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Methyl ester and aromatic ether modification of mitragynine for generation of mitragynine-specific polyclonal antibodies. J Immunol Methods 2022; 507:113291. [DOI: 10.1016/j.jim.2022.113291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022]
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Zhang M, Sharma A, León F, Avery B, Kjelgren R, McCurdy CR, Pearson BJ. Plant growth and phytoactive alkaloid synthesis in kratom [Mitragyna speciosa (Korth.)] in response to varying radiance. PLoS One 2022; 17:e0259326. [PMID: 35472200 PMCID: PMC9041851 DOI: 10.1371/journal.pone.0259326] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/27/2022] [Indexed: 01/22/2023] Open
Abstract
Leaves harvested from kratom [Mitragyna speciosa (Korth.)] have a history of use as a traditional ethnobotanical medicine to combat fatigue and improve work productivity in Southeast Asia. In recent years, increased interest in the application and use of kratom has emerged globally, including North America, for its potential application as an alternative source of medicine for pain management and opioid withdrawal syndrome mitigation. Although the chemistry and pharmacology of major kratom alkaloids, mitragynine and 7-hydroxymitragynine, are well documented, foundational information on the impact of plant production environment on growth and kratom alkaloids synthesis is unavailable. To directly address this need, kratom plant growth, leaf chlorophyll content, and alkaloid concentration were evaluated under three lighting conditions: field full sun (FLD-Sun), greenhouse unshaded (GH-Unshaded), and greenhouse shaded (GH-Shaded). Nine kratom alkaloids were quantified using an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method. Greenhouse cultivation generally promoted kratom height and width extension by 93-114% and 53-57%, respectively, compared to FLD-Sun. Similarly, total leaf area and leaf number were increased by 118-160% and 54-80% under such conditions. Average leaf size of plants grown under GH-Shaded was 41 and 69% greater than GH-Unshaded and FLD-Sun, respectively; however, no differences were observed between GH-Unshaded and FLD-Sun treatments. At the termination of the study, total leaf chlorophyll a+b content of FLD-Sun was 17-23% less than those grown in the greenhouse. Total leaf dry mass was maximized when cultivated in the greenhouse and was 89-91% greater than in the field. Leaf content of four alkaloids to include speciociliatine, mitraphylline, corynantheidine, and isocorynantheidine were not significantly impacted by lighting conditions, whereas 7-hydroxymitragynine was below the lower limit of quantification across all treatments. However, mitragynine, paynantheine, and corynoxine concentration per leaf dry mass were increased by 40%, 35%, and 111%, respectively, when cultivated under GH-Shaded compared to FLD-Sun. Additionally, total alkaloid yield per plant was maximized and nearly tripled for several alkaloids when plants were cultivated under such conditions. Furthermore, rapid, non-destructive chlorophyll evaluation correlated well (r2 = 0.68) with extracted chlorophyll concentrations. Given these findings, production efforts where low-light conditions can be implemented are likely to maximize plant biomass and total leaf alkaloid production.
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Affiliation(s)
- Mengzi Zhang
- Department of Environmental Horticulture, Mid-Florida Research and Education Center, Institute of Food and Agricultural Sciences, University of Florida, Apopka, Florida, United States of America
| | - Abhisheak Sharma
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
| | - Francisco León
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
| | - Bonnie Avery
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
- Translational Drug Development Core, Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, United States of America
| | - Roger Kjelgren
- Department of Environmental Horticulture, Mid-Florida Research and Education Center, Institute of Food and Agricultural Sciences, University of Florida, Apopka, Florida, United States of America
| | - Christopher R. McCurdy
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
- Translational Drug Development Core, Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, United States of America
| | - Brian J. Pearson
- Department of Environmental Horticulture, Mid-Florida Research and Education Center, Institute of Food and Agricultural Sciences, University of Florida, Apopka, Florida, United States of America
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Mills JM, Guy JW, Oestreich JH. Digital Storytelling Review in a Pharmacy Self-Care Course. PHARMACY 2022; 10:pharmacy10020045. [PMID: 35448704 PMCID: PMC9032475 DOI: 10.3390/pharmacy10020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Digital storytelling is a type of active learning that allows instructors to simulate real-life situations through a series of connected videos. While this technique has been used in other healthcare education disciplines, its use in pharmacy has not been well documented. A digital storytelling model was incorporated in a required self-care pharmacy course to assess if the technique was helpful to improve the knowledge, confidence, and satisfaction of students. Due to a shift in online learning, the self-care course offered a remote exam review session containing a digital storytelling model, and this approach was compared to an in-person exam review that followed a lecture-based model held earlier in the course. Pre- and post-knowledge assessments were given to determine the impact of the digital storytelling review. There were 50 students involved in both sessions and there was a 70% response rate in the digital storytelling group and a 90% response rate in the lecture-based group. Students’ knowledge numerically improved, but not to a statistically significant level for most questions. Nonetheless, students reported more confidence (p < 0.05) in their ability to pass the upcoming exam following the digital storytelling review. Thematic analysis revealed that the digital storytelling session was engaging and interactive, though time-management and breakout rooms could be further optimized. Based on these results, exam review in a required self-care pharmacy course using a digital storytelling format may be a suitable method for students to apply course content and may particularly be of utility in online or hybrid courses.
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Affiliation(s)
- Jenna M. Mills
- Department of Pharmacy Practice, College of Pharmacy, University of Findlay, Findlay, OH 45840, USA;
- Correspondence:
| | - Jason W. Guy
- Department of Pharmacy Practice, College of Pharmacy, University of Findlay, Findlay, OH 45840, USA;
| | - Julie H. Oestreich
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Findlay, Findlay, OH 45840, USA;
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Abstract
Kratom is a plant with opioid-like properties known to produce stimulant and analgesic effects. Although there are numerous studies on the psychoactive components of kratom, less is known about the toxicity. Specifically, few reports describe kratom-induced hepatotoxicity and demonstrate histological features. We provide a case report detailing the clinicopathologic findings of drug-induced liver injury caused by kratom. The laboratory workup included significant elevation of total bilirubin and alkaline phosphatase. Liver biopsy demonstrated a prominent canalicular cholestatic pattern, mixed portal inflammation, and newly described perivenular necrosis. This report provides additional information on kratom toxicity because its use continues to rise.
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105
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Sharma V, Cottler LB, Bares CB, Lopez-Quintero C. Kratom Use Among U.S. Adolescents: Analyses of the 2019 National Survey on Drug Use and Health. J Adolesc Health 2022; 70:677-681. [PMID: 34836801 PMCID: PMC9328154 DOI: 10.1016/j.jadohealth.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Kratom (Mitragyna speciosa) is an opioid-like psychoactive substance not approved by the U.S. Food and Drug Administration that could be used due to its euphoric, stimulant, and analgesic effects. Kratom is gaining popularity in the U.S. and becoming a reason of concern among pediatricians. METHODS Data from the 2019 National Survey on Drug Use and Health were analyzed to estimate the prevalence and identify correlates of lifetime and past 12-month kratom use among 13,397 U.S. adolescents. Multivariable logistic regression models were conducted to assess the associations of interest. RESULTS Lifetime and past 12-month prevalence of kratom use was .44% (95% confidence interval [CI] .32-.60) and .27% (95% CI .18-.40), respectively. Past 12-month cigarette use was associated with lifetime kratom use (adjusted odds ratio 2.60, 95% CI 1.07-6.35). Past 12-month cannabis use was associated with past 12-month kratom use (adjusted odds ratio 2.48, 95% CI 1.15-5.35). CONCLUSIONS This first report on the epidemiology of adolescent kratom use provides a baseline to assess kratom use trends in future years and identify potential correlates of use among adolescents.
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Affiliation(s)
- Vinita Sharma
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Linda B. Cottler
- Department of Epidemiology, University of Florida, Gainesville, Florida
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106
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Principales plantes et champignons psychotropes. ACTUALITES PHARMACEUTIQUES 2022. [DOI: 10.1016/j.actpha.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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107
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Michienzi AE, Borek HA. Emerging Agents of Substance Use/Misuse. Emerg Med Clin North Am 2022; 40:265-281. [DOI: 10.1016/j.emc.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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108
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Swogger MT, Smith KE, Garcia-Romeu A, Grundmann O, Veltri CA, Henningfield JE, Busch LY. Understanding Kratom Use: A Guide for Healthcare Providers. Front Pharmacol 2022; 13:801855. [PMID: 35308216 PMCID: PMC8924421 DOI: 10.3389/fphar.2022.801855] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/02/2022] [Indexed: 12/12/2022] Open
Abstract
Kratom (Mitragyna speciosa Korth., Rubiaceae) is a plant native to Southeast Asia, where it has been used for centuries as a mild stimulant and as medicine for various ailments. More recently, as kratom has gained popularity in the West, United States federal agencies have raised concerns over its safety leading to criminalization in some states and cities. Some of these safety concerns have echoed across media and broad-based health websites and, in the absence of clinical trials to test kratom’s efficacy and safety, considerable confusion has arisen among healthcare providers. There is, however, a growing literature of peer-reviewed science that can inform healthcare providers so that they are better equipped to discuss kratom use with consumers and people considering kratom use within the context of their overall health and safety, while recognizing that neither kratom nor any of its constituent substances or metabolites have been approved as safe and effective for any disease. An especially important gap in safety-related science is the use of kratom in combination with physiologically active substances and medicines. With these caveats in mind we provide a comprehensive overview of the available science on kratom that has the potential to i clarity for healthcare providers and patients. We conclude by making recommendations for best practices in working with people who use kratom.
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Affiliation(s)
- Marc T Swogger
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Kirsten E Smith
- Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oliver Grundmann
- Department of Pharmaceutical Sciences, Midwestern University College of Pharmacy, Glendale, AZ, United States.,College of Pharmacy, Department of Medicinal Chemistry, University of Florida, Gainesville, FL, United States
| | - Charles A Veltri
- Department of Pharmaceutical Sciences, Midwestern University College of Pharmacy, Glendale, AZ, United States
| | - Jack E Henningfield
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Pinney Associates, Bethesda, MD, United States
| | - Lorna Y Busch
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
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109
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Smith KE, Rogers JM, Dunn KE, Grundmann O, McCurdy CR, Schriefer D, Epstein DH. Searching for a Signal: Self-Reported Kratom Dose-Effect Relationships Among a Sample of US Adults With Regular Kratom Use Histories. Front Pharmacol 2022; 13:765917. [PMID: 35300296 PMCID: PMC8921773 DOI: 10.3389/fphar.2022.765917] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/31/2022] [Indexed: 12/15/2022] Open
Abstract
There is limited understanding regarding kratom use among US adults. Although motivations for use are increasingly understood, typical kratom doses, threshold of (low and high) doses for perceived effectiveness, and effects produced during cessation are not well documented. We aimed to extend prior survey work by recruiting adults with current and past kratom exposure. Our goal was to better understand kratom dosing, changes in routines, and perception of effects, including time to onset, duration, and variability of beneficial and adverse outcomes from use and cessation. Among respondents who reported experiencing acute kratom effects, we also sought to determine if effects were perceived as helpful or unhelpful in meeting daily obligations. Finally, we attempted to detect any signal of a relationship between the amount of kratom consumed weekly and weeks of regular use with ratings of beneficial effects from use and ratings of adverse effects from cessation. We conducted an online survey between April-May 2021 by re-recruiting participants from a separate study who reported lifetime kratom use. A total of 129 evaluable surveys were collected. Most (59.7%) had used kratom >100 times and reported currently or having previously used kratom >4 times per week (62 weeks on average). Under half (41.9%) reported that they considered themselves to be a current "regular kratom user." A majority (79.8%) reported experiencing acute effects from their typical kratom dose and that onset of effects began in minutes but dissipated within hours. Over a quarter reported that they had increased their kratom dose since use initiation, whereas 18.6% had decreased. Greater severity of unwanted effects from ≥1 day of kratom cessation was predicted by more weeks of regular kratom use (β = 6.74, p = 0.02). Acute kratom effects were largely reported as compatible with, and sometimes helpful in, meeting daily obligations. In the absence of human laboratory studies, survey methods must be refined to more precisely assess dose-effect relationships. These can help inform the development of controlled observational and experimental studies needed to advance the public health understanding of kratom product use.
