Am J Pharm Educ 2023; 87:100561. [PMID: 37423388 DOI: 10.1016/j.ajpe.2023.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
The 2022-2023 Professional Affairs Committee was charged to (1) Devise a framework and 3-year workplan for the Academia-Community Pharmacy Transformation Pharmacy Collaborative to be integrated within the American Association of Colleges of Pharmacy (AACP) Transformation Center. This plan should include the focus area(s) to be continued and developed by the Center, potential milestone dates or events, and necessary resources; and (2) Provide recommendations on focus areas and/or potential questions for the Pharmacy Workforce Center to consider for the 2024 National Pharmacist Workforce Study. This report provides the background and methodology utilized to develop the framework and 3-year workplan focused on (1) community-based pharmacy pipeline development for recruitment, programming, and retention, (2) programming and resources for community-based pharmacy practice, and (3) research areas for community-based pharmacy practice. The Committee offers suggested revisions for 5 current AACP policy statements, 7 recommendations pertaining to the first charge, and 9 recommendations pertaining to the second charge.
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Affiliation(s)
- Bella Mehta
- The Ohio State University, Columbus, OH, USA
| | - Megan G Smith
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Amie Brooks
- American College of Clinical Pharmacy, Lenexa, KS, USA
| | - Anna Dopp
- American Society of Health-System Pharmacists, Bethesda, MD, USA
| | - Brigid Groves
- American Pharmacists Association, Washington, DC, USA
| | | | | | - Anandi V Law
- Western University of the Health Sciences, Pomona, CA, USA
| | | | | | | | - Carlie Traylor
- National Community Pharmacists Association, Alexandria, VA, USA
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Badshah I, Anwar M, Murtaza B, Khan MI. Molecular mechanisms of morphine tolerance and dependence; novel insights and future perspectives. Mol Cell Biochem 2023:10.1007/s11010-023-04810-3. [PMID: 37470850 DOI: 10.1007/s11010-023-04810-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
Drug addiction is a devastating condition that poses a serious burden on the society. The use of some drugs like morphine for their tremendous analgesic properties is also accompanied with developing tolerance, dependence and the withdrawal symptoms. These symptoms are frequently severe enough to reinforce the person in recovery to start over the use of drug again and hinder the clinical use of drugs like morphine for chronic pain. Research into opioid receptors and related molecular pathways has seen resurgence in the wake of the growing opioid epidemic. The current study provides a comprehensive scientific exploration of the molecular mechanisms and underlying signalling in morphine tolerance and dependence. It also critically evaluates current therapeutic approaches, shedding light on their efficacy and limitations, and future prospects. The graphical abstract depicts an overview of the pathways involved in the emergence of morphine-related tolerance and dependence including NMDA, Nitric oxide, and PPAR, as well as behavioural sensitization along with present and future innovative treatment strategies including stem cell therapy that have been discussed in the current manuscript.
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Affiliation(s)
- Ismail Badshah
- Riphah Institute of Pharmaceutical Sciences, G-7/4 Campus, Islamabad, Pakistan
| | - Maira Anwar
- Riphah Institute of Pharmaceutical Sciences, G-7/4 Campus, Islamabad, Pakistan
| | - Babar Murtaza
- Riphah Institute of Pharmaceutical Sciences, G-7/4 Campus, Islamabad, Pakistan.
| | - Muhammad Imran Khan
- Department of Biomedical Sciences, Pak Austria Fachhochschule: Institute of Applied Sciences and Technology, Haripur, Khyber Pakhtunkhwa, Pakistan.
