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Heywood J, Smallets S, Paustenbach D. Beneficial and adverse health effects of kratom (Mitragyna speciosa): A critical review of the literature. Food Chem Toxicol 2024; 192:114913. [PMID: 39134135 DOI: 10.1016/j.fct.2024.114913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/25/2024] [Accepted: 08/06/2024] [Indexed: 08/25/2024]
Abstract
Used in Southeast Asia for generations, kratom gained popularity in the United States and elsewhere over the past several decades. Derived from Mitragyna speciosa, kratom preparations including leaves, teas, powders, capsules, and extracts may yield stimulant, analgesic, and opioid-like effects that occur dose-dependently based on concentrations of kratom's key alkaloids, mitragynine and 7-hydroxymitragynine. Such effects are responsible for kratom's potential as a reduced-harm alternative to opiates and as a withdrawal treatment. But these properties are also associated with tolerance development and addictive potential. Given mitragynine and 7-hydroxymitragynine activity on cytochrome P450 isoforms and opioid receptors, adverse effects among polysubstance users are a concern. Current literature on the toxicology of kratom is reviewed, including product alkaloid concentrations, in vitro and in vivo data, epidemiological evidence, and human case data. The potential harms and benefits of kratom products are discussed within an exposure assessment framework, and recommendations for industry are presented. Current evidence indicates that kratom may have therapeutic potential in some persons and that products present few risks with typical, non-polysubstance use. However, few studies identified alkaloid doses at which adverse effects were expected in humans or animals. Such research is needed to inform future assessments of kratom's risks and benefits.
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Affiliation(s)
- J Heywood
- Paustenbach and Associates, 1550 Wewatta Street, Suite 200, Denver, CO, USA.
| | - S Smallets
- Paustenbach and Associates, 1550 Wewatta Street, Suite 200, Denver, CO, USA
| | - D Paustenbach
- Paustenbach and Associates, 970 West Broadway, Suite E, Jackson, WY, USA
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Müller CP, Yang Y, Singh D, Lenz B, Müller E. [Kratom-From natural remedy to addictive drug and back]. DER NERVENARZT 2024; 95:824-829. [PMID: 39085520 DOI: 10.1007/s00115-024-01721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Kratom/ketum is a psychoactive herbal preparation that has been used for a long time as a remedy and performance-enhancing substance in Southeast Asia. The advancement of globalization is making kratom increasingly more available in the western world, where it is becoming increasingly more used. OBJECTIVE The current research on kratom and its ingredients is presented. MATERIAL AND METHODS An overview of the use and effects of kratom is exemplary given on the basis of reports. The instrumentalization of the drug and its consequences up to the development of addiction are discussed. RESULTS Consumption is accompanied by several instrumentalizeable effects so that kratom is used as a therapeutic substance in the self-management of pain, anxiety and depression as well as other substance addictions. Another benefit comes from the performance-enhancing effects on physical work and in a social context. Consumption is usually well controlled, rarely escalates and has few and mostly mild aversive side effects. The danger arises from consumption particularly when there is an escalation of the dose and from mixed consumption with other psychoactive substances. The main alkaloid mitragynine and the more potent 7‑hydroxy-mitragynine are considered mainly responsible for the effect. Both have a complex pharmacology that involves partial µ‑opioid receptor agonism. DISCUSSION Epidemiological, clinical and neurochemical studies have shown that kratom only has a limited addictive drug profile, which might suggest a medical use as a remedy or substitute in addiction treatment.
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Affiliation(s)
- Christian P Müller
- Bereich Suchtmedizin, Klinik für Psychiatrie und Psychosomatik, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Deutschland.
- Institut für Psychopharmakologie, Zentralinstitut für Seelische Gesundheit, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland.
| | - Yuting Yang
- Centre for Drug Research, Universiti Sains Malaysia, Penang, Malaysia
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Penang, Malaysia
| | - Bernd Lenz
- Department für Süchtiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
| | - Elisabeth Müller
- Department für Psychiatrie und Psychotherapie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
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LoParco CR, Bone C, Berg CJ, Rossheim ME, Peeri NC, Tillett KK, Seo DC. Associations Between Opioid and Kratom Use in the USA: Differences by Race/Ethnicity and Sexual Orientation. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02142-6. [PMID: 39196491 DOI: 10.1007/s40615-024-02142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/18/2024] [Accepted: 08/17/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Kratom is federally unregulated and is marketed as an opioid alternative despite limited evidence and known negative effects. Disparities in associations between opioid and kratom use may be partly attributed to race/ethnicity and sexual orientation given differences in marketing, use motives, and prescriber practices. METHODS Data: 2021 nationally representative National Survey on Drug Use and Health among individuals aged 18 + . We used weighted logistic regression analyses to assess race/ethnicity and sexual orientation as moderators of associations between past-year opioid (1) use (total sample, n = 44,877) and (2) misuse and use disorder (among those with past-year opioid use, n = 10,398) and the outcome of kratom use (lifetime, past year). RESULTS 26.76% reported past-year opioid use, and among those, 12.20% and 7.54% reported past-year opioid misuse and use disorder, respectively; 1.72% and 0.67% had lifetime and past-year kratom use, respectively. Opioid use was positively associated with lifetime (aOR = 2.69, 95%CI = 1.98, 3.66) and past-year (aOR = 3.84, 95%CI = 2.50, 5.92) kratom use; associations among non-Hispanic Black and Hispanic (vs. non-Hispanic White) participants were weaker (p < 0.01). Among participants reporting past-year opioid use, misuse and use disorder were positively associated with lifetime (aORmisuse = 2.46, 95%CI = 1.60, 3.78; aORuse disorder = 5.58, 95%CI = 2.82, 11.04) and past-year (aORmisuse = 2.40, 95%CI = 1.26, 4.59; aORuse disorder = 3.08, 95%CI = 1.48, 6.41) kratom use; among bisexual (vs. heterosexual) participants, opioid use disorder was associated with a lower probability of lifetime kratom use (p < 0.01). DISCUSSION We observed positive associations between opioid and kratom use, with potential disparities among certain racial/ethnic and sexual orientation groups. Research should examine the mechanisms contributing to these differences to inform prevention and intervention efforts.