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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
| | - Jeffrey M Rogers
- Real-World Assessment, Prediction, and Treatment Unit, 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
| | - Oliver Grundmann
- Department of Medicinal Chemistry, 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
| | - Destiny Schriefer
- Real-World Assessment, Prediction, and Treatment Unit, 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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110
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Vitamin C Plasma Levels Associated with Inflammatory Biomarkers, CRP and RDW: Results from the NHANES 2003–2006 Surveys. Nutrients 2022; 14:nu14061254. [PMID: 35334908 PMCID: PMC8950002 DOI: 10.3390/nu14061254] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 01/20/2023] Open
Abstract
Although undisputed for its anti-inflammatory and immune system boosting properties, vitamin C remains an inconsistently investigated nutrient in the United States. However, subclinical inadequacies may partly explain increased inflammation and decreased immune function within the population. This secondary analysis cross-sectional study used the 2003–2006 NHANES surveys to identify more clearly the association between plasma vitamin C and clinical biomarkers of acute and chronic inflammation C-reactive protein (CRP) and red cell distribution width (RDW). From plasma vitamin C levels separated into five defined categories (deficiency, hypovitaminosis, inadequate, adequate, and saturating), ANOVA tests identified significant differences in means in all insufficient vitamin C categories (deficiency, hypovitaminosis, and inadequate) and both CRP and RDW in 7607 study participants. There were also statistically significant differences in means between sufficient plasma vitamin C levels (adequate and saturating categories) and CRP. Significant differences were not identified between adequate and saturating plasma vitamin C levels and RDW. Although inadequate levels of vitamin C may not exhibit overt signs or symptoms of deficiency, differences in mean levels identified between inflammatory biomarkers suggest a closer examination of those considered at risk for inflammatory-driven diseases. Likewise, the subclinical levels of inflammation presented in this study provide evidence to support ranges for further clinical inflammation surveillance.
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111
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Lin YT, Wang LK, Hung KC, Chang CY, Wu LC, Ho CH, Chen JY. Prevalence and Predictors of Insufficient Plasma Vitamin C in a Subtropical Region and Its Associations with Risk Factors of Cardiovascular Diseases: A Retrospective Cross-Sectional Study. Nutrients 2022; 14:nu14051108. [PMID: 35268083 PMCID: PMC8912640 DOI: 10.3390/nu14051108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 02/06/2023] Open
Abstract
Background: to evaluate the prevalence and predictors of insufficient plasma vitamin C among adults in a subtropical region and its associations with cardiovascular disease risk factors including dyslipidemia and lipid-independent markers, namely homocysteine, high-sensitivity C-reactive protein (hs-CRP) and lipoprotein(a). Methods: Data of this retrospective cross-sectional study were extracted from electronic medical database of a Medical Center. Based on plasma vitamin C status, subjects were split into two groups—subjects with sufficient and insufficient plasma vitamin C levels (<50 µmol/L, ≤8.8 mg/L). Results: Prevalence of insufficient plasma vitamin C in 3899 adults was 39%. Multivariate logistic regression identified male gender, high body mass index, age 20−39, and winter/spring as independent predictors of insufficient vitamin C among all subjects. Greater proportions of subjects with insufficient plasma vitamin C had lower high-density lipoprotein cholesterol levels and elevated levels of triglyceride, homocysteine and hs-CRP (all p < 0.001). There were no differences in total cholesterol, low-density lipoprotein cholesterol and lipoprotein(a) between groups. Conclusions: There was a high prevalence of insufficient plasma vitamin C in the subtropical region, which indicates that insufficient plasma vitamin C remains a public health issue. Further study is needed to confirm these findings and to determine the underlying mechanisms.
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Affiliation(s)
- Yao-Tsung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan 71004, Taiwan; (Y.-T.L.); (L.-K.W.); (K.-C.H.)
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Li-Kai Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan 71004, Taiwan; (Y.-T.L.); (L.-K.W.); (K.-C.H.)
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan 71004, Taiwan; (Y.-T.L.); (L.-K.W.); (K.-C.H.)
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Chia-Yu Chang
- Department of Neurology, Chi Mei Medical Center, Tainan 71004, Taiwan;
- The Center for General Education, Southern Taiwan University of Science and Technology, Tainan 80424, Taiwan
| | - Li-Ching Wu
- Center for Precision Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan;
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan 71004, Taiwan;
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan 71004, Taiwan; (Y.-T.L.); (L.-K.W.); (K.-C.H.)
- Correspondence:
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112
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Ji L, Zhao X, Zhang Y, Zhao P, Gong R, Li F, Huang H. Efficacy and safety of Qinghua Zhixie Decoction against diarrhea-predominate irritable bowel syndrome: A protocol for a randomized controlled trial. Medicine (Baltimore) 2022; 101:e28895. [PMID: 35244043 PMCID: PMC8896428 DOI: 10.1097/md.0000000000028895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diarrhea-predominant irritable bowel syndrome (D-IBS) is the main subtypes of irritable bowel syndrome (IBS). In recent years, more than half of IBS patients have received complementary and alternative medicine. Traditional Chinese herbal formula is widely used in Asia, and clinical studies have also found that Chinese herbal formula could significantly improve abdominal pain and diarrhea. We plan to carry out a randomized, controlled, double blind, clinical studies to observe the clinical efficacy of Qinghua Zhixie decoction in the treatment of D-IBS. METHODS Four hundred sixty-four participants will be randomly assigned to the treatment group and control group. Patients in both groups would take medications and stimulations simultaneously. The outcomes of IBS symptom severity score, quality of life, psychological states, and recurrence rate will be recorded. Statistics will be analyzed with the SPSS 22.0. CONCLUSIONS The findings of the study will identify the safety and efficacy of Qinghua Zhixie decoction in the treatment of D-IBS. TRIAL REGISTRATION OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/C8MHW.
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Affiliation(s)
- Lijiang Ji
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, Jiangsu, China
| | - Xiaoying Zhao
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuyan Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ping Zhao
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, Jiangsu, China
| | - Rui Gong
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Fang Li
- Department of Gastroenterology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, Jiangsu Province, China
| | - Hua Huang
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, Jiangsu, China
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113
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Larsen I, Zhang E, Farahmand P. Current Understanding of the Effects and Potential Clinical Utility of Kratom: A Review. J Psychiatr Pract 2022; 28:92-97. [PMID: 35238820 DOI: 10.1097/pra.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The increasingly widespread use of kratom in the United States has raised concerns about its safety as well as spurring research into potential applications of its active ingredients in medical treatments. METHODS We reviewed the literature published over the past 20 years, including peer-reviewed publications and data released by United States government health agencies to provide an overview of this topic. RESULTS A variety of potentially beneficial and adverse effects of kratom use related to its opioid and stimulant properties have been documented, including addiction and withdrawal. Preliminary research in animals and case reports in humans have suggested medical utility for kratom in treating alcohol and opioid use disorders, pain, depression, and anxiety. However, the lack of controlled, standardized studies limits the clinical utility of this agent and is a barrier to safe consumption. CONCLUSIONS Historically, kratom has been used for medical purposes and for the treatment of alcohol and substance use disorders. The currently available literature suggests a potential for similar clinical applications. However, without controlled research studies or regulation, kratom poses numerous health risks to consumers.
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114
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Physiological dependence to mitragynine indicated by a rapid cross-dependence procedure with heroin-dependent mice. Psychopharmacology (Berl) 2022; 239:897-908. [PMID: 35107609 DOI: 10.1007/s00213-022-06080-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
The potential of mitragynine to produce physiological dependence (withdrawal) was assessed using a rapid assessment procedure with male ICR mice exposed to heroin-admixed food followed by naloxone (subcutaneously, s.c.) precipitation of withdrawal. Initial studies indicated that 3 days of exposure to 3.0 mg/g of heroin-admixed food followed by naloxone (0.6 mg/kg) reliably precipitated withdrawal jumping and weight loss. Lower concentrations of heroin-admixed food and lower doses of naloxone produced fewer withdrawal signs. A longer exposure to heroin-admixed food did not produce significantly greater amounts of jumping or weight loss. Further, these withdrawal signs were dose-dependently reversed by s.c. administration of heroin immediately following naloxone administration. Mitragynine (s.c.) also dose-dependently suppressed naloxone-precipitated withdrawal signs. Additionally, both jumping and weight loss were suppressed over a comparable range of mitragynine doses when administered by gavage with a noticeably, but not significantly, higher potency than with s.c. administration. The ED50 values for mitragynine for the suppression of withdrawal by any route (354-911 μmol/kg) were greater than the minimally effective dose that decreased locomotor activity (251 μmol/kg) and from 40- to 104-fold greater than those for heroin. The results suggest inherent opioid dependence liability of mitragynine. The in vivo potency relations between mitragynine and heroin are consistent with a conclusion of dependence-producing effects, indicated by the suppression of withdrawal, comparable to standard opioid μ-receptor agonists, differing primarily in terms of potency. The present paper provides a method for the rapid assessment of physiological dependence liability applicable to other kratom plant constituents or any potential opioid dependence-producing agents.
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115
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Singh D, Narayanan S, Vicknasingam B, Prozialeck WC, Smith KE, Corazza O, Henningfield JE, Grundmann O. The Use of Kratom (Mitragyna speciosa Korth.) Among People Who Co-use Heroin and Methamphetamine in Malaysia. J Addict Med 2022; 16:223-228. [PMID: 34001777 DOI: 10.1097/adm.0000000000000876] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Kratom (Mitragyna speciosa Korth.), an indigenous medicinal plant, has been widely used as a traditional remedy in Southeast Asia. However, its combined consumption with other substances has received scarce attention. This study investigates the use of kratom among adults with a history of using heroin and methamphetamine in Malaysia. METHODS A total of 332 patients who were mandated to undergo drug rehabilitation participated in this cross-sectional study. The study data were collected through face-to-face interviews using a semi-structured questionnaire. RESULTS The majority were males (95%, n = 314/332) and Malays (98%, n = 325/332) with a mean age of 32.3 years (SD = 9.16). Over two thirds of the respondents used kratom to alleviate heroin withdrawal symptoms and to reduce methamphetamine intake; 59% used it as a substitute for heroin and methamphetamine. A similar proportion used kratom to reduce heroin intake (58%), while only 15% used it for its euphoric effects. Multivariate analysis showed that previous attendees of government rehabilitation programs had lower odds of using kratom as a heroin substitute. CONCLUSIONS The potential of kratom to alleviate heroin withdrawal symptoms, and to reduce methamphetamine and heroin intake, among people who co-use heroin and methamphetamine warrants further research.