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Farkas DJ, Cooper ZD, Heydari LN, Hughes AC, Rawls SM, Ward SJ. Kratom Alkaloids, Cannabinoids, and Chronic Pain: Basis of Potential Utility and Role in Therapy. Cannabis Cannabinoid Res 2023. [PMID: 37466474 DOI: 10.1089/can.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Introduction: Chronic neuropathic pain is as a severe detriment to overall quality of life for millions of Americans. Current pharmacological treatment options for chronic neuropathic pain are generally limited in efficacy and may pose serious adverse effects such as risk of abuse, nausea, dizziness, and cardiovascular events. Therefore, many individuals have resorted to methods of pharmacological self-treatment. This narrative review summarizes the existing literature on the utilization of two novel approaches for the treatment of chronic pain, cannabinoid constituents of Cannabis sativa and alkaloid constituents of Mitragyna speciosa (kratom), and speculates on the potential therapeutic benefits of co-administration of these two classes of compounds. Methods: We conducted a narrative review summarizing the primary motivations for use of both kratom and cannabis products based on epidemiological data and summarize the pre-clinical evidence supporting the application of both kratom alkaloids and cannabinoids for the treatment of chronic pain. Data collection was performed using the PubMed electronic database. The following word combinations were used: kratom and cannabis, kratom and pain, cannabis and pain, kratom and chronic pain, and cannabis and chronic pain. Results: Epidemiological evidence reports that the self-treatment of pain is a primary motivator for use of both kratom and cannabinoid products among adult Americans. Further evidence shows that use of cannabinoid products may precede kratom use, and that a subset of individuals concurrently uses both kratom and cannabinoid products. Despite its growing popularity as a form of self-treatment of pain, there remains an immense gap in knowledge of the therapeutic efficacy of kratom alkaloids for chronic pain in comparison to that of cannabis-based products, with only three pre-clinical studies having been conducted to date. Conclusion: There is sufficient epidemiological evidence to suggest that both kratom and cannabis products are used to self-treat pain, and that some individuals actively use both drugs, which may produce potential additive or synergistic therapeutic benefits that have not yet been characterized. Given the lack of pre-clinical investigation into the potential therapeutic benefits of kratom alkaloids against forms of chronic pain, further research is warranted to better understand its application as a treatment alternative.
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Affiliation(s)
- Daniel J Farkas
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Ziva D Cooper
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, California, USA
| | - Laila N Heydari
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Amanda C Hughes
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Scott M Rawls
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
- Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Sara Jane Ward
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
- Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
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Ebenuwa I, Violet PC, Padayatty SJ, Wang Y, Tu H, Wilkins KJ, Moore DF, Eck P, Schiffmann R, Levine M. Vitamin C Urinary Loss in Fabry Disease: Clinical and Genomic Characteristics of Vitamin C Renal Leak. J Nutr 2023; 153:1994-2003. [PMID: 37229630 PMCID: PMC10375496 DOI: 10.1016/j.tjnut.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/30/2022] [Accepted: 12/08/2022] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Reduced plasma vitamin C concentrations in chronic diseases may result from abnormal urinary excretion of vitamin C: a renal leak. We hypothesized that vitamin C renal leak may be associated with disease-mediated renal dysregulation, resulting in aberrant vitamin C renal reabsorption and increased urinary loss. OBJECTIVES We investigated the prevalence, clinical characteristics, and genomic associations of vitamin C renal leak in Fabry disease, an X-linked lysosomal disease associated with renal tubular dysfunction and low plasma vitamin C concentrations. METHODS We conducted a non-randomized cross-sectional cohort study of men aged 24-42 y, with Fabry disease (n = 34) and controls without acute or chronic disease (n = 33). To match anticipated plasma vitamin C concentrations, controls were placed on a low-vitamin C diet 3 wk before inpatient admission. To determine the primary outcome of vitamin C renal leak prevalence, subjects were fasted overnight, and matched urine and fasting plasma vitamin C measurements were obtained the following morning. Vitamin C renal leak was defined as presence of urinary vitamin C at plasma concentrations below 38 μM. Exploratory outcomes assessed the association between renal leak and clinical parameters, and genomic associations with renal leak using single nucleotide polymorphisms (SNPs) in the vitamin C transporter SLC23A1. RESULTS Compared with controls, the Fabry cohort had 16-fold higher odds of renal leak (6% vs. 52%; OR: 16; 95% CI: 3.30, 162; P < 0.001). Renal leak was associated with higher protein creatinine ratio (P < 0.01) and lower hemoglobin (P = 0.002), but not estimated glomerular filtration rate (P = 0.54). Renal leak, but not plasma vitamin C, was associated with a nonsynonymous single nucleotide polymorphism in vitamin C transporter SLC23A1 (OR: 15; 95% CI: 1.6, 777; P = 0.01). CONCLUSIONS Increased prevalence of renal leak in adult men with Fabry disease may result from dysregulated vitamin C renal physiology and is associated with abnormal clinical outcomes and genomic variation.