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Affiliation(s)
- Cassidy R LoParco
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Carlton Bone
- College of Liberal Arts and Sciences, Portland State University, Portland, OR, USA
| | - Carla J Berg
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Matthew E Rossheim
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Noah C Peeri
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kayla K Tillett
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Dong-Chul Seo
- School of Public Health, Indiana University Bloomington, Bloomington, IN, USA
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Garba SA, Shaari K, Abdul Manap MR, Lee SY, Abdulazeez I, Mohd Faudzi SM. Quantitative analysis of selected alkaloids of Mitragyna speciosa using 1H quantitative nuclear magnetic resonance spectroscopy. MAGNETIC RESONANCE IN CHEMISTRY : MRC 2024. [PMID: 39189504 DOI: 10.1002/mrc.5477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024]
Abstract
Mitragyna speciosa is a perennial plant native to Asia, well known for its psychoactive properties. Its major alkaloid mitragynine is known to have sedative and euphoric effects. Hence, the plant has been a subject of abuse, leading to addiction, necessitating efficient analytical methods to detect its psychoactive constituents. However, current chromatography-based methods for detecting the alkaloids are time consuming and costly. Quantitative nuclear magnetic resonance (qNMR) spectroscopy emerges as a promising alternative due to its nondestructive nature, structural insights, and short analysis time. Hence, a rapid and precise qNMR method was developed to quantify selected major psychoactive alkaloids in various parts of M. speciosa. Mitragynine, specioliatine, and speciogynine were quantified in relation to the integral value of the -OCH3 groups of the alkaloids and the internal standard 1,4-dinitrobenzene. The precision and reproducibility of the method gave a relative standard deviation (RSD) of 2%, demonstrating the reliability of the method. In addition, the method showed excellent specificity, sensitivity, high linearity range (R2 = 0.999), and limits of detection (LOD) and quantification (LOQ) values. The analysis revealed that the red-veined M. speciosa leaves contained higher levels of mitragynine (32.34 mg/g), specioliatine (16.84 mg/g) and speciogynine (7.69 mg/g) compared to the green-veined leaves, stem bark, or fruits.
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Affiliation(s)
- Suleiman Abubakar Garba
- Natural Medicines and Products Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Malaysia
- Chemistry Department, Faculty of Natural and Applied Sciences, Sule Lamido University, Kafin Hausa, Nigeria
| | - Khozirah Shaari
- Natural Medicines and Products Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Soo Yee Lee
- School of Food Studies & Gastronomy, Faculty of Social Sciences & Leisure Management, Taylor's University, Subang Jaya, Malaysia
- Food Security & Nutrition Impact Lab, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Isah Abdulazeez
- Chemistry Department, School of Secondary Education Sciences, Federal College of Education Zaria, Tudun Wada, Nigeria
| | - Siti Munirah Mohd Faudzi
- Natural Medicines and Products Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Chemistry, Faculty of Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Karunakaran T, Ganasan J, Rusmadi NN, Santhanam R, Mordi MN. In-vitro hepatotoxic activity of mitragynine and paynantheine isolated from the leaves of Mitragyna speciosa Korth. (Kratom). Nat Prod Res 2024:1-5. [PMID: 38982630 DOI: 10.1080/14786419.2024.2375760] [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: 04/15/2024] [Accepted: 06/25/2024] [Indexed: 07/11/2024]
Abstract
Mitragynine, a primary alkaloid found in kratom leaves has been reported to have a broad range of pharmacological and toxicological properties while its congener, paynatheine has comparatively less information available on these aspects. Mitragynine and its congener, paynantheine, were isolated from the ethanol kratom leaves extract using gravity column chromatography techniques. Our study evaluated the cytotoxicity potential of mitragynine and paynantheine on normal human liver cell line, HL-7702, and human hepatoma cell line, HepG2. Mitragynine exhibited a moderate inhibitory effect on the HepG2 cell line with IC50 value of 42.11 ± 1.31 μM in comparison with vinblastine (IC50: 15.45 ± 0.72 μM) while it showed non-cytotoxic properties towards the HL-7702 cell line with concentrations ranging below 200 μM. In contrast, paynantheine exhibited weak cytotoxic properties towards HepG2 and HL-7702 cell lines. Further comprehensive evaluations of both compounds are needed to establish more details on the cytotoxicity potential of kratom alkaloids.
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Affiliation(s)
| | | | | | - Rameshkumar Santhanam
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, Kuala Nerus, Terengganu, Malaysia
| | - Mohd Nizam Mordi
- Centre for Drug Research, Universiti Sains Malaysia, Penang, Malaysia
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Graham K, Cantu C, Houston R. Sequence variation of commercially available kratom products at universal DNA barcode regions. J Forensic Sci 2024; 69:1421-1428. [PMID: 38775145 DOI: 10.1111/1556-4029.15547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/13/2024] [Accepted: 05/07/2024] [Indexed: 06/28/2024]
Abstract
Mitragyna speciosa, commonly known as kratom, is a narcotic plant that is used for its unique mood-enhancing and pain-relieving effects. It is marketed throughout the United States as a 'legal high' and has gained popularity as an alternative to opioids. However, kratom's increasing involvement in accidental overdoses, especially among polydrug users, has prompted warnings from the Drug Enforcement Agency (DEA) and the Food and Drug Administration (FDA). Despite these warnings, kratom remains legal federally, although it is banned in six states. This legal disparity complicates monitoring and enforcement efforts in states where kratom is illegal. Common forensic techniques using morphology or chemical analysis are beneficial in some instances but are not useful in source attribution because most seized kratom is powdered and the alkaloid content of samples can vary within products, making sourcing unreliable. This study focused on developing a DNA barcoding method to access sequence variation in commercial kratom products. It evaluated the utility of one nuclear barcode region (ITS) and three chloroplast barcode regions (matK, rbcL, and trnH-psbA) in assessing sequence variation across commercially available kratom products. Novel polymorphisms were discovered, and the ITS region showed the greatest variation between samples. Among the 15 kratom products tested, only two haplotypes were identified across the four barcoding regions. The findings highlight the potential of DNA barcoding as a forensic tool in the traceability and enforcement against illegal kratom distribution. Nonetheless, the limited haplotypic diversity points to a need for further development and expansion of the M. speciosa DNA sequence database.