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Affiliation(s)
- Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Penang, Malaysia (DS, BV); School of Social Sciences, Universiti Sains Malaysia, Penang, Malaysia (SN); Department of Pharmacology, College of Graduate Studies, Midwestern University, Downers Grove, IL(WCP); National Institute on Drug Abuse Intramural Research Program, Baltimore, MD (KES); Department of Clinical, Pharmaceutical and Biological Sciences, School of Life and Medical Sciences, College Lane, Hatfield, United Kingdom (OC); Pinney Associates, Bethesda, MD and Johns Hopkins University School of Medicine, Baltimore, MD (JEH); Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL (OG)
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Karunakaran T, Ngew KZ, Zailan AAD, Mian Jong VY, Abu Bakar MH. The Chemical and Pharmacological Properties of Mitragynine and Its Diastereomers: An Insight Review. Front Pharmacol 2022; 13:805986. [PMID: 35281925 PMCID: PMC8907881 DOI: 10.3389/fphar.2022.805986] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
Mitragynine, is a naturally occurring indole alkaloid that can be isolated from the leaves of a psychoactive medicinal plant. Mitragyna speciosa, also known as kratom, is found to possess promising analgesic effects on mediating the opioid receptors such as µ (MOR), δ (DOR), and κ (KOR). This alkaloid has therapeutic potential for pain management as it has limited adverse effect compared to a classical opioid, morphine. Mitragynine is frequently regarded to behave like an opioid but possesses milder withdrawal symptoms. The use of this alkaloid as the source of an analgesic candidate has been proven through comprehensive preclinical and clinical studies. The present data have shown that mitragynine is able to bind to opioid receptors, particularly MOR, to exhibit the analgesic effect. Moreover, the chemical and pharmacological aspects of mitragynine and its diastereomers, speciogynine, speciociliatine, and mitraciliatine, are discussed. It is interesting to know how the difference in stereochemical configuration could lead to the difference in the bioactivity of the respective compounds. Hence, in this review, the updated pharmacological and toxicological properties of mitragynine and its diastereomers are discussed to render a comprehensive understanding of the pharmacological properties of mitragynine and its diastereomers based on their structure–activity relationship study.
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Affiliation(s)
- Thiruventhan Karunakaran
- Centre for Drug Research, Universiti Sains Malaysia, Pulau Pinang, Malaysia
- School of Chemical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
- *Correspondence: Thiruventhan Karunakaran, ; Vivien Yi Mian Jong,
| | - Kok Zhuo Ngew
- Centre for Drug Research, Universiti Sains Malaysia, Pulau Pinang, Malaysia
- School of Chemical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | | | - Vivien Yi Mian Jong
- Centre of Applied Science Studies, Universiti Teknologi MARA, Kuching, Malaysia
- *Correspondence: Thiruventhan Karunakaran, ; Vivien Yi Mian Jong,
| | - Mohamad Hafizi Abu Bakar
- Bioprocess Technology Division, School of Industrial Technology, Universiti Sains Malaysia, Pulau Pinang, Malaysia
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Nukitram J, Cheaha D, Sengnon N, Wungsintaweekul J, Limsuwanchote S, Kumarnsit E. Ameliorative effects of alkaloid extract from Mitragyna speciosa (Korth.) Havil. Leaves on methamphetamine conditioned place preference in mice. JOURNAL OF ETHNOPHARMACOLOGY 2022; 284:114824. [PMID: 34763040 DOI: 10.1016/j.jep.2021.114824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Mitragyna speciosa (Korth.) Havil., popularly known as Kratom (KT), is a medicinal plant used for pain suppression in Southeast Asia. It has been claimed to assist drug users withdraw from methamphetamine (METH) dependence. However, its use was controversial and not approved yet. AIM OF THE STUDY This study was conducted to characterize local field potential (LFP) patterns in the nucleus accumbens (NAc) and the hippocampus (HP) in mice with METH conditioned place preference (CPP) that were treated with KT alkaloid extract. MATERIALS AND METHODS Male Swiss albino ICR mice were implanted with intracraneal electrodes into the NAc and HP. To induce METH CPP, animals were injected intraperitoneally once a day with METH (1 mg/kg) and saline (0.9% w/v) alternately and put into METH/saline compartments to experience the associations between drug/saline injection and the unique environmental contexts for 10 sessions. Control group received saline injection paired with both saline/saline compartments. On post-conditioning day, effects of 40 (KT40), 80 (KT80) mg/kg KT alkaloid extract and 20 mg/kg bupropion (BP) on CPP scores and LFP powers and NAc-HP coherence were tested. RESULTS Two-way ANOVA revealed significant induction of CPP by METH sessions (P < 0.01). Multiple comparisons indicated that METH CPP was completely abolished by KT80 (P < 0.001). NAc gamma I (30.0-44.9 Hz) and HP delta (1.0-3.9 Hz) powers were significantly increased in mice with METH CPP (P < 0.01). The elevated NAc gamma I was significantly suppressed by KT80 (P < 0.05) and the increased HP delta was significantly reversed by KT40 (P < 0.01) and KT80 (P < 0.001). In addition, NAc-HP coherence was also significantly increased in gamma I (30.0-44.9 Hz) frequency range (P < 0.05) but it was reversed by KT80 (P < 0.05). Treatment with BP did not produce significant effect on these parameters. CONCLUSIONS These findings demonstrated that KT alkaloid extract significantly reversed CPP scores and LFP patterns induced by METH administration. The ameliorative effects of the extract might be beneficial for treatment of METH craving and addiction.
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Affiliation(s)
- Jakkrit Nukitram
- Physiology Program, Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla, 90112, Thailand; Biosignal Research Center for Health, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla, 90112, Thailand
| | - Dania Cheaha
- Biology Program, Division of Biological Science, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla, 90112, Thailand; Biosignal Research Center for Health, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla, 90112, Thailand
| | - Narumon Sengnon
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla, 90112, Thailand
| | - Juraithip Wungsintaweekul
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla, 90112, Thailand
| | - Supattra Limsuwanchote
- Pharmacology Program, Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla, 90112, Thailand
| | - Ekkasit Kumarnsit
- Physiology Program, Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla, 90112, Thailand; Biosignal Research Center for Health, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla, 90112, Thailand.
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Henningfield JE, Wang DW, Huestis MA. Kratom Abuse Potential 2021: An Updated Eight Factor Analysis. Front Pharmacol 2022; 12:775073. [PMID: 35197848 PMCID: PMC8860177 DOI: 10.3389/fphar.2021.775073] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/22/2021] [Indexed: 12/30/2022] Open
Abstract
Drugs are regulated in the United States (US) by the Controlled Substances Act (CSA) if assessment of their abuse potential, including public health risks, show such control is warranted. An evaluation via the 8 factors of the CSA provides the comprehensive assessment required for permanent listing of new chemical entities and previously uncontrolled substances. Such an assessment was published for two kratom alkaloids in 2018 that the Food and Drug Administration (FDA) have identified as candidates for CSA listing: mitragynine (MG) and 7-hydroxymitragynine (7-OH-MG) (Henningfield et al., 2018a). That assessment concluded the abuse potential of MG was within the range of many other uncontrolled substances, that there was not evidence of an imminent risk to public health, and that a Schedule I listing (the only option for substances that are not FDA approved for therapeutic use such as kratom) carried public health risks including drug overdoses by people using kratom to abstain from opioids. The purpose of this review is to provide an updated abuse potential assessment reviewing greater than 100 studies published since January 1, 2018. These include studies of abuse potential and physical dependence/withdrawal in animals; in-vitro receptor binding; assessments of potential efficacy treating pain and substance use disorders; pharmacokinetic/pharmacodynamic studies with safety-related findings; clinical studies of long-term users with various physiological endpoints; and surveys of patterns and reasons for use and associated effects including dependence and withdrawal. Findings from these studies suggest that public health is better served by assuring continued access to kratom products by consumers and researchers. Currently, Kratom alkaloids and derivatives are in development as safer and/or more effective medicines for treating pain, substances use disorders, and mood disorders. Placing kratom in the CSA via scheduling would criminalize consumers and possession, seriously impede research, and can be predicted to have serious adverse public health consequences, including potentially thousands of drug overdose deaths. Therefore, CSA listing is not recommended. Regulation to minimize risks of contaminated, adulterated, and inappropriately marketed products is recommended.
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Ahmad I, Prabowo WC, Arifuddin M, Fadraersada J, Indriyanti N, Herman H, Purwoko RY, Nainu F, Rahmadi A, Paramita S, Kuncoro H, Mita N, Narsa AC, Prasetya F, Ibrahim A, Rijai L, Alam G, Mun’im A, Dej-adisai S. Mitragyna Species as Pharmacological Agents: From Abuse to Promising Pharmaceutical Products. Life (Basel) 2022; 12:life12020193. [PMID: 35207481 PMCID: PMC8878704 DOI: 10.3390/life12020193] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/13/2022] [Indexed: 01/07/2023] Open
Abstract
Mitragyna is a genus belonging to the Rubiaceae family and is a plant endemic to Asia and Africa. Traditionally, the plants of this genus were used by local people to treat some diseases from generation to generation. Mitragyna speciosa (Korth.) Havil. is a controversial plant from this genus, known under the trading name “kratom”, and contains more than 40 different types of alkaloids. Mitragynine and 7-hydroxymitragynine have agonist morphine-like effects on opioid receptors. Globally, Mitragyna plants have high economic value. However, regulations regarding the circulation and use of these commodities vary in several countries around the world. This review article aims to comprehensively examine Mitragyna plants (mainly M. speciosa) as potential pharmacological agents by looking at various aspects of the plants. A literature search was performed and information collected using electronic databases including Scopus, ScienceDirect, PubMed, directory open access journal (DOAJ), and Google Scholar in early 2020 to mid-2021. This narrative review highlights some aspects of this genus, including historical background and botanical origins, habitat, cultivation, its use in traditional medicine, phytochemistry, pharmacology and toxicity, abuse and addiction, legal issues, and the potential of Mitragyna species as pharmaceutical products.
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Affiliation(s)
- Islamudin Ahmad
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (M.A.); (J.F.); (N.I.); (N.M.)
- Pharmaceutical Research and Development Laboratory of FARMAKA TROPIS, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (W.C.P.); (H.H.); (H.K.); (A.C.N.); (F.P.); (A.I.); (L.R.)
- Correspondence:
| | - Wisnu Cahyo Prabowo
- Pharmaceutical Research and Development Laboratory of FARMAKA TROPIS, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (W.C.P.); (H.H.); (H.K.); (A.C.N.); (F.P.); (A.I.); (L.R.)
| | - Muhammad Arifuddin
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (M.A.); (J.F.); (N.I.); (N.M.)
| | - Jaka Fadraersada
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (M.A.); (J.F.); (N.I.); (N.M.)
| | - Niken Indriyanti
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (M.A.); (J.F.); (N.I.); (N.M.)
| | - Herman Herman
- Pharmaceutical Research and Development Laboratory of FARMAKA TROPIS, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (W.C.P.); (H.H.); (H.K.); (A.C.N.); (F.P.); (A.I.); (L.R.)
| | | | - Firzan Nainu
- Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia; (F.N.); (G.A.)
| | - Anton Rahmadi
- Department of Agricultural Product Technology, Faculty of Agriculture, Universitas Mulawarman, Samarinda 75119, Indonesia;
| | - Swandari Paramita
- Research Center of Natural Products from Tropical Rainforest (PUI-PT OKTAL), Department of Community Medicine, Faculty of Medicine, Universitas Mulawarman, Samarinda 75119, Indonesia;
| | - Hadi Kuncoro
- Pharmaceutical Research and Development Laboratory of FARMAKA TROPIS, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (W.C.P.); (H.H.); (H.K.); (A.C.N.); (F.P.); (A.I.); (L.R.)
| | - Nur Mita
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (M.A.); (J.F.); (N.I.); (N.M.)
| | - Angga Cipta Narsa
- Pharmaceutical Research and Development Laboratory of FARMAKA TROPIS, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (W.C.P.); (H.H.); (H.K.); (A.C.N.); (F.P.); (A.I.); (L.R.)
| | - Fajar Prasetya
- Pharmaceutical Research and Development Laboratory of FARMAKA TROPIS, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (W.C.P.); (H.H.); (H.K.); (A.C.N.); (F.P.); (A.I.); (L.R.)
| | - Arsyik Ibrahim
- Pharmaceutical Research and Development Laboratory of FARMAKA TROPIS, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (W.C.P.); (H.H.); (H.K.); (A.C.N.); (F.P.); (A.I.); (L.R.)
| | - Laode Rijai
- Pharmaceutical Research and Development Laboratory of FARMAKA TROPIS, Faculty of Pharmacy, Universitas Mulawarman, Samarinda 75119, Indonesia; (W.C.P.); (H.H.); (H.K.); (A.C.N.); (F.P.); (A.I.); (L.R.)
| | - Gemini Alam
- Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia; (F.N.); (G.A.)
| | - Abdul Mun’im
- Laboratory of Pharmacognosy-Phytochemistry, Faculty of Pharmacy, Universitas Indonesia, Depok 16424, Indonesia;
| | - Sukanya Dej-adisai
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat-Yai, Songkhla 90110, Thailand;
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Smith MT, Kong D, Kuo A, Imam MZ, Williams CM. Analgesic Opioid Ligand Discovery Based on Nonmorphinan Scaffolds Derived from Natural Sources. J Med Chem 2022; 65:1612-1661. [PMID: 34995453 DOI: 10.1021/acs.jmedchem.0c01915] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Strong opioid analgesics, including morphine, are the mainstays for treating moderate to severe acute pain and alleviating chronic cancer pain. However, opioid-related adverse effects, including nausea or vomiting, sedation, respiratory depression, constipation, pruritus (itch), analgesic tolerance, and addiction and abuse liability, are problematic. In addition, the use of opioids to relieve chronic noncancer pain is controversial due to the "opioid crisis" characterized by opioid misuse or abuse and escalating unintentional death rates due to respiratory depression. Hence, considerable research internationally has been aimed at the "Holy Grail" of the opioid analgesic field, namely the discovery of novel and safer opioid analgesics with improved opioid-related adverse effects. In this Perspective, medicinal chemistry strategies are addressed, where structurally diverse nonmorphinan-based opioid ligands derived from natural sources were deployed as lead molecules. The current state of play, clinical or experimental status, and novel opioid ligand discovery approaches are elaborated in the context of retaining analgesia with improved safety and reduced adverse effects, especially addiction liability.