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Affiliation(s)
- Ifechukwude Ebenuwa
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health, Bethesda, MD, USA.
| | - Pierre-Christian Violet
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health, Bethesda, MD, USA
| | - Sebastian J Padayatty
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health, Bethesda, MD, USA
| | - Yaohui Wang
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health, Bethesda, MD, USA
| | - Hongbin Tu
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health, Bethesda, MD, USA
| | - Kenneth J Wilkins
- Biostatistics Program, Office of Clinical Research Support, Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David F Moore
- Developmental and Metabolic Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda MD, USA
| | - Peter Eck
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Raphael Schiffmann
- Developmental and Metabolic Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda MD, USA
| | - Mark Levine
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health, Bethesda, MD, USA
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Weleff J, Kovacevich A, Burson J, Nero N, Anand A. Clinical Presentations and Treatment of Phenibut Toxicity and Withdrawal: A Systematic Literature Review. J Addict Med 2023; 17:407-417. [PMID: 37579098 DOI: 10.1097/adm.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This systematic review aimed to identify published articles that evaluated all phenibut toxicity and withdrawal cases to understand better their clinical presentations and treatments. METHODS A comprehensive literature search was conducted using Medline (Ovid), Embase (Ovid), and Cochrane Library databases to capture all published cases on the presentations and management of phenibut toxicity or withdrawal. RESULTS Sixty-two cases from 36 studies on presentation and management of phenibut toxicity or phenibut withdrawal were identified. Of all subjects, 80.7% were male. The average age was 30.9 years (SD, 13.2 years; range, 0-71 years). A total of 86.8% reported obtaining phenibut online, and 63.2% reported concomitant substance use with other addictive agents; benzodiazepines and alcohol were the most combined drugs. The average length of hospital stay was 5.0 days (n = 25; SD, 5.4 days; range, 1-25 days) for phenibut toxicity and 7.7 days (n = 20; SD, 7.8 days; range, 0-30 days) for phenibut withdrawals. The most common symptoms reported during phenibut toxicity were altered mental status, somnolence, psychosis, and movement disorders. Of the phenibut toxicity cases, 48.7% required intubation. Benzodiazepines and antipsychotics were most used to treat phenibut toxicity. For phenibut withdrawal cases, 95.7% reported daily use. The most common symptoms reported during phenibut withdrawals were anxiety, irritability or agitation, insomnia, and psychosis. Sixteen (69.6%) of phenibut withdrawal cases required multiple medications for treatment. Benzodiazepines, baclofen, atypical antipsychotics, gabapentanoids, and barbiturates were commonly used to treat phenibut withdrawals. CONCLUSIONS The seriousness of presentations, combined with the assortments of medications used for both syndromes, reflects the potential dangers of phenibut use and the need for systematized treatment protocols.
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Affiliation(s)
- Jeremy Weleff
- From the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (JW); Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH (JW, AK, AA); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN (JB); Education Institute, Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, OH (NN); Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH (AA)
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Tabanelli R, Brogi S, Calderone V. Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going? Int J Mol Sci 2023; 24:10888. [PMID: 37446064 DOI: 10.3390/ijms241310888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
This review article offers an outlook on the use of opioids as therapeutics for treating several diseases, including cancer and non-cancer pain, and focuses the analysis on the opportunity to target opioid receptors for treating opioid use disorder (OUD), drug withdrawal, and addiction. Unfortunately, as has been well established, the use of opioids presents a plethora of side effects, such as tolerance and physical and physiological dependence. Accordingly, considering the great pharmacological potential in targeting opioid receptors, the identification of opioid receptor ligands devoid of most of the adverse effects exhibited by current therapeutic agents is highly necessary. To this end, herein, we analyze some interesting molecules that could potentially be useful for treating OUD, with an in-depth analysis regarding in vivo studies and clinical trials.