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Affiliation(s)
- Kari Graham
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, Texas, USA
| | - Cesar Cantu
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, Texas, USA
| | - Rachel Houston
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, Texas, USA
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Pansai N, Wungsintaweekul J, Wichienchot S. The effects of Mitragyna speciosa extracts on intestinal microbiota and their metabolites in vitro fecal fermentation. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2024. [PMID: 38923512 DOI: 10.1002/jsfa.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Kratom (Mitragyna speciosa) has a long history of traditional use. It contains various alkaloids and polyphenols. The properties of kratom's alkaloids have been well-documented. However, the property of kratom's polyphenols in water-soluble phase have been less frequently reported. This study assessed the effects of water-soluble Mitragyna speciosa (kratom) extract (MSE) on gut microbiota and their metabolite production in fecal batch culture. RESULTS The water-soluble kratom extract (MSE0) and the water-soluble kratom extract after partial sugar removal (MSE50) both contained polyphenols, with total phenolic levels of 2037.91 ± 51.13 and 3997.95 ± 27.90 mg GAE/g extract, respectively and total flavonoids of 81.10 ± 1.00 and 84.60 ± 1.43 mg CEQ/g extract. The gut microbiota in fecal batch culture was identified by 16S rRNA gene sequencing at 0 and 24 h of fermentation. After fermentation, MSE50 stimulated the growth of Bifidobacterium more than MSE0. MSE0 gave the highest total fatty acids level among the treatments. The phenolic metabolites produced by some intestinal microbiota during fecal fermentation at 24 h were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The major metabolite of biotransformation of both water-soluble MSEs by intestinal microbiota was pyrocatechol (9.85-11.53%). CONCLUSION The water-soluble MSEs and their produced metabolites could potentially be used as ingredients for functional and medicinal food production that supports specific gut microbiota. © 2024 Society of Chemical Industry.
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Affiliation(s)
- Nattha Pansai
- Center of Excellence in Functional Foods and Gastronomy, Faculty of Agro-Industry, Prince of Songkla University, Songkhla, Thailand
| | - Juraithip Wungsintaweekul
- Pharmacognosy and Pharmaceutical Botany Program, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
| | - Santad Wichienchot
- Center of Excellence in Functional Foods and Gastronomy, Faculty of Agro-Industry, Prince of Songkla University, Songkhla, Thailand
- Functional Food and Nutrition Program, Faculty of Agro-Industry, Prince of Songkla University, Songkhla, Thailand
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Yang Y, Müller CP, Singh D. Kratom (Mitragyna speciosa) Use and Mental Health: A Systematic Review and Multilevel Meta-Analysis. Eur Addict Res 2024; 30:252-274. [PMID: 38889703 DOI: 10.1159/000539338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/02/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Kratom (Mitragyna speciosa) is a medicinal tree native to Southeast Asia. The present multilevel meta-analysis describes the association between kratom use and the positive and negative indicators of mental health. METHODS A total of thirty-six articles were included in the meta-analysis to examine the associations, using a random-effects model. RESULTS The pooled effect size showed a very small positive association between kratom use and negative indicators of mental health {r = 0.092, 95% confidence interval (CI) = [0.020, 0.164], p < 0.05}, while no significant association was found with positive indicators of mental health (r = -0.031, 95% CI = [-0.149, 0.087], p > 0.05). Pooled effect sizes of specific mental health outcomes indicated that kratom use showed only a small positive correlation with externalizing disorders (r = 0.201, 95% CI = [0.107, 0.300], p < 0.001). No significant association was found between kratom use and quality of life (r = 0.069, 95% CI = [-0.104, 0.242], p > 0.05) and internalizing disorders (r = -0.001, 95% CI = [-0.115, 0.095], p > 0.05). Multilevel moderator analysis showed that the pooled effect size of the association between kratom use and substance use disorder was stronger in Malaysia (r = 0.347, 95% CI = [0.209, 0.516], p < 0.001), and with the mean age (β1 = -0.035, 95% CI = [-0.055, -0.014], p = 0.003), and the drug profile of those who were not co-using other drugs (r = 0.347, 95% CI = [0.209, 0.516], p < 0.001). CONCLUSION The meta-analysis supports the kratom instrumentalization concept, in that a positive gain from kratom consumption can be achieved without any significant adverse associations with mental health.
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Affiliation(s)
- Yuting Yang
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Institute of Psychopharmacology, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
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Ameline A, Gheddar L, Arbouche N, Blanchot A, Raul JS, Kintz P. Testing for Kratom alkaloids in fingernail clippings - not only mitragynine. J Pharm Biomed Anal 2024; 243:116078. [PMID: 38489958 DOI: 10.1016/j.jpba.2024.116078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/20/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
Kratom (Mitragyna speciosa) is a species of large tree that grows in Southeast Asia and is part of the Rubiaceae family. Its fresh leaves are harvested for their medicinal properties and used for their psychoactive effects. Kratom contains many biologically active alkaloids, including mitragynine and 7-OH-mitragynine, which are considered the two most important psychoactive components and constitute approximately 66% and 2% of the total alkaloid content. Other alkaloids are present in the plant, such as speciogynine, speciociliatine and paynantheine, but have less psychoactive activity. Over the past decade, the sale of kratom powder has increased on the Internet. This led to a significant increase in forensic cases. Given the lack of data existing in the literature, and the total absence of data in nails, the authors report a study to determine the best target alkaloids for documenting kratom consumption in this matrix. Fingernail clippings from a supposed kratom powder user were analyzed after liquid-liquid extraction, chromatography separation using a HSS C18 column and performed on an ultra-high performance liquid chromatography coupled to a tandem mass spectrometer. In the specimen, mitragynine was quantified at 229 pg/mg, speciogynine and paynantheine were both quantified at 2 pg/mg, and speciociliatine was quantified at 19 pg/mg. 7-OH-mitragynine was not detected. The interpretation of these concentrations is complex, since there is currently no reference in the literature, as this is the first identification of mitragynine and other kratom alkaloids in nails. Nevertheless, in view of the high concentration of mitragynine, the subject seems to be a repetitive user of kratom. According to the measured concentrations, it seems that mitragynine remains the best target to document kratom consumption, but the identification of the other alkaloids would enhance the specificity of the test.