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Grundmann O, Veltri CA, Morcos D, Knightes D, Smith KE, Rogers JM. How essential is kratom availability and use during COVID-19? Use pattern analysis based on survey and social media data. Subst Abus 2022; 43:865-877. [PMID: 35179453 PMCID: PMC9808747 DOI: 10.1080/08897077.2021.2007517] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Kratom, a tree native to Southeast Asia, is increasingly used in Western countries for self-treatment of pain, psychiatric disorders, and mitigation of withdrawal symptoms from drugs of abuse. Because kratom is solely supplied from its native locations, supply shortages during the COVID-19 pandemic may impact the availability of preparations and hence force consumers to change their patterns of use. The aim of this study was to understand if and how COVID-19 was influencing kratom purchasing and use. Methods: Additional questions specific to kratom availability and changes in use during COVID-19 were added to an international online survey with responses collected between January and July 2020. During the same period, kratom-related social media posts to Twitter, Reddit, and Bluelight were analyzed for themes similar to the survey questions. Results: The survey results indicated no changes in kratom use patterns although the sample size was relatively small (n = 70) with younger consumers reporting a potential issue in obtaining their desired products from their usual sources. The survey respondents identified primarily as non-Hispanic whites (87.1%). Social media themes revolved primarily around quitting kratom during COVID-19, misinformation about the effects of kratom on COVID-19, and other non-COVID-related discussions. While some consumers may increase their kratom dose because of additional stress, a majority of discussions centered around reducing or rationing kratom due to COVID-19 or a perceived dependence. Access to quality kratom products was also a major discussion topic on social media. Conclusions: Kratom use patterns did not change due to COVID-19 but consumers were concerned about potential product shortages and resulting quality issues. Clinicians and public health officials need to be informed and educated about kratom use as a potential mitigation strategy for substance use disorders and for self-treatment of pain.
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Affiliation(s)
- Oliver Grundmann
- College of Pharmacy, Department of Medicinal Chemistry, University of Florida, FL 32611, USA.,College of Pharmacy, Department of Pharmaceutical Sciences, Midwestern University, Glendale, AZ, 85308, USA
| | - Charles A. Veltri
- College of Pharmacy, Department of Pharmaceutical Sciences, Midwestern University, Glendale, AZ, 85308, USA
| | - Diana Morcos
- College of Pharmacy, Department of Pharmaceutical Sciences, Midwestern University, Glendale, AZ, 85308, USA
| | - David Knightes
- College of Pharmacy, Department of Pharmaceutical Sciences, Midwestern University, Glendale, AZ, 85308, USA
| | - Kirsten E. Smith
- National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd. Baltimore, MD 21224, USA
| | - Jeffery M. Rogers
- National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd. Baltimore, MD 21224, USA
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Mitragynine improves cognitive performance in morphine-withdrawn rats. Psychopharmacology (Berl) 2022; 239:313-325. [PMID: 34693456 DOI: 10.1007/s00213-021-05996-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE The treatment of opiate addiction is an unmet medical need. Repeated exposure to opiates disrupts cognitive performance. Opioid substitution therapy, with, e.g., methadone, may further exacerbate the cognitive deficits. Growing evidence suggests that mitragynine, the primary alkaloid from the Kratom (Mitragyna speciosa) leaves, may serve as a promising alternative therapy for opiate addiction. However, the knowledge of its health consequences is still limited. OBJECTIVES We aimed to examine the cognitive effects of mitragynine substitution in morphine-withdrawn rats. Furthermore, we asked whether neuronal addiction markers like the brain-derived neurotrophic factor (BDNF) and Ca2+/calmodulin-dependent kinase II alpha (αCaMKII) might mediate the observed effects. METHODS Male Sprague-Dawley rats were given morphine at escalating doses before treatment was discontinued to induce a spontaneous morphine withdrawal. Then, vehicle or mitragynine (5 mg/kg, 15 mg/kg, or 30 mg/kg) substitution was given for 3 days. A vehicle-treated group was used as a control. Withdrawal signs were scored after 24 h, 48 h, and 72 h, while novel object recognition (NOR) and attentional set-shifting (ASST) were tested during the substitution period. RESULTS Discontinuation of morphine significantly induced morphine withdrawal signs and cognitive deficit in the ASST. The substitution with mitragynine was able to alleviate the withdrawal signs. Mitragynine did not affect the recognition memory in the NOR but significantly improved the reversal learning deficit in the morphine-withdrawn rats. CONCLUSIONS These data support the idea that mitragynine could be used as safe medication therapy to treat opiate addiction with beneficial effects on cognitive deficits.
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Respiratory effects of oral mitragynine and oxycodone in a rodent model. Psychopharmacology (Berl) 2022; 239:3793-3804. [PMID: 36308562 PMCID: PMC9671979 DOI: 10.1007/s00213-022-06244-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/20/2022] [Indexed: 10/31/2022]
Abstract
RATIONALE Kratom derives from Mitragyna speciosa (Korth.), a tropical tree in the genus Mitragyna (Rubiaceae) that also includes the coffee tree. Kratom leaf powders, tea-like decoctions, and commercial extracts are taken orally, primarily for health and well-being by millions of people globally. Others take kratom to eliminate opioid use for analgesia and manage opioid withdrawal and use disorder. There is debate over the possible respiratory depressant overdose risk of the primary active alkaloid, mitragynine, a partial μ-opioid receptor agonist, that does not signal through ß-arrestin, the primary opioid respiratory depressant pathway. OBJECTIVES Compare the respiratory effects of oral mitragynine to oral oxycodone in rats with the study design previously published by US Food and Drug Administration (FDA) scientists for evaluating the respiratory effects of opioids (Xu et al., Toxicol Rep 7:188-197, 2020). METHODS Blood gases, observable signs, and mitragynine pharmacokinetics were assessed for 12 h after 20, 40, 80, 240, and 400 mg/kg oral mitragynine isolate and 6.75, 60, and 150 mg/kg oral oxycodone hydrochloride. FINDINGS Oxycodone administration produced significant dose-related respiratory depressant effects and pronounced sedation with one death each at 60 and 150 mg/kg. Mitragynine did not yield significant dose-related respiratory depressant or life-threatening effects. Sedative-like effects, milder than produced by oxycodone, were evident at the highest mitragynine dose. Maximum oxycodone and mitragynine plasma concentrations were dose related. CONCLUSIONS Consistent with mitragynine's pharmacology that includes partial µ-opioid receptor agonism with little recruitment of the respiratory depressant activating β-arrestin pathway, mitragynine produced no evidence of respiratory depression at doses many times higher than known to be taken by humans.
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Harun N, Azzalia Kamaruzaman N, Mohamed Sofian Z, Hassan Z. Mini Review: Potential Therapeutic Values of Mitragynine as an Opioid Substitution Therapy. Neurosci Lett 2022; 773:136500. [DOI: 10.1016/j.neulet.2022.136500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/29/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
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Prevete E, Kuypers KPC, Theunissen EL, Corazza O, Bersani G, Ramaekers JG. A systematic review of (pre)clinical studies on the therapeutic potential and safety profile of kratom in humans. Hum Psychopharmacol 2022; 37:e2805. [PMID: 34309900 PMCID: PMC9285932 DOI: 10.1002/hup.2805] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Kratom (Mitragyna speciosa) is a tropical plant traditionally used as an ethnomedicinal remedy for several conditions in South East Asia. Despite the increased interest in its therapeutical benefits in Western countries, little scientific evidence is available to support such claims, and existing data remain limited to kratom's chronic consumption. OBJECTIVE Our study aims to investigate (pre)clinical evidence on the efficacy of kratom as a therapeutic aid and its safety profile in humans. METHODS A systematic literature search using PubMed and the Medline database was conducted between April and November 2020. RESULTS Both preclinical (N = 57) and clinical (N = 18) studies emerged from our search. Preclinical data indicated a therapeutic value in terms of acute/chronic pain (N = 23), morphine/ethanol withdrawal, and dependence (N = 14), among other medical conditions (N = 26). Clinical data included interventional studies (N = 2) reporting reduced pain sensitivity, and observational studies (N = 9) describing the association between kratom's chronic (daily/frequent) use and safety issues, in terms of health consequences (e.g., learning impairment, high cholesterol level, dependence/withdrawal). CONCLUSIONS Although the initial (pre)clinical evidence on kratom's therapeutic potential and its safety profile in humans is encouraging, further validation in large, controlled clinical trials is required.
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Affiliation(s)
- Elisabeth Prevete
- Department of Neuropsychology and PsychopharmacologyFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Kim Paula Colette Kuypers
- Department of Neuropsychology and PsychopharmacologyFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Eef Lien Theunissen
- Department of Neuropsychology and PsychopharmacologyFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Ornella Corazza
- Department of Clinical, Pharmacological and Biological SciencesCollege LaneUniversity of HertfordshireHatfieldUnited Kingdom,Department of Medico‐Surgical Sciences and BiotechnologiesFaculty of Pharmacy and MedicineSapienza University of RomeLatinaItaly
| | - Giuseppe Bersani
- Department of Medico‐Surgical Sciences and BiotechnologiesFaculty of Pharmacy and MedicineSapienza University of RomeLatinaItaly
| | - Johannes Gerardus Ramaekers
- Department of Neuropsychology and PsychopharmacologyFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
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Rogers JM, Smith KE, Schriefer D, Epstein DH. For Better or Worse: Self-reported Changes in Kratom and Other Substance Use as a Result of the COVID-19 Pandemic. Subst Abuse 2022; 16:11782218221123977. [PMID: 36199697 PMCID: PMC9527987 DOI: 10.1177/11782218221123977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/10/2022] [Indexed: 12/01/2022]
Abstract
Background: Kratom is taken to self-treat pain and symptoms of psychiatric disorders, including substance-use disorders (SUDs) and opioid withdrawal. Before COVID-19, kratom use was increasing in the US, however, there are few published data on whether that trend continued during the COVID-19 pandemic, which could have affected kratom use in multiple ways. Aim: To examine COVID-19-related changes in kratom use and how these changes were experienced, relative to changes in other commonly used substances. Methods: Using Amazon Mechanical Turk, 2615 evaluable surveys were completed between September 2020 and March 2021. Responses from past-month and past-year kratom-using adults (N = 174) indicating changes for the better or worse were examined using generalized linear mixed effects models, and relevant open-text responses (n = 85) were thematically coded. Results: For kratom 33% (n = 58) reported a Covid-related increase and 24% (n = 42) reported a Covid-related decrease. Controlling for changes in amount used, alcohol (OR = 5.02), tobacco (OR = 4.72), and nonmedical opioid use (OR = 3.42) were all more likely to have changed for the worse, compared with kratom use. Relative to decreases in kratom use, decreases in alcohol (OR = 3.21) and tobacco (OR = 6.18) use were more likely to be changes for the better. Cannabis use was the only substance to display a probability lower than 50% of being a decrease for the better, and of the increases, cannabis use displayed the highest probability of being for the better. Conclusions: Increases in kratom and cannabis use were less likely than alcohol and tobacco to be reported as changes for the worse, and decreases in kratom and cannabis use were more likely than alcohol and tobacco to be reported as changes for the better. These findings indicate that people differently conceptualize their relationships with kratom and cannabis, compared to their relationships with alcohol and tobacco.