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Affiliation(s)
- Rita Tabanelli
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Simone Brogi
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
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Straw A, Mills J, Winters R, Van de Roovaart H, Chen AM. Community pharmacies and the empowerment of self-care in the United States. Explor Res Clin Soc Pharm 2023; 10:100266. [PMID: 37151372 PMCID: PMC10160781 DOI: 10.1016/j.rcsop.2023.100266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023] Open
Abstract
Background As part of self-care, patients prevent diseases or conditions, maintain, or enhance their current health status, and address current health challenges. As a key member of the healthcare team, the role of the pharmacist in relation to self-care is important, given the ease of access to pharmacists in a variety of care settings. Objectives To describe the structure and function of self-care within community pharmacies throughout the United States (U.S.). Methods The literature within the U.S. was reviewed related to self-care definitions and practice, the role and training of the pharmacist, and challenges and opportunities for pharmacists. Results Within the U.S., self-care is broader than simply products found in the "over-the-counter" (OTC) section of pharmacies; it includes pharmacists involvement in disease prevention, evaluation and maintenance of current health status, and assistance in managing health challenges. There is growing recognition of the significance of pharmacists in aiding patients in self-care, due to publication of outcomes related to pharmacist-provided self-care support. Accreditation standards require student pharmacists to develop knowledge and competency related to the broadest definition of self-care; resources exist related to curricular content and student evaluation and assessment support. The evolving role of the pharmacist in relation to self-care has presented challenges in terms of recognition and renumeration for services and workload issues. Efforts are currently underway to address these challenges. Conclusions Spiraling health care costs, poor health outcomes, and continued health disparities indicate a need to better support U.S. patients on their health care journey, which often begins with self-care. There is a plethora of opportunities for pharmacists to advocate for expanding roles related to self-care, including participation in national efforts to recognize the outcomes of pharmacists in self-care.
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Affiliation(s)
- Andrew Straw
- Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH 45314, USA
| | - Jenna Mills
- University of Findlay College of Pharmacy, 1000 N. Main St., Findlay, OH 45840, USA
| | - Rachel Winters
- Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH 45314, USA
| | | | - Aleda M.H. Chen
- Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH 45314, USA
- Corresponding author.
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Henningfield JE, Chawarski MC, Garcia-Romeu A, Grundmann O, Harun N, Hassan Z, McCurdy CR, McMahon LR, Sharma A, Shoaib M, Singh D, Smith KE, Swogger MT, Vicknasingam B, Walsh Z, Wang DW, Huestis MA. Kratom withdrawal: Discussions and conclusions of a scientific expert forum. Drug Alcohol Depend Rep 2023; 7:100142. [PMID: 37397437 PMCID: PMC10311168 DOI: 10.1016/j.dadr.2023.100142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Jack E. Henningfield
- PinneyAssociates, Bethesda, MD 20814, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Marek C. Chawarski
- Departments of Psychiatry and Emergency Medicine, Yale School of Medicine, New Haven, CT 06519, United States
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Norsyifa Harun
- Centre for Drug Research, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Zurina Hassan
- Centre for Drug Research, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Christopher R. McCurdy
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, United States
- Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, FL 32610, United States
| | - Lance R. McMahon
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
| | - Abhisheak Sharma
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, United States
- Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, FL 32610, United States
| | - Mohammed Shoaib
- Institute of Neuroscience, Medical School, Newcastle University, Newcastle Upon Tyne NE2 4HH, United Kingdom
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Kirsten E. Smith
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States
| | - Marc T. Swogger