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Karunakaran T, Vicknasingam B, Chawarski MC. Phytochemical analysis of water and ethanol liquid extracts prepared using freshly harvested leaves of Mitragyna speciosa (Korth.). Nat Prod Res 2024:1-8. [PMID: 38842220 DOI: 10.1080/14786419.2024.2362428] [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: 12/14/2023] [Accepted: 05/27/2024] [Indexed: 06/07/2024]
Abstract
Mitragyna speciosa, also known as kratom, has been reported to have a broad range of pharmacological properties. Freshly harvested leaves and their water extracts are consumed in Southeast Asia while preparations made from dried leaf material are consumed in Western countries. Our study evaluated the phytochemical composition of freshly harvested kratom leaves using LCMS/MS analysis of water and ethanol liquid extracts. Mitragynine and its congeners, including 7-hydroxymitragynine, speciocilliatine, speciogynine, paynantheine, as well as bioactive phenolics including chlorogenic acid, o-coumaric acid, quercitrin, and rutin were identified. However, 7-hydroxymitragynine was detected solely in the water-liquid extract. Currently, unknown compounds were also present in the chromatograms and mass spectra. The study results support that 7-hydroxymitragynine is a post-harvest oxidative derivative or metabolite of mitragynine. Further rigorous and comprehensive evaluations of the phytochemical composition of freshly harvested kratom leaves utilising advanced spectrometric methods are needed to establish the full spectrum of phytochemicals within the plant.
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Affiliation(s)
| | | | - Marek C Chawarski
- Departments of Emergency Medicine and Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Henningfield JE, Grundmann O, Huestis MA, Smith KE. Kratom safety and toxicology in the public health context: research needs to better inform regulation. Front Pharmacol 2024; 15:1403140. [PMID: 38887550 PMCID: PMC11180979 DOI: 10.3389/fphar.2024.1403140] [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: 03/18/2024] [Accepted: 04/30/2024] [Indexed: 06/20/2024] Open
Abstract
Although kratom use has been part of life for centuries in Southeast Asia, the availability and use of kratom in the United States (US) increased substantially since the early 2000s when there was little information on kratom pharmacology, use patterns, and effects, all critical to guiding regulation and policy. Here we provide a synthesis of research with several hundred English-language papers published in the past 5 years drawing from basic research, epidemiological and surveillance data, and recent clinical research. This review of available literature aims to provide an integrated update regarding our current understanding of kratom's benefits, risks, pharmacology, and epidemiology, which may inform United States-based kratom regulation. Recent surveillance indicates there are likely several million past-year kratom consumers, though estimates vary widely. Even without precise prevalence data, kratom use is no longer a niche, with millions of United States adults using it for myriad reasons. Despite its botanical origins in the coffee tree family and its polypharmacy, kratom is popularly characterized as an opioid with presumed opioid-system-based risks for addiction or overdose. Neuropharmacology, toxicology, and epidemiology studies show that kratom is more accurately characterized as a substance with diverse and complex pharmacology. Taken together the work reviewed here provides a foundation for future scientific studies, as well as a guide for ongoing efforts to regulate kratom. This work also informs much-needed federal oversight, including by the United States Food and Drug Administration. We conclude with recommendations for kratom regulation and research priorities needed to address current policy and knowledge gaps around this increasingly used botanical product.
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Affiliation(s)
- Jack E. Henningfield
- Pinney Associates, Inc., Bethesda, MD, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Bethesda, MD, United States
| | - Oliver Grundmann
- College of Pharmacy, Department of Medicinal Chemistry, University of Florida, Gainesville, FL, United States
| | - Marilyn A. Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, United States
| | - Kirsten E. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Awad M, Burke HH, Oakman SA. Kratom-Induced Psychiatric Decompensation and Paranoid Delusions. Cureus 2024; 16:e54626. [PMID: 38524086 PMCID: PMC10959423 DOI: 10.7759/cureus.54626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Kratom is a plant extract readily available for purchase in the USA. It is known to produce both stimulant and opioid-related effects, predisposing it to abuse. The long-term effects of kratom are poorly understood. In rare cases, serious side effects have been reported. Here, we report a case of a patient with a history of bipolar type schizoaffective disorder presenting with acute onset paranoia and delusions. The patient had been hospitalized seven times previously with psychotic symptoms, with no reported history of paranoid delusional thought content in previous admissions. It was discovered that the patient had been ingesting increasingly large quantities of kratom in the weeks leading up to the admission. It is believed that kratom may be responsible for the novel symptoms contributing to the patient's acute psychiatric decompensation.