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Affiliation(s)
- Jeffrey M Rogers
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Kirsten E Smith
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Destiny Schriefer
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - David H Epstein
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
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Henningfield JE, Grundmann O, Garcia-Romeu A, Swogger MT. We Need Better Estimates of Kratom Use Prevalence. Am J Prev Med 2022; 62:132-133. [PMID: 34922651 DOI: 10.1016/j.amepre.2021.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jack E Henningfield
- PinneyAssociates, Bethesda, 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, Florida
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marc T Swogger
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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128
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Rogers JM, Smith KE, Strickland JC, Epstein DH. Kratom Use in the US: Both a Regional Phenomenon and a White Middle-Class Phenomenon? Evidence From NSDUH 2019 and an Online Convenience Sample. Front Pharmacol 2021; 12:789075. [PMID: 34987402 PMCID: PMC8721145 DOI: 10.3389/fphar.2021.789075] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/18/2021] [Indexed: 12/02/2022] Open
Abstract
Kratom products available in the United States are becoming increasingly diverse both in terms of content and in terms of how they are marketed. Prior survey research indicates that kratom has been primarily used in the US to self-treat anxiety, depression, pain, fatigue, and substance use disorder (SUD) symptoms. Kratom is also well-known for its use as a short- or long-term full opioid agonist substitute. Therefore, use may be greater in regions particularly impacted by addiction to prescription opioids. Use may also be greater in demographic groups targeted by media outlets (such as specific podcasts) in which kratom is touted. Here, we aimed to determine whether lifetime and past-year kratom use were associated with region of residence and with being young, White, post-secondary educated, and employed. To strengthen confidence in our findings, we analyzed data from two sources: our own crowdsourced online convenience sample and the 2019 National Survey on Drug Use and Health (NSDUH). In our sample (N = 2,615), 11.1% reported lifetime and 6.7% reported past-year kratom use, and the odds of kratom use were higher among people who were White, younger, at least high school educated, employed, and above the poverty line, as well as those reporting nonmedical opioid use, past-year SUD, or lifetime SUD treatment; residence was not a significant predictor. In NSDUH data, suburban residence and other demographic factors, concordant with those from the crowdsourced sample, were associated with kratom use. Taken together, the findings support a general "White middle-class suburban" profile of the modal kratom user, but more research is needed to understand it. In the interim, focus should be on our finding that lifetime nonmedical opioid use was associated with an up to five times greater likelihood of past-year kratom use, suggesting that drug-use history may presently be the strongest predictor of kratom use.
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Affiliation(s)
- Jeffrey M. Rogers
- Real-world Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States
| | - Kirsten E. Smith
- Real-world Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States
| | - Justin C. Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 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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129
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Hiranita T, Obeng S, Sharma A, Wilkerson JL, McCurdy CR, McMahon LR. In vitro and in vivo pharmacology of kratom. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2021; 93:35-76. [PMID: 35341571 DOI: 10.1016/bs.apha.2021.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Kratom products have been historically and anecdotally used in south Asian countries for centuries to manage pain and opioid withdrawal. The use of kratom products has dramatically increased in the United States. More than 45 kratom alkaloids have been isolated, yet the overall pharmacology of the individual alkaloids is still not well characterized. The purpose of this chapter is to summarize in vitro and in vivo opioid activities of the primary kratom alkaloid mitragynine and its more potent metabolite 7-hydroxymitragynine. Following are experimental procedures described to characterize opioid receptor activity; receptor binding and functional assays, antinociceptive assays, operant conditioning assays, and respiratory plethysmography. The capacity of kratom alkaloids to confer tolerance and physical dependence as well as their pharmacokinetic properties are also summarized. The data reviewed here suggest that kratom products and mitragynine possess low efficacy agonist activity at the mu-opioid receptor in vivo. In addition, kratom products and mitragynine have been demonstrated to antagonize the effects of high efficacy mu-opioid agonists. The data further suggest that 7-hydroxymitragynine formed in vivo by metabolism of mitragynine may be minimally involved in the overall behavioral profile of mitragynine and kratom, whereas 7-hydroxymitragynine itself, at sufficiently high doses administered exogenously, shares many of the same abuse- and dependence-related behavioral effects associated with traditional opioid agonists. The apparent low efficacy of kratom products and mitragynine at mu-opioid receptors supports the development of these ligands as effective and potentially safe medications for opioid use disorder.
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Affiliation(s)
- Takato Hiranita
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Samuel Obeng
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, United States; Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Abhisheak Sharma
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, United States; Translational Drug Development Core, Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Jenny L Wilkerson
- Department of Pharmacodynamics, 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; Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, United States; Translational Drug Development Core, Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Lance R McMahon
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, United States.
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130
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Akbarialiabad H, Taghrir MH, Abdollahi A, Ghahramani N, Kumar M, Paydar S, Razani B, Mwangi J, Asadi-Pooya AA, Malekmakan L, Bastani B. Long COVID, a comprehensive systematic scoping review. Infection 2021; 49:1163-1186. [PMID: 34319569 PMCID: PMC8317481 DOI: 10.1007/s15010-021-01666-x] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/10/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To find out what is known from literature about Long COVID until January 30, 2021. METHODS We undertook a four-step search with no language restriction. A preliminary search was made to identify the keywords. A search strategy of all electronic databases resulted in 66 eligible studies. A forward and backward search of the references and citations resulted in additional 54 publications. Non-English language articles were translated using Google Translate. We conducted our scoping review based on the PRISMA-ScR Checklist. RESULTS Of 120 papers, we found only one randomized clinical trial. Of the 67 original studies, 22 were cohort, and 28 were cross-sectional studies. Of the total 120 publications, 49.1% focused on signs and symptoms, 23.3% on management, and 10.8% on pathophysiology. Ten publications focused on imaging studies. The results are also presented extensively in a narrative synthesis in separated sections (nomenclature, diagnosis, pathophysiology, risk factors, signs/symptoms, management). CONCLUSIONS The controversies in its definition have impaired proper recognition and management. The predominant symptoms were: fatigue, breathlessness, arthralgia, sleep difficulties, and chest pain. Recent reports also point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness.
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Affiliation(s)
- Hossein Akbarialiabad
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Taghrir
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Abdollahi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA, 17033, USA
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Razani
- Cardiology Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
- John Cochran Division, Veterans Affairs St. Louis Healthcare System, St. Louis, MO, 63106, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - John Mwangi
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahar Bastani
- Professor of Medicine-Nephrology, Saint Louis University School of Medicine, Saint Louis, MO, USA.
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131
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Chakraborty S, Uprety R, Slocum ST, Irie T, Le Rouzic V, Li X, Wilson LL, Scouller B, Alder AF, Kruegel AC, Ansonoff M, Varadi A, Eans SO, Hunkele A, Allaoa A, Kalra S, Xu J, Pan YX, Pintar J, Kivell BM, Pasternak GW, Cameron MD, McLaughlin JP, Sames D, Majumdar S. Oxidative Metabolism as a Modulator of Kratom's Biological Actions. J Med Chem 2021; 64:16553-16572. [PMID: 34783240 DOI: 10.1021/acs.jmedchem.1c01111] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The leaves of Mitragyna speciosa (kratom), a plant native to Southeast Asia, are increasingly used as a pain reliever and for attenuation of opioid withdrawal symptoms. Using the tools of natural products chemistry, chemical synthesis, and pharmacology, we provide a detailed in vitro and in vivo pharmacological characterization of the alkaloids in kratom. We report that metabolism of kratom's major alkaloid, mitragynine, in mice leads to formation of (a) a potent mu opioid receptor agonist antinociceptive agent, 7-hydroxymitragynine, through a CYP3A-mediated pathway, which exhibits reinforcing properties, inhibition of gastrointestinal (GI) transit and reduced hyperlocomotion, (b) a multifunctional mu agonist/delta-kappa antagonist, mitragynine pseudoindoxyl, through a CYP3A-mediated skeletal rearrangement, displaying reduced hyperlocomotion, inhibition of GI transit and reinforcing properties, and (c) a potentially toxic metabolite, 3-dehydromitragynine, through a non-CYP oxidation pathway. Our results indicate that the oxidative metabolism of the mitragynine template beyond 7-hydroxymitragynine may have implications in its overall pharmacology in vivo.