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, United States
| | | | - Zachary Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC V1V 1V7, Canada
| | | | - Marilyn A. Huestis
- PinneyAssociates, Bethesda, MD 20814, United States
- Thomas Jefferson University, Philadelphia, PA 19144, United States
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Jarka C, Gregoire K. Precipitated withdrawal with kratom use following naltrexone administration. Ment Health Clin 2023; 13:155-158. [PMID: 37448827 PMCID: PMC10337879 DOI: 10.9740/mhc.2023.06.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/12/2023] [Indexed: 07/15/2023] Open
Abstract
Kratom is an herbal supplement with reports of use for natural pain relief or treatment of opioid withdrawal symptoms. Kratom has metabolites that bind to and agonize mu-opioid receptors similar to opiate medications. There have been reports of serious adverse reactions, with a potential for dependence with long-term use and withdrawal that may occur upon discontinuation. Naltrexone can result in abrupt withdrawal symptoms when used with opioids or opioid-like supplements such as kratom. This case report describes withdrawal precipitated by naltrexone administration in a patient with undisclosed chronic kratom use. This case highlights the importance of thorough assessment of all self-administered herbal and over-the-counter supplements as they may have serious interactions with other prescribed medications and affect therapeutic outcomes.
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Affiliation(s)
- Courtney Jarka
- Clinical Pharmacy Specialist Critical Care, Catholic Health System, Kenmore Mercy Hospital, Kenmore, New York
| | - Kelsey Gregoire
- Clinical Pharmacy Specialist Critical Care, Catholic Health System, Kenmore Mercy Hospital, Kenmore, New York
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Prevete E, Kuypers KPC, Theunissen EL, Esposito G, Ramaekers JG, Pasquini M, Corazza O. Clinical Implications of Kratom ( Mitragyna speciosa) Use: a Literature Review. Curr Addict Rep 2023; 10:317-334. [PMID: 37266188 PMCID: PMC10177737 DOI: 10.1007/s40429-023-00478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 06/03/2023]
Abstract
Purpose of Review This work aims to provide an up-to-date review of the preclinical and clinical scientific literature on the therapeutic value of kratom to better understand the underlying mechanisms related to its use and inform future therapeutic applications. Recent Findings A growing number of studies, mainly of cross-sectional nature, describe the widespread use of kratom by individuals to self-treat pain, psychiatric symptoms, and substance use disorders (SUD) outside a controlled clinical setting. Preclinical evidence suggests kratom is effective as an analgesic agent and might decrease the self-administration of other drugs. A randomized controlled trial has further supported kratom's therapeutic value as an analgesic. Investigations in nonclinical samples of long-term kratom users also indicate its therapeutic benefit in managing SUD symptoms (e.g., craving) and long-term or acute symptoms (e.g., withdrawal) for alcohol, opioids, and other illicit drugs. However, episodes of kratom-related intoxications have also been reported, often due to the adulteration and the contamination of kratom products mainly sold online or mixed toxicities when consumed outside clinical and traditional settings. Summary Evidence on the clinical implications of kratom use is still limited and uncertain, with kratom research constantly evolving. Therefore, further randomized trials are needed.
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Affiliation(s)
- Elisabeth Prevete
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell’Università 30, 00185 Rome, Italy
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Kim Paula Colette Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Eef Lien Theunissen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 84, 38068 Rovereto, Italy
| | - Johannes Gerardus Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell’Università 30, 00185 Rome, Italy
| | - Ornella Corazza
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 84, 38068 Rovereto, Italy
- Department of Clinical, Pharmacological and Biological Sciences, University of Hertfordshire, College Lane, Hatfield, AL10 9AB UK
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Mukhopadhyay S, Gupta S, Wilkerson JL, Sharma A, McMahon LR, McCurdy CR. Receptor Selectivity and Therapeutic Potential of Kratom in Substance Use Disorders. Curr Addict Rep 2023. [DOI: 10.1007/s40429-023-00472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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