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Affiliation(s)
- Matthew Awad
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School - Twin Cities, Minneapolis, USA
| | - Hugh H Burke
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School - Twin Cities, Minneapolis, USA
| | - Scott A Oakman
- Department of Psychiatry, Regions Hospital, St. Paul, USA
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Smith KE, Panlilio LV, Feldman JD, Grundmann O, Dunn KE, McCurdy CR, Garcia-Romeu A, Epstein DH. Ecological Momentary Assessment of Self-Reported Kratom Use, Effects, and Motivations Among US Adults. JAMA Netw Open 2024; 7:e2353401. [PMID: 38277146 PMCID: PMC10818224 DOI: 10.1001/jamanetworkopen.2023.53401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024] Open
Abstract
Importance Kratom products, which are sold legally in most of the US, contain alkaloids with opioidergic, adrenergic, and serotonergic activity. Millions of people use kratom to relieve pain, improve mood, or self-manage substance use disorders (SUDs). Kratom use has primarily been examined via surveys, in which recall biases among satisfied users may lead to minimization of transient negative outcomes. Further prospective study of kratom use, such as with ecological momentary assessment (EMA), is needed. Objective To characterize proximal motivators, effects, and patterns of kratom use and to assess whether use frequency is associated with motivations, effects, past-year criteria for SUD for kratom (KUD), or other substance use. Design, Setting, and Participants For this prospective cross-sectional study, an intensive longitudinal smartphone-based EMA in which participants' current behaviors and experiences were repeatedly sampled in real time was conducted between July 1 and October 31, 2022. Participants comprised a convenience sample of US adults who used kratom at least 3 days per week for at least 4 weeks at the time of online screening. Criteria for past-year KUD were based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Data analysis was performed between November 2022 and November 2023. Exposure The exposure was 13 401 kratom-use events across 15 days. Main Outcomes and Measures A baseline survey covering demographics, health, kratom attitudes and behaviors, use motivations, other substance use, and KUD was administered before EMA. Data for the following EMA entries were then collected: event-contingent entries for kratom use (product, dose, and proximal motivations), follow-up entries (short-term effects and consequences of use events), random-prompt entries (mood), beginning-of-day entries (effects of kratom on sleep), and end-of-day entries (daily subjective descriptions of kratom effects). Bayesian regression was used to estimate means and credible intervals. Results A total of 357 participants completed the EMA. Their mean (SD) age was 38.0 (11.1) years; more than half were men (198 [55.5%]). Participants reported overall motivators of use on the baseline survey that involved managing psychiatric and SUD problems, but proximal motivators evaluated during the EMA involved situation-specific needs such as increasing energy and productivity and decreasing pain. Acute effects were considered congruent with daily obligations. Use patterns, despite having some distinguishing features, were generally similar in their motivators and effects; participants used kratom predominantly during the daytime and seemed to find use frequencies that suited their needs. Higher use patterns were associated with symptoms of physical dependence (eg, withdrawal or tolerance). Co-used substances included caffeine, nicotine, vitamins, and cannabis. Conclusions and Relevance Most participants in this study reported using kratom in a seemingly nonproblematic way. When such use appeared problematic, the key element was usually that withdrawal avoidance became a proximal motivator. Longitudinal studies examining changes in kratom use patterns and effects over time are needed.
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Affiliation(s)
- Kirsten E. Smith
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leigh V. Panlilio
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland
| | - Jeffrey D. Feldman
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville
| | - Kelly E. Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher R. McCurdy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David H. Epstein
- Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland
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Bowe A, Kerr PL. Endogenous Opioid Activity as the Mechanism of Action for Mitragyna speciosa (Kratom): The Current State of the Evidence. ADVANCES IN NEUROBIOLOGY 2024; 35:287-313. [PMID: 38874729 DOI: 10.1007/978-3-031-45493-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Kratom (Mitragyna speciosa) is a substance derived from botanical compounds native to Southeast Asia. This substance has been cultivated predominantly in Thailand, Malaysia, Vietnam, and Myanmar, where it has historically been used in traditional medicine as a near panacea for several health problems. Such ritualistic use of kratom has been present for centuries; however, recreational use appears to have increased globally, especially in the United States. Pharmacodynamic and pharmacokinetic studies have found that kratom demonstrates a unique parabolic, dose-dependent pattern of effects ranging from stimulation to opioid and analgesic effects. Pharmacological research indicates that kratom is both a mu opioid receptor (μ-OR; MOR) and a kappa opioid receptor (κ-OR; KOR) agonist, which mediates its analgesic effects. Other research suggests that kratom may simultaneously act on dopaminergic and serotonergic receptors, which mediate its stimulant effects. This chapter reviews the literature related to the structural, functional, and cultural characteristics of kratom use. We begin with an overview of current and historical patterns of kratom, followed by a review of data on the pharmacodynamics and pharmacokinetics of kratom thus far.
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MESH Headings
- Mitragyna
- Humans
- Plant Extracts/pharmacology
- Animals
- Receptors, Opioid, kappa/metabolism
- Receptors, Opioid, kappa/agonists
- Analgesics, Opioid/pharmacology
- Analgesics, Opioid/therapeutic use
- Receptors, Opioid, mu/metabolism
- Receptors, Opioid, mu/agonists
- Asia, Southeastern
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Affiliation(s)
- Adina Bowe
- West Virginia University School of Medicine-Charleston, Charleston, WV, USA.
| | - Patrick L Kerr
- West Virginia University School of Medicine-Charleston, Charleston, WV, USA
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15
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McCurdy CR, Sharma A, Smith KE, Veltri CA, Weiss ST, White CM, Grundmann O. An update on the clinical pharmacology of kratom: uses, abuse potential, and future considerations. Expert Rev Clin Pharmacol 2024; 17:131-142. [PMID: 38217374 PMCID: PMC10846393 DOI: 10.1080/17512433.2024.2305798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/11/2024] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Kratom (Mitragyna speciosa) has generated substantial clinical and scientific interest as a complex natural product. Its predominant alkaloid mitragynine and several stereoisomers have been studied for activity in opioid, adrenergic, and serotonin receptors. While awaiting clinical trial results, the pre-clinical evidence suggests a range of potential therapeutic applications for kratom with careful consideration of potential adverse effects. AREAS COVERED The focus of this review is on the pharmacology, pharmacokinetics, and potential drug-drug interactions of kratom and its individual alkaloids. A discussion on the clinical pharmacology and toxicology of kratom is followed by a summary of user surveys and the evolving concepts of tolerance, dependence, and withdrawal associated with kratom use disorder. EXPERT OPINION With the increasing use of kratom in clinical practice, clinicians should be aware of the potential benefits and adverse effects associated with kratom. While many patients may benefit from kratom use with few or no reported adverse effects, escalating dose and increased use frequency raise the risk for toxic events in the setting of polysubstance use or development of a use disorder.