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Affiliation(s)
- Soumen Chakraborty
- Center for Clinical Pharmacology, University of Health Sciences & Pharmacy and Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Rajendra Uprety
- Department of Neurology and Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York 10065, United States
| | - Samuel T Slocum
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Takeshi Irie
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York 10065, United States
| | - Valerie Le Rouzic
- Department of Neurology and Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York 10065, United States
| | - Xiaohai Li
- Department of Molecular Therapeutics, Scripps Research Institute, Jupiter, Florida 33458, United States
| | - Lisa L Wilson
- Department of Pharmacodynamics, University of Florida, Gainesville, Florida 32610, United States
| | - Brittany Scouller
- Centre for Biodiscovery, School of Biological Science, Victoria University of Wellington, Wellington 6012, New Zealand
| | - Amy F Alder
- Centre for Biodiscovery, School of Biological Science, Victoria University of Wellington, Wellington 6012, New Zealand
| | - Andrew C Kruegel
- Department of Chemistry, Columbia University, New York 10027, United States
| | - Michael Ansonoff
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey 08854-8021, United States
| | - Andras Varadi
- Department of Neurology and Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York 10065, United States
| | - Shainnel O Eans
- Department of Pharmacodynamics, University of Florida, Gainesville, Florida 32610, United States
| | - Amanda Hunkele
- Department of Neurology and Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York 10065, United States
| | - Abdullah Allaoa
- Department of Neurology and Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York 10065, United States
| | - Sanjay Kalra
- Department of Neurology and Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York 10065, United States
| | - Jin Xu
- Department of Neurology and Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York 10065, United States
| | - Ying Xian Pan
- Department of Neurology and Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York 10065, United States
| | - John Pintar
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey 08854-8021, United States
| | - Bronwyn M Kivell
- Centre for Biodiscovery, School of Biological Science, Victoria University of Wellington, Wellington 6012, New Zealand
| | - Gavril W Pasternak
- Department of Neurology and Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York 10065, United States
| | - Michael D Cameron
- Department of Molecular Therapeutics, Scripps Research Institute, Jupiter, Florida 33458, United States
| | - Jay P McLaughlin
- Department of Pharmacodynamics, University of Florida, Gainesville, Florida 32610, United States
| | - Dalibor Sames
- Department of Chemistry, Columbia University, New York 10027, United States
| | - Susruta Majumdar
- Center for Clinical Pharmacology, University of Health Sciences & Pharmacy and Washington University School of Medicine, St. Louis, Missouri 63110, United States
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132
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Hartley C, Bulloch M, Penzak SR. Clinical Pharmacology of the Dietary Supplement, Kratom (Mitragyna speciosa). J Clin Pharmacol 2021; 62:577-593. [PMID: 34775626 DOI: 10.1002/jcph.2001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022]
Abstract
Kratom (Mitragyna speciosa) consists of over 40 alkaloids with two of them, mitragynine (MG) and 7-OH-mitragynine (7-OH-MG) being the main psychoactive compounds. MG and 7-OH-MG each target opioid receptors and have been referred to as atypical opioids. They exert their pharmacologic effects on the μ, δ, and κ opioid receptors. In addition, they affect adrenergic, serotonergic, and dopaminergic pathways. Kratom has been touted as an inexpensive, legal alternative to standard opioid replacement therapy such as methadone and buprenorphine. Other uses for kratom include chronic pain, attaining a "legal high," and numerous CNS disorders including anxiety depression and post-traumatic stress disorder (PTSD). Kratom induces analgesia and mild euphoria with a lower risk of respiratory depression or adverse central nervous system effects compared to traditional opioid medications. Nonetheless, kratom has been associated with both physical and psychological dependence with some individuals experiencing classic opioid withdrawal symptoms upon abrupt cessation. Kratom use has been linked to serious adverse effects including liver toxicity, seizures, and death. These risks are often compounded by poly-substance abuse. Further, kratom may potentiate the toxicity of coadministered medications through modulation of cytochrome P450, P-glycoprotein, and uridine diphosphate glucuronosyltransferase enzymes (UGDT). In 2016 the U.S. Drug Enforcement Administration (DEA) took steps to classify kratom as a federal schedule 1 medication; however, due to public resistance, this plan was set aside. Until studies are conducted that define kratom's role in treating opioid withdrawal and/or other CNS conditions, kratom will likely remain available as a dietary supplement for the foreseeable future. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Chad Hartley
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, 36849, United States
| | - Marilyn Bulloch
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, 36849, United States
| | - Scott R Penzak
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, 36849, United States
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133
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Yusoff NHM, Hassan Z, Murugaiyah V, Müller CP. The effect of mitragynine on extracellular activity of brain dopamine and its metabolites. Brain Res Bull 2021; 178:1-8. [PMID: 34774992 DOI: 10.1016/j.brainresbull.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
Kratom, derived from the plant Mitragyna speciosa (M. speciosa) Korth is a traditional psychoactive preparation widely used in Southeast Asia and increasingly in the rest of the world. Use and abuse of Kratom preparations can be attributed to mitragynine (MIT), the main psychoactive compound isolated from its leaves. While MIT may have beneficial effects as a recreational drug, for pain management, and for opiate withdrawal, it may have an addiction potential at higher doses. However, its action in the reward system of the brain is currently unknown. This study investigated how mitragynine (10 mg/kg, i.p.) affects extracellular activity of dopamine (DA) and its metabolites, 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in the prefrontal cortex (PFC), nucleus accumbens (NAc) and caudate putamen (CPu) of the brain, compared to morphine (MOR; 10 mg/kg, i.p.) and methamphetamine (METH; 10 mg/kg, i.p.). Using in-vivo microdialysis in freely moving rats, we found a significant increase of extracellular DA after MOR and METH, but not after MIT in all three brain regions. MIT led to a significant increase of DOPAC and/or HVA in these brain regions while MOR and METH had only moderate effects. These findings suggest a strong and prolonged effect of MIT on DA synthesis/metabolism, but not on extracellular DA activity, which may limit the addiction risk of MIT, in contrast to MOR and METH.
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Affiliation(s)
- Nurul H M Yusoff
- Centre for Drug Research, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
| | - Zurina Hassan
- Centre for Drug Research, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.
| | - Vikneswaran Murugaiyah
- Discipline of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
| | - Christian P Müller
- Centre for Drug Research, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia; Section of Addiction Medicine, Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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134
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Jasim RK, Hassan Z, Singh D, Boyer E, Gam LH. Characterization of urinary protein profile in regular kratom ( Mitragyna speciosa korth.) users in Malaysia. J Addict Dis 2021; 40:235-246. [PMID: 34747343 DOI: 10.1080/10550887.2021.1981122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mitragyna speciosa (Korth.) also known as kratom or ketum has been traditionally used for its diverse medicinal value in Southeast Asia. Despite of its therapeutic value, kratom's safety profile remains deficiently elucidated. Our study aims to characterize the urinary protein profile of regular kratom users to determine its toxic effects on renal functioning. A total of 171 respondents (comprising of n = 88 regular kratom users, and n = 83 healthy controls) were recruited for this study. Urine specimens were collected and analyzed using SDS-PAGE, followed by LC/MS/MS analysis. Our results show albumin is the primary, and most abundant form of protein excreted in kratom user's urine specimens (n = 60/64), indicating that kratom users are predisposed to proteinuria. Kratom users had an elevated urinary protein (with an intensity of 66.7 kDa band), and protein: creatinine ratio (PCR) concentrations relative to healthy controls. However, kratom user's urinary creatinine concentration was found to be in the normal range as the healthy control group. While, kratom users who tested positive for illicit drug use had an elevated urinary albumin concentration. Our preliminary findings indicate that regular consumption of freshly brewed kratom solution over a protracted period (for an average of eleven years) seems to induce proteinuria, suggestive of an early stage of kidney injury. Hence, further studies are urgently needed to confirm our findings, and establish kratom's renal impairing effects.
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Affiliation(s)
- Rana Khudhair Jasim
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Zurina Hassan
- Centre of Drug Research, Universiti Sains Malaysia, Penang, Malaysia
| | - Darshan Singh
- Centre of Drug Research, Universiti Sains Malaysia, Penang, Malaysia
| | - Edward Boyer
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lay-Harn Gam
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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135
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Amin HS, Irfan F, Karim SI, Almeshari SM, Aldosari KA, Alzahrani AM, Almogbel AT, Alfouzan SM, Alsaif AA. The prevalence of irritable bowel syndrome among Saudi population in Riyadh by use of Rome IV criteria and self-reported dietary restriction. Saudi J Gastroenterol 2021; 27:383-390. [PMID: 34747875 PMCID: PMC8656325 DOI: 10.4103/sjg.sjg_43_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/05/2021] [Accepted: 08/14/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorder. Diet may play a role in triggering the symptoms. We aimed to measure the prevalence of IBS and its types, and its association with food restrictions among the Saudi population, using the Rome IV criteria. METHODS A cross-sectional study was conducted in the outpatient clinics of three major hospitals in Riyadh in conjunction with an electronic survey which was shared on social media. A total of 1,319 subjects (706 males and 613 females) completed a questionnaire of four domains (sociodemography, Rome IV, food restriction, and herbs) between Nov 2019 and February 2020. Convenience sampling was used. RESULTS IBS was diagnosed in 104 subjects (7.9%) and, of these, 52% were IBS-M (mixed) type. The prevalence was higher in women than in men (4.9% vs. 3.0%; P = 0.006). A significant association was found between the presence of IBS symptoms and low income (P = 0.010), and not working (P < 0.0001). Most of the IBS patients showed food restriction related to milk (P < 0.0001) and legumes (P = 0.0029), besides other types of food and drinks. CONCLUSIONS IBS is less common among the Saudi population. A female gender, low family income, and working status, have the highest association with IBS. The foods most often restricted were legumes and milk. Future community studies may present an opportunity to relate with cultural differences and food preferences.
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Affiliation(s)
- Hussein S. Amin
- Department of Family and Community Medicine, Member of Chair of Medical Education Research and Development, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Farhana Irfan
- Department of Family and Community Medicine, Member of Chair of Medical Education Research and Development, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Syed I. Karim
- Department of Family and Community Medicine, Member of Chair of Medical Education Research and Development, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | | | | - Anas A. Alsaif
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Pentylenetetrazol-like stimulus is not produced following naloxone-precipitated mitragynine withdrawal in rats. Psychopharmacology (Berl) 2021; 238:3183-3191. [PMID: 34333672 DOI: 10.1007/s00213-021-05934-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/08/2021] [Indexed: 01/22/2023]
Abstract
RATIONALE Kratom (Mitragyna speciosa Korth), a native medicinal plant of Southeast Asia, is proposed to exhibit potential therapeutic value as an opioid substitute. However, studies of its negative emotional states resulting from withdrawal particularly of its main psychoactive compound, mitragynine (MG), are limited. OBJECTIVES Using the pentylenetetrazol (PTZ) discrimination assay, this study aims to investigate the effects of MG in responding to the PTZ stimulus and to assess the generalisation effects of withdrawal from MG to the PTZ stimulus. METHODS Rats (n = 20) were trained on a tandem (FR-10, VI-15) schedule of food reinforcement to press one lever after administration of the anxiogenic compound PTZ (16 mg/kg, i.p.) and an alternate lever after vehicle. Following acute tests, training was suspended, and rats were chronically treated with MG or morphine at 8-h intervals for 9 days and withdrawal was precipitated on the tenth day using naloxone (1 mg/kg, i.p.). The rats were tested for generalisation to PTZ at 2, 8 and 24 h after the last dose of MG or morphine administration. RESULTS Unlike morphine that produced dose-related PTZ-like stimulus, MG at 3, 10, 30 and 45 mg/kg doses showed no substitution to the PTZ discriminative stimulus. In contrast to morphine which produced a time-dependent generalisation to the PTZ stimulus, naloxone did not precipitate withdrawal effects in MG-treated rats as they selected the vehicle lever at three withdrawal time points. CONCLUSION These results demonstrate that MG produces a very different response to morphine withdrawal that is not associated with anxiogenic-like subjective symptoms. These characteristics of MG may provide further support for use as a novel pharmacotherapeutic intervention for managing opioid use disorder.
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137
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Effendy MA, Yunusa S, Zain ZM, Hassan Z. Real time monitoring of dopamine release evoked by mitragynine (Kratom): An insight through electrochemical sensor. Neurosci Lett 2021; 763:136183. [PMID: 34418508 DOI: 10.1016/j.neulet.2021.136183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mitragynine, the major indole alkaloid from Mitragyna speciosa has been reported previously to possess abuse liability. However, there are insufficient data suggesting the mechanism through which this pharmacological agent causes addiction. AIMS In this study, we investigated the effects of mitragynine on dopamine (DA) level and dopamine transporter (DAT) expression from the rat's frontal cortex. METHODS DA level was recorded in the brain samples of animals treated with acute or repeated exposure for 4 consecutive days with either vehicle or mitragynine (1 and 30 mg/kg) using electrochemical sensor. Animals were then decapitated and the brain regions were removed, snap-frozen in liquid nitrogen and immediately stored at -80 °C. DA level was quantified using Enzyme linked immunosorbent assay (ELISA) kits and DAT gene expression was determined using quantitative real time polymerase chain reaction (RT-qPCR). RESULTS/OUTCOME Mitragynine (1 and 30 mg/kg) did not increase DA release following acute treatment, however, after repeated exposure at day 4, mitragynine significantly and dose dependently increased DA release in the frontal cortex. In this study, we also observed a significant increase in DAT mRNA expression at day 4 in group treated with mitragynine (30 mg/kg). CONCLUSION/INTERPRETATION Data from this study indicates that mitragynine significantly increased DA release when administered repeatedly, increased in DAT mRNA expression with the highest tested dose (30 mg/kg). Therefore, the rewarding effects observed after mitragynine administration could be due to its ability to increase DA content in certain areas of the brain especially the frontal cortex.
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Affiliation(s)
| | - Suleiman Yunusa
- Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, Malaysia; Department of Pharmacology, Bauchi State University Gadau, PMB 65, Bauchi State, Nigeria
| | - Zainiharyati M Zain
- Electrochemical Material and Sensor Laboratory, Faculty of Applied Sciences, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia.
| | - Zurina Hassan
- Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, Malaysia.