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Affiliation(s)
- Christopher R McCurdy
- College of Pharmacy, Department of Pharmaceutics, University of Florida, FL, 32610, U.S.A
- College of Pharmacy, Department of Medicinal Chemistry, University of Florida, FL, 32610, U.S.A
| | - Abhisheak Sharma
- College of Pharmacy, Department of Pharmaceutics, University of Florida, FL, 32610, U.S.A
| | - Kirsten E. Smith
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, MD, 21205, U.S.A
| | - Charles A. Veltri
- Midwestern University, College of Pharmacy, Department of Pharmaceutical Sciences, Glendale, AZ, 85308, U.S.A
| | - Stephanie T. Weiss
- Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, U.S.A
| | - Charles M. White
- University of Connecticut School of Pharmacy, Storrs, CT, and Department of Pharmacy, Hartford Hospital, Hartford, CT, U.S.A
| | - Oliver Grundmann
- College of Pharmacy, Department of Medicinal Chemistry, University of Florida, FL, 32610, U.S.A
- Midwestern University, College of Pharmacy, Department of Pharmaceutical Sciences, Glendale, AZ, 85308, U.S.A
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16
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Kiyokawa M, Kwon AK, Cape MC, Streltzer JM. Kratom use disorder: case reports on successful treatment with home induction of buprenorphine-naloxone. Fam Pract 2023; 40:596-598. [PMID: 37499179 DOI: 10.1093/fampra/cmad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Kratom has been used for different reasons such as pain, opioid withdrawal, and relaxation. Kratom can cause dependence and overdose, and it's classified under 'drugs of concern' by the US Drug Enforcement Administration. Despite these concerns, kratom is legal in most of the United States and many countries around the world with easy accessibility. Literature searches reveal recommendations to use buprenorphine (or buprenorphine-naloxone), which are medications to treat opioid use disorder, in order to treat patients with kratom use disorder; however, there are no formal guidelines available. Buprenorphine (or buprenorphine-naloxone) induction is recommended to be conducted under observation (i.e. in the clinic) in the United States, but COVID-19 has resulted in shifts toward telehealth. OBJECTIVES Describe case series of successful management of kratom use disorder using telehealth followed by unobserved buprenorphine-naloxone home induction and highlight implications for future management, including maintenance dosage and induction method. METHODS We present 2 very similar kratom use disorder patients who reported taking 35 g of kratom per day who underwent unobserved buprenorphine-naloxone home induction. RESULTS Both were seen via telehealth initially. They reported no adverse effects before, during, or after the unobserved home induction on buprenorphine-naloxone but stabilized on significantly different dosages. CONCLUSION Telehealth followed by unobserved buprenorphine-naloxone induction at home may be an alternative to traditional buprenorphine-naloxone induction where treatment accessibility is limited. In addition to daily doses of kratom use, other factors, such as duration of kratom use and individual psychological factors may determine the most comfortable dose of buprenorphine-naloxone.
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Affiliation(s)
- Miki Kiyokawa
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Anthony K Kwon
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Micaiah C Cape
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Jon M Streltzer
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
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Chichagi F, Alikhani R, Beigi Harchegani A. Cardiovascular health in kratom users; a narrative review. J Addict Dis 2023:1-13. [PMID: 37982301 DOI: 10.1080/10550887.2023.2282033] [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: 11/21/2023]
Abstract
BACKGROUND Kratom, also known as Mitragyna speciosa, is a plant that originates in Southeast Asia and possesses unique pharmacological characteristics. It is commonly consumed in the form of tea made by boiling the leaves or using the leaves to create the powder. According to its pain-relieving effects, the prevalence of kratom use around the world has increased, which has various implications for healthcare providers. Mitragynine is a well-known active compound in kratom. OBJECTIVE This review aims to provide a comprehensive perspective on the cardiovascular effects of mitragynine and its potential cardiotoxicity through the literature. METHOD Authors searched PubMed, Scopus, and Google Scholar databases using appropriate search strategies for each database. After the screening, all relevant studies were included. RESULTS Although kratom may have the potential for therapeutic benefits, it has been associated with multi-organ damage and cardiac toxicity in some cases. According to the available data, tachycardia and hypertension are the most common adverse effects. Other possible cardiovascular effects include atherosclerosis, ventricular arrhythmia, cardiomyopathy, dose-dependent prolonged QTc interval, myocarditis, cardiomegaly, and cardiopulmonary arrest. CONCLUSION While prior research has indicated the possible negative effects of mitragynine overdose on the cardiovascular system, there are no definitive conclusions, and additional investigations are needed.
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Affiliation(s)
- Fatemeh Chichagi
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Alikhani
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Asghar Beigi Harchegani
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Bachu AK, Singal P, Griffin B, Harbaugh L, Prasad S, Jain L, Mohiuddin S, Papudesi BN, Nagi T, Youssef NA, Chopra A, Ahmed S. Kratom use and mental health: A systematic literature review and case example. J Addict Dis 2023:1-12. [PMID: 37942896 DOI: 10.1080/10550887.2023.2273192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This review aims to synthesize and critically evaluate the existing literature on kratom use and its possible association with induction of psychotic and manic symptoms, in order to identify potential areas for future research that would improve our understanding of the risks of kratom consumption. METHODS An electronic search was performed using five major databases: including PubMed, Scopus, Google Scholar, Web of Science, and PsycINFO. keywords such as kratom, Mitragyna speciosa, mania, psychosis, bipolar disorder, schizophrenia, schizoaffective, case report, and case series. The retrieved articles on initial search were screened based on predefined inclusion and exclusion criteria for this study, and then data synthesis was performed to analyze relevant information from the included studies. RESULTS Six prior papers were found using (1 case series and 5 case reports). These included 10 cases, involving kratom use association with mania and psychosis. The ages of patients ranged from 28 to 55 years mean age was 38, and (SD 13.74), the majority were males (8 out of 11). Patients had durations of kratom use ranging from 2 wk to 15 years. Significant association was found between kratom use and the worsening of psychotic and manic symptoms in individuals with psychiatric conditions. CONCLUSIONS Our research highlights the possibility of worsening preexisting psychiatric conditions in the context of kratom use. This study emphasizes the need for clinical evaluation of patients for kratom use. Additional research is required to gain a deeper understanding of the potential mental health implications of kratom use, especially among vulnerable populations.
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Affiliation(s)
- Anil K Bachu
- Baptist Health - UAMS Psychiatry Residency Program, North Little Rock, AR, USA
- AHN Psychiatry and Behavioral Health Institute, Pittsburgh, PA, USA
| | - Prakamya Singal
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Brittany Griffin
- Baptist Health - UAMS Psychiatry Residency Program, North Little Rock, AR, USA
| | - Lauren Harbaugh
- Arkansas College of Osteopathic Medicine, Fort Smith, AR, USA
| | - Sakshi Prasad
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Lakshit Jain
- Department of Psychiatry, University of Connecticut, Farmington, CT, USA
| | - Syed Mohiuddin
- Arkansas College of Osteopathic Medicine, Fort Smith, AR, USA
| | | | - Tarika Nagi
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, NY, USA
| | - Nagy A Youssef
- Department of Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Amit Chopra
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Saeed Ahmed
- Rutland Regional Medical Center, Rutland, VT, USA
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Hossain R, Sultana A, Nuinoon M, Noonong K, Tangpong J, Hossain KH, Rahman MA. A Critical Review of the Neuropharmacological Effects of Kratom: An Insight from the Functional Array of Identified Natural Compounds. Molecules 2023; 28:7372. [PMID: 37959790 PMCID: PMC10648626 DOI: 10.3390/molecules28217372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Kratom (Mitragyna speciosa Korth. Havil) has been considered a narcotic drug for years, barred by the law in many parts of the world, while extensive research over the past few decades proves its several beneficial effects, some of which are still in ambiguity. In many countries, including Thailand, the indiscriminate use and abuse of kratom have led to the loss of life. Nonetheless, researchers have isolated almost fifty pure compounds from kratom, most of which are alkaloids. The most prevalent compounds, mitragynine and 7-hydroxy mitragynine, are reported to display agonist morphine-like effects on human μ-opioid receptors and antagonists at κ- and δ-opioid receptors with multimodal effects at other central receptors. Mitragynine is also credited to be one of the modulatory molecules for the Keap1-Nrf2 pathway and SOD, CAT, GST, and associated genes' upregulatory cascades, leading it to play a pivotal role in neuroprotective actions while evidently causing neuronal disorders at high doses. Additionally, its anti-inflammatory, antioxidative, antibacterial, and gastroprotective effects are well-cited. In this context, this review focuses on the research gap to resolve ambiguities about the neuronal effects of kratom and demonstrate its prospects as a therapeutic target for neurological disorders associated with other pharmacological effects.
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Affiliation(s)
- Rahni Hossain
- School of Allied Health Sciences, College of Graduate Studies, Walailak University, Nakhon Si Thammarat 80160, Thailand; (R.H.); (M.N.); (K.N.)
- Research Excellence Center for Innovation and Health Product (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Abida Sultana
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chittagong 4331, Bangladesh;
| | - Manit Nuinoon
- School of Allied Health Sciences, College of Graduate Studies, Walailak University, Nakhon Si Thammarat 80160, Thailand; (R.H.); (M.N.); (K.N.)
- Hematology and Transfusion Science Research Center, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Kunwadee Noonong
- School of Allied Health Sciences, College of Graduate Studies, Walailak University, Nakhon Si Thammarat 80160, Thailand; (R.H.); (M.N.); (K.N.)
- Research Excellence Center for Innovation and Health Product (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Jitbanjong Tangpong
- School of Allied Health Sciences, College of Graduate Studies, Walailak University, Nakhon Si Thammarat 80160, Thailand; (R.H.); (M.N.); (K.N.)
- Research Excellence Center for Innovation and Health Product (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Kazi Helal Hossain
- Angiogenesis and Brain Development Laboratory, Department of Neurosciences, Huntington Medical Research Institutes (HMRI), Pasadena, CA 91105, USA;
| | - Md Atiar Rahman
- School of Allied Health Sciences, College of Graduate Studies, Walailak University, Nakhon Si Thammarat 80160, Thailand; (R.H.); (M.N.); (K.N.)
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chittagong 4331, Bangladesh;
- Research Excellence Center for Innovation and Health Product (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand
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20
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Sornsenee P, Chimplee S, Romyasamit C. Evaluation of Antibacterial, Antibiofilm, Antioxidant, and Anti-Inflammatory Activities of Kratom Leaves (Mitragyna speciosa) Fermentation Supernatant Containing Lactobacillus rhamnosus GG. Probiotics Antimicrob Proteins 2023:10.1007/s12602-023-10142-x. [PMID: 37713167 DOI: 10.1007/s12602-023-10142-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/16/2023]
Abstract
Kratom (Mitragyna speciosa) leaves are commonly used to enhance endurance and treat various diseases. This study evaluated the effect of kratom leaf fermentation with Lactobacillus rhamnosus. Antibacterial activity was investigated against Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), Escherichia coli, and E. coli O157:H7. Biofilm inhibition and eradication assays were also performed. Antioxidant properties were determined by measuring the total phenolic and flavonoid content and DPPH and ABTS scavenging activities. Nitric oxide and TNF-α, IL-1β, and IL-6 expressions in LPS-stimulated RAW 264.7 macrophage cells were also measured. Aqueous kratom extract exhibited promising effects against free radicals and pro-inflammatory cytokines. Notably, all fermented kratoms showed significant antibacterial activity against the tested pathogens and antibiofilm formation by S. aureus and MRSA. Furthermore, the eradication of established biofilms of fermented kratoms was observed in S. aureus (day 2, 50 mg/mL) and E. coli (day 2, 100 mg/mL and day 4, 50 mg/mL). To the best of our knowledge, this study is the first to report that fermented and non-fermented kratoms could be nutraceutical sources of antibacterial, antibiofilm, antioxidant, and anti-inflammatory substances against related diseases and can be applied further in dietary or cosmetic products with health-promoting effects.