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138
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Leong Bin Abdullah MFI, Singh D. The Adverse Cardiovascular Effects and Cardiotoxicity of Kratom ( Mitragyna speciosa Korth.): A Comprehensive Review. Front Pharmacol 2021; 12:726003. [PMID: 34646135 PMCID: PMC8504575 DOI: 10.3389/fphar.2021.726003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Kratom or Mitragyna speciosa (Korth.) has received overwhelming attention recently due to its alleged pain-relieving effects. Despite its potential therapeutic value, kratom use has been linked to many occurrences of multiorgan toxicity and cardiotoxicity. Accordingly, the current narrative review aimed to provide a detailed account of kratom's adverse cardiovascular effects and cardiotoxicity risk, based on in vitro studies, poison center reports, coroner and autopsy reports, clinical case reports, and clinical studies. Methods: An electronic search was conducted to identify all research articles published in English from 1950 to 2021 using the major research databases, such as Google Scholar, Web of Science, PubMed, Scopus, Mendeley, EMBASE, Cochrane Library, and Medline. We then analyzed the literature's discussion of adverse cardiovascular effects, toxicity, and mortality related to kratom use. Results: Our findings revealed that, although in vitro studies have found kratom preparations' most abundant alkaloid-mitragynine-to cause a prolonged QTc interval and an increased risk of torsades de pointes, a clinical study examining humans' regular consumption of kratom did not report such a risk. However, this latter study did show that regular kratom use could induce an increased QTc interval in a dose-dependent manner. A few case reports also highlighted that kratom consumption is associated with ventricular arrhythmia and cardiopulmonary arrest, but this association could have ensued when kratom was co-administered with another substance. Similarly, analyses of national poison data showed that kratom's most common adverse acute cardiovascular effects include tachycardia and hypertension. Meanwhile, coroner and autopsy reports indicated that kratom's cardiovascular sequelae encompass coronary atherosclerosis, myocardial infarction, hypertensive cardiovascular disease, left ventricular hypertrophy, cardiac arrhythmia, cardiomegaly, cardiomyopathy, focal band necrosis in the myocardium, and myocarditis. Given the available data, we deduced that all cardiac eventualities reported in the literature could have been compounded by polysubstance use and unresolved underlying medical illnesses. Conclusion: Although kratom use has been associated with death and cardiotoxicity, especially at higher doses and when associated with other psychoactive drugs, the dearth of data and methodological limitations reported in existing studies do not allow a definitive conclusion, and further studies are still necessary to address this issue.
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Affiliation(s)
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Gelugor, Malaysia
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139
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Woo SM, Davis WD, Aggarwal S, Clinton JW, Kiparizoska S, Lewis JH. Herbal and dietary supplement induced liver injury: Highlights from the recent literature. World J Hepatol 2021; 13:1019-1041. [PMID: 34630872 PMCID: PMC8473494 DOI: 10.4254/wjh.v13.i9.1019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/08/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
Herbal-induced liver injury (HILI) is an important and increasingly concerning cause of liver toxicity, and this study presents recent updates to the literature. An extensive literature review was conducted encompassing September 2019 through March 2021. Studies with clinically significant findings were analyzed and included in this review. We emphasized those studies that provided a causality assessment methodology, such as Roussel Uclaf Causality Assessment Method scores. Our review includes reports of individual herbals, including Garcinia cambogia, green tea extract, kratom as well as classes such as performance enhancing supplements, Traditional Chinese medicine, Ayurvedic medicine and herbal contamination. Newly described herbals include ashwagandha, boldo, skyfruit, and 'Thermo gun'. Several studies discussing data from national registries, including the United States Drug-Induced Liver Injury (DILI) Network, Spanish DILI Registry, and Latin American DILI Network were incorporated. There has also been a continued interest in hepatoprotection, with promising use of herbals to counter hepatotoxicity from anti-tubercular medications. We also elucidated the current legal conversation surrounding use of herbals by presenting updates from the Federal Drug Administration. The highlights of the literature over the past year indicate interest in HILI that will continue as the supplement industry in the United States grows.
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Affiliation(s)
- Stephanie M Woo
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States.
| | - William D Davis
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Soorya Aggarwal
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Joseph W Clinton
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Sara Kiparizoska
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - James H Lewis
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
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140
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León F, Obeng S, Mottinelli M, Chen Y, King TI, Berthold EC, Kamble SH, Restrepo LF, Patel A, Gamez-Jimenez LR, Lopera-Londoño C, Hiranita T, Sharma A, Hampson AJ, Canal CE, McMahon LR, McCurdy CR. Activity of Mitragyna speciosa ("Kratom") Alkaloids at Serotonin Receptors. J Med Chem 2021; 64:13510-13523. [PMID: 34467758 PMCID: PMC9235362 DOI: 10.1021/acs.jmedchem.1c00726] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Kratom alkaloids have mostly been evaluated for their opioid activity but less at other targets that could contribute to their physiological effects. Here, we investigated the in vitro and in vivo activity of kratom alkaloids at serotonin receptors (5-HTRs). Paynantheine and speciogynine exhibited high affinity for 5-HT1ARs and 5-HT2BRs, unlike the principal kratom alkaloid mitragynine. Both alkaloids produced antinociceptive properties in rats via an opioid receptor-independent mechanism, and neither activated 5-HT2BRs in vitro. Paynantheine, speciogynine, and mitragynine induced lower lip retraction and antinociception in rats, effects blocked by a selective 5-HT1AR antagonist. In vitro functional assays revealed that the in vivo 5-HT1AR agonistic effects may be due to the metabolites 9-O-desmethylspeciogynine and 9-O-desmethylpaynantheine and not the parent compounds. Both metabolites did not activate 5-HT2BR, suggesting low inherent risk of causing valvulopathy. The 5-HT1AR agonism by kratom alkaloids may contribute to the mood-enhancing effects associated with kratom use.
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Affiliation(s)
- Francisco León
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina 29208, United States
| | - Samuel Obeng
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
| | - Marco Mottinelli
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
| | - Yiming Chen
- Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University, Atlanta, Georgia 30341, United States
| | - Tamara I King
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
- Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, Florida 32610, United States
| | - Erin C Berthold
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
- Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, Florida 32610, United States
| | - Shyam H Kamble
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
- Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, Florida 32610, United States
| | - Luis F Restrepo
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
| | - Avi Patel
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
| | - Lea R Gamez-Jimenez
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
| | - Carolina Lopera-Londoño
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
| | - Takato Hiranita
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
| | - Abhisheak Sharma
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
- Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, Florida 32610, United States
| | - Aidan J Hampson
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Clinton E Canal
- Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University, Atlanta, Georgia 30341, United States
| | - Lance R McMahon
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
| | - Christopher R McCurdy
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
- Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, Florida 32610, United States
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141
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di Michele F. Why use nutraceutical strategies for the Irritable Bowel Syndrome. Curr Med Chem 2021; 29:2075-2092. [PMID: 34533437 DOI: 10.2174/0929867328666210917115255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/30/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022]
Abstract
Irritable bowel syndrome (IBS) is a chronic functional bowel disorder, often stress-related, identified by many abdominal symptoms, the most important of which is the chronic visceral abdominal pain. Therefore, IBS commonly impairs the quality of life of patients, moreover it is frequently linked to depressive and anxiety symptoms. The treatment of IBS primarily focuses on symptoms relief. Unfortunately, up to now, no efficacious therapies have been found. Therefore, it would be important to develop new anti-IBS interventions. The aim of this brief review is to summarize the current evidence of nutraceutical supplementation in IBS treatment, with probiotics, prebiotics, synbiotics, butyrate, palmitoylethanolamide and colostrum. Since nutraceutics are over the counter products, the review has the purpose to better inform the medicinal chemist and the practitioner about the possible benefit mechanisms and the many advantages that these therapies offer. All of these compounds present multiple mechanisms of action, such as restoring the physiological microbiota, potentiating gastrointestinal barrier's function, immunomodulatory, anti-inflammatory and antinociceptive activities. From the literature data it results that these compounds are not only capable to improve IBS symptomatology, but mainly display an optimal safety and tolerability profile. Although extensive studies must be carried out to reinforce the evidences from the so far limited clinical trials, the supplementation with these compounds may be useful considering the warnings of prescription medicines for special populations of patients, such as elders, youngsters, or patients who need a combination therapy. Finally, the nutraceutical approach may improve adherence to treatment, given its better acceptance by the patients compared to pharmacological therapy.
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Affiliation(s)
- Flavia di Michele
- Dept Systems Medicine, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy
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142
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Prozialeck WC, Lamar PC, Krupp M, Moon M, Phelps LE, Grundmann O. Kratom Use Within the Context of the Evolving Opioid Crisis and the COVID-19 Pandemic in the United States. Front Pharmacol 2021; 12:729220. [PMID: 34512353 PMCID: PMC8427750 DOI: 10.3389/fphar.2021.729220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 12/18/2022] Open
Abstract
Kratom (Mitragyna speciosa, Korth.) is an evergreen tree that is indigenous to Southeast Asia. When ingested, kratom leaves or decoctions from the leaves have been reported to produce complex stimulant and opioid-like effects. For generations, native populations in Southeast Asia have used kratom products to stave off fatigue, improve mood, alleviate pain and manage symptoms of opioid withdrawal. Despite the long history of kratom use in Asia, it is only within the past 10-20 years that kratom has emerged as an important herbal agent in the United States, where it is being used for the self-treatment of pain, opioid withdrawal symptoms, and mood disorders. The increase in the use of kratom in the United States has coincided with the serious epidemic of opioid abuse and dependence. Since 2015, efforts to restrict access to prescription opioids have resulted in a marked increase in the use of "street" opioids such as heroin and illicit fentanyl. At the same time, many patients with chronic pain conditions or opioid use disorder have been denied access to appropriate medical help. The lack of access to care for patients with chronic pain and opioid use disorder has been magnified by the emergence of the COVID-19 pandemic. In this report, we highlight how these converging factors have led to a surge in interest in kratom as a potential harm reduction agent in the treatment of pain and opioid use disorder.
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Affiliation(s)
- Walter C Prozialeck
- Department of Pharmacology, Midwestern University, Downers Grove, IL, United States
| | - Peter C Lamar
- Department of Pharmacology, Midwestern University, Downers Grove, IL, United States
| | - Michael Krupp
- Department of Pharmacology, Midwestern University, Downers Grove, IL, United States
| | - Matthew Moon
- Department of Pharmacology, Midwestern University, Downers Grove, IL, United States
| | - Laura E Phelps
- Department of Pharmacology, Midwestern University, Downers Grove, IL, United States
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United States
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143
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Abstract
Consumption of herbal supplements has been linked to multiorgan toxicities. Kratom is an herbal extract that has gained popularity for its analgesic and psychotropic properties. Several cases of kratom-induced liver injury have been reported, but data on multiorgan involvement remain scarce. We present the case of a 37-year-old woman who developed a mixed hepatocellular and cholestatic pattern of acute liver injury, acute kidney injury, and pancolitis after prolonged use of kratom-containing herbal supplements.
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144
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Smith KE, Rogers JM, Schriefer D, Grundmann O. Therapeutic benefit with caveats?: Analyzing social media data to understand the complexities of kratom use. Drug Alcohol Depend 2021; 226:108879. [PMID: 34216869 PMCID: PMC8355181 DOI: 10.1016/j.drugalcdep.2021.108879] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/11/2021] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mitragyna speciosa, referred to as "kratom", is increasingly used in the United States for self-treating pain, psychiatric, and substance use disorder symptoms. It is used by some to attenuate opioid withdrawal and as a longer-term drug substitute. Most self-report data have come from online surveys, small in-person surveys, and case reports. These may not be representative of the broader kratom-using population. PURPOSE Analyze user-generated social media posts to determine if independent, descriptive accounts are generally consistent with prior U.S. kratom survey findings and gain a more nuanced understanding of kratom use patterns. METHODS Reddit posts mentioning kratom from 42 subreddits between June 2019-July 2020 were coded by two independent raters. FINDINGS Relevant posts (number of comments, upvotes, and downvotes) from 1274 posts comprised the final sample (n = 280). Of the 1521 codes applied, 1273 (83.69%) were concordant. Desirable kratom effects were described among a majority, but so too were adverse effects. Reports of kratom as acute self-treatment for opioid withdrawal were more prominent compared to longer-term opioid substitution. Quantitative analysis found higher kratom doses associated (p < .001) with greater odds of reported kratom addiction (OR = 3.56) or withdrawal (OR = 5.88), with slightly lower odds of desirable effects (OR = 0.53, p = .014). Despite perceived therapeutic benefits, kratom was characterized by some in terms of addiction that, in some cases, appeared dose-dependent. Polydrug use was also prominently discussed. CONCLUSIONS Results validated many prior survey findings while illustrating complexities of kratom use that are not being fully captured and require continued investigation.
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Affiliation(s)
- Kirsten E Smith
- National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd., Baltimore, MD 21224, USA.
| | - Jeffrey M Rogers
- National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd., Baltimore, MD 21224, USA
| | - Destiny Schriefer
- National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd., Baltimore, MD 21224, USA
| | - Oliver Grundmann
- College of Pharmacy, Department of Medicinal Chemistry, University of Florida, FL 32610, USA
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145
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Lynch E, Troob J, Lebwohl B, Freedberg DE. Who uses probiotics and why? A survey study conducted among general gastroenterology patients. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000742. [PMID: 34446439 PMCID: PMC8395278 DOI: 10.1136/bmjgast-2021-000742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background The rapid growth of the probiotic industry suggests patients will continue to seek advice from gastroenterologists about probiotics. To best address patient questions and concerns, we must first understand who uses probiotics and why. Methods This was a cross-sectional study conducted in the endoscopy suite of an academic hospital from June to October of 2019. Surveys were anonymous and contained a combination of multiple choice, free text and Likert scale questions. Participants privately completed a paper survey in English or Spanish and the results were reviewed with them by study personnel to clarify responses. Descriptive statistics were generated and multivariable logistic regression modelling was used to compare characteristics of probiotic users versus non-users. Results During the 5-month study period, 600 patients were approached and 537 (90%) agreed to participate. Among participants, 89% completed at least 24 survey items and were included in the analysis. Overall, 27% of patients reported probiotic use. Bloating, rather than diarrhoea, was the main gastrointestinal symptom associated with use of probiotics (aOR 2.59, 95% CI 1.52 to 4.44 for bloating; aOR 1.03, 95% CI 0.55 to 1.94 for diarrhoea). Frequent reasons cited for taking probiotics were the beliefs that they improved overall health and longevity (54%) and that they improved gastrointestinal symptoms (45%). Conclusions Probiotic use is common among general gastroenterology patients, many of whom believe that probiotics confer general rather than specific gastrointestinal health benefits. Symptoms—especially bloating—and not sociodemographic factors seem to motivate probiotic use. By understanding patient expectations for probiotics, clinicians can better advise them.
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Affiliation(s)
- Elissa Lynch
- Division of Digestive and Liver Diseases, Columbia University, New York, NY, USA
| | - Jordan Troob
- Division of Digestive and Liver Diseases, Columbia University, New York, NY, USA
| | - Benjamin Lebwohl
- Division of Digestive and Liver Diseases, Columbia University, New York, NY, USA
| | - Daniel E Freedberg
- Division of Digestive and Liver Diseases, Columbia University, New York, NY, USA
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146
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Buckhalter S, Soubeyrand E, Ferrone SAE, Rasmussen DJ, Manduca JD, Al-Abdul-Wahid MS, Frie JA, Khokhar JY, Akhtar TA, Perreault ML. The Antidepressant-Like and Analgesic Effects of Kratom Alkaloids are accompanied by Changes in Low Frequency Oscillations but not ΔFosB Accumulation. Front Pharmacol 2021; 12:696461. [PMID: 34413776 PMCID: PMC8369573 DOI: 10.3389/fphar.2021.696461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022] Open
Abstract
Mitragyna speciosa (“kratom”), employed as a traditional medicine to improve mood and relieve pain, has shown increased use in Europe and North America. Here, the dose-dependent effects of a purified alkaloid kratom extract on neuronal oscillatory systems function, analgesia, and antidepressant-like behaviour were evaluated and kratom-induced changes in ΔFosB expression determined. Male rats were administered a low or high dose of kratom (containing 0.5 or 1 mg/kg of mitragynine, respectively) for seven days. Acute or repeated low dose kratom suppressed ventral tegmental area (VTA) theta oscillatory power whereas acute or repeated high dose kratom increased delta power, and reduced theta power, in the nucleus accumbens (NAc), prefrontal cortex (PFC), cingulate cortex (Cg) and VTA. The repeated administration of low dose kratom additionally elevated delta power in PFC, decreased theta power in NAc and PFC, and suppressed beta and low gamma power in Cg. Suppressed high gamma power in NAc and PFC was seen selectively following repeated high dose kratom. Both doses of kratom elevated NAc-PFC, VTA-NAc, and VTA-Cg coherence. Low dose kratom had antidepressant-like properties whereas both doses produced analgesia. No kratom-induced changes in ΔFosB expression were evident. These results support a role for kratom as having both antidepressant and analgesic properties that are accompanied by specific changes in neuronal circuit function. However, the absence of drug-induced changes in ΔFosB expression suggest that the drug may circumvent this cellular signaling pathway, a pathway known for its significant role in addiction.
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Affiliation(s)
- Shoshana Buckhalter
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON, Canada
| | - Eric Soubeyrand
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON, Canada
| | - Sarah A E Ferrone
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
| | - Duncan J Rasmussen
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
| | - Joshua D Manduca
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON, Canada
| | | | - Jude A Frie
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada.,Collaborative Program in Neuroscience, University of Guelph, Guelph, ON, Canada
| | - Jibran Y Khokhar
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada.,Collaborative Program in Neuroscience, University of Guelph, Guelph, ON, Canada
| | - Tariq A Akhtar
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON, Canada
| | - Melissa L Perreault
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada.,Collaborative Program in Neuroscience, University of Guelph, Guelph, ON, Canada
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147
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Xu KY, Mintz CM, Borodovsky JT, Glaser PEA, Bierut LJ, Grucza RA. Prevalence of Kratom Use and Co-Occurring Substance Use Disorders in the United States. Prim Care Companion CNS Disord 2021; 23:21br02930. [PMID: 34352941 PMCID: PMC8647372 DOI: 10.4088/pcc.21br02930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Kevin Y Xu
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
- Corresponding author: Kevin Y. Xu, MD, MPH, Department of Psychiatry, Washington University School of Medicine, 420 South Euclid Ave, Campus Box 8134, St Louis, MO 63110
| | - Carrie M Mintz
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Jacob T Borodovsky
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
- Center for Technology and Behavioral Health, Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Paul E A Glaser
- William Greenleaf Eliot Division of Child Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Laura J Bierut
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
- Alvin J Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, Missouri
| | - Richard A Grucza
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
- Departments of Family and Community Medicine and Health and Outcomes Research, St Louis University, St Louis, Missouri
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148
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Halim SA, Low JH, Chee YC, Alias MR. Seizures among young adults consuming kratom beverages in Malaysia: A case series. Epilepsy Behav 2021; 121:108057. [PMID: 34052638 DOI: 10.1016/j.yebeh.2021.108057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/08/2021] [Accepted: 05/08/2021] [Indexed: 11/30/2022]
Abstract
We report a case series of young adults who were admitted to hospital with seizures after regular kratom beverage consumption. This study aimed to determine kratom consumption habits and seizure characteristics and to explore whether chronic kratom ingestion without concomitant drug abuse leads to recurrent seizure or epilepsy. All patients underwent blood investigations, a brain computed tomography (CT) scan, electroencephalography, and urine testing for mitragynine and drug toxicology. Eleven participants who had a positive urine mitragynine test were included in the study. The longest duration of kratom consumption was 84 months: - most drank more than eight times per month (>200 mL/drink). Seizure developed within 10 minutes or up to 72 hours post-ingestion. Seizure occurred one to three times per year in most cases. Four patients had a focal to bilateral tonic-clonic seizure whereas the remaining participants had a generalized tonic-clonic seizure. Four patients mixed kratom with diphenhydramine syrup, and one patient took methamphetamine. Two patients had positive urine results for recreational drugs (opioid and amphetamine). This study provided indirect evidence that chronic kratom use with or without concomitant drug abuse can cause recurrent seizures in susceptible individuals, which may progress to epilepsy or require antiepileptic medication.
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Affiliation(s)
- Sanihah Abdul Halim
- Department of Internal Medicine (Neurology), School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
| | - Jen Hou Low
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Yong Chuan Chee
- Department of Internal Medicine (Neurology), School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Muhamad Ridzuan Alias
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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149
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Groff D, Stuckey H, Philpott C, Van Dyke E, Silvis M, Leong SL, Bone C. Kratom use disorder: a primer for primary care physicians. J Addict Dis 2021; 40:131-141. [PMID: 34281482 DOI: 10.1080/10550887.2021.1950263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Kratom is a substance similar to opioids that is often used for its euphoric effects, however it can be obtained legally in most of the United States. The substance is often not assessed on routine urine drug screen, however it is estimated that millions of people engage in kratom use each year and level of use is rising. Given the increasing prevalence of kratom use, and its potentially lethal consequences, it is imperative that primary care physicians be familiar with this substance and have a framework to approach identification and treatment of individuals with kratom use disorder. This manuscript offers a review of the epidemiology and pharmacology of kratom, along with guidance for care of individuals with kratom use disorder in the primary care setting.
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Affiliation(s)
- Destin Groff
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Heather Stuckey
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Carolyn Philpott
- UC Health: University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Erika Van Dyke
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Matthew Silvis
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Shou Ling Leong
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Curtis Bone
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
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150
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Hassan R, Sreenivasan S, Müller CP, Hassan Z. Methadone, Buprenorphine, and Clonidine Attenuate Mitragynine Withdrawal in Rats. Front Pharmacol 2021; 12:708019. [PMID: 34322028 PMCID: PMC8311127 DOI: 10.3389/fphar.2021.708019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Kratom or Mitragyna speciosa Korth has been widely used to relieve the severity of opioid withdrawal in natural settings. However, several studies have reported that kratom may by itself cause dependence following chronic consumption. Yet, there is currently no formal treatment for kratom dependence. Mitragynine, is the major psychoactive alkaloid in kratom. Chronic mitragynine treatment can cause addiction-like symptoms in rodent models including withdrawal behaviour. In this study we assessed whether the prescription drugs, methadone, buprenorphine and clonidine, could mitigate mitragynine withdrawal effects. In order to assess treatment safety, we also evaluated hematological, biochemical and histopathological treatment effects. Methods: We induced mitragynine withdrawal behaviour in a chronic treatment paradigm in rats. Methadone (1.0 mg/kg), buprenorphine (0.8 mg/kg) and clonidine (0.1 mg/kg) were i.p. administered over four days during mitragynine withdrawal. These treatments were stopped and withdrawal sign assessment continued. Thereafter, toxicological profiles of the treatments were evaluated in the blood and in organs. Results: Chronic mitragynine treatment caused significant withdrawal behaviour lasting at least 5 days. Methadone, buprenorphine, as well as clonidine treatments significantly attenuated these withdrawal signs. No major effects on blood or organ toxicity were observed. Conclusion: These data suggest that the already available prescription medications methadone, buprenorphine, and clonidine are capable to alleviate mitragynine withdrawal signs rats. This may suggest them as treatment options also for problematic mitragynine/kratom use in humans.
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Affiliation(s)
- Rahimah Hassan
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | - Sasidharan Sreenivasan
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Minden, Malaysia
| | - Christian P Müller
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia.,Section of Addiction Medicine, Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Zurina Hassan
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia.,Addiction Behaviour and Neuroplasticity Laboratory, National Neuroscience Institute, Singapore, Singapore
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