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Affiliation(s)
- Phoomjai Sornsenee
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Siriphorn Chimplee
- Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Chonticha Romyasamit
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand.
- Research Center of Excellence in Innovation of Essential Oil, Walailak University, Thasala, Nakhon Si Thammarat, Thailand.
- Research Center in Tropical Pathobiology, Walailak University, Thasala District, Nakhon Si Thammarat, Thailand.
- Center of Excellent in Marijuana, Hemp and Kratom, Walailak University, Nakhon Si Thammarat, 80160, Thailand.
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Huisman G, Menke M, Grundmann O, Schreiber R, Mason N. Examining the Psychoactive Differences between Kratom Strains. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6425. [PMID: 37510657 PMCID: PMC10379209 DOI: 10.3390/ijerph20146425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Kratom (Mitragyna speciosa) is a Southeast Asian plant containing various alkaloids that induce pharmacological effects in humans. In Western countries, online vendors sell a variety of different kratom strains which are marketed to have distinct effect profiles. However, as of yet such marketing claims are unsubstantiated, and therefore the current study investigated whether differently colored kratom products can induce distinct effects, as self-reported by users. Six hundred forty-four current kratom users were anonymously surveyed to compare the self-reported effects of and motivations for using kratom products sold as red, green, and white strains. Most of the survey respondents were customers of the same kratom vendor, the products of which had been analyzed for their alkaloid content by an independent laboratory. The survey respondents reported distinct subjective experiences for different kratom strains, in a manner congruent with common marketing descriptions. However, the product analyses revealed no significant cross-strain differences in alkaloid content, suggesting that the reported effect differences might be disproportionally influenced by marketing narratives and anecdotal reports. Future studies should engage a more diverse population and include kratom strains from various vendors. Controlled, blinded experiments could assess whether the reported effect differences stem from a placebo effect or from alternative factors, e.g., minor alkaloids and terpenes.
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Affiliation(s)
- Guido Huisman
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Maximilian Menke
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
| | - Rudy Schreiber
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Natasha Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
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Arhin M, Mobley J, Hamad H, Remick P. Successful Management of Kratom Use Disorder With Buprenorphine and Naloxone. Cureus 2023; 15:e41146. [PMID: 37519540 PMCID: PMC10386870 DOI: 10.7759/cureus.41146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Kratom is an unregulated herbal supplement that is growing in popularity in the United States. Its primary active ingredients, mitragynine, and 7-hydroxymitragynine, are partial agonists that act on mu- and delta-opioid receptors in the central nervous system, producing analgesia and a sense of euphoria. Kratom use can lead to addiction and adverse side effects, such as seizures, hallucinations, and coma. This case report presents a male in his 40s with a history of kratom use, who presented to the clinic seeking help for his addiction. The patient had been using kratom for several years to self-medicate for his anxiety and depression and gradually developed a kratom addiction. The patient was successfully treated with buprenorphine/naloxone, which helped alleviate his withdrawal symptoms and allowed him to abstain from kratom. This case underscores the growing issue of kratom addiction in the United States and the critical need for physician awareness in treating withdrawal.
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Affiliation(s)
- Martin Arhin
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Julian Mobley
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Hamad Hamad
- Family Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Paul Remick
- Family Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
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23
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Prevete E, Kuypers KPC, Theunissen EL, Esposito G, Ramaekers JG, Pasquini M, Corazza O. Clinical Implications of Kratom ( Mitragyna speciosa) Use: a Literature Review. CURRENT ADDICTION REPORTS 2023; 10:317-334. [PMID: 37266188 PMCID: PMC10177737 DOI: 10.1007/s40429-023-00478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 06/03/2023]
Abstract
Purpose of Review This work aims to provide an up-to-date review of the preclinical and clinical scientific literature on the therapeutic value of kratom to better understand the underlying mechanisms related to its use and inform future therapeutic applications. Recent Findings A growing number of studies, mainly of cross-sectional nature, describe the widespread use of kratom by individuals to self-treat pain, psychiatric symptoms, and substance use disorders (SUD) outside a controlled clinical setting. Preclinical evidence suggests kratom is effective as an analgesic agent and might decrease the self-administration of other drugs. A randomized controlled trial has further supported kratom's therapeutic value as an analgesic. Investigations in nonclinical samples of long-term kratom users also indicate its therapeutic benefit in managing SUD symptoms (e.g., craving) and long-term or acute symptoms (e.g., withdrawal) for alcohol, opioids, and other illicit drugs. However, episodes of kratom-related intoxications have also been reported, often due to the adulteration and the contamination of kratom products mainly sold online or mixed toxicities when consumed outside clinical and traditional settings. Summary Evidence on the clinical implications of kratom use is still limited and uncertain, with kratom research constantly evolving. Therefore, further randomized trials are needed.
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Affiliation(s)
- Elisabeth Prevete
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell’Università 30, 00185 Rome, Italy
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Kim Paula Colette Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Eef Lien Theunissen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 84, 38068 Rovereto, Italy
| | - Johannes Gerardus Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell’Università 30, 00185 Rome, Italy
| | - Ornella Corazza
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 84, 38068 Rovereto, Italy
- Department of Clinical, Pharmacological and Biological Sciences, University of Hertfordshire, College Lane, Hatfield, AL10 9AB UK
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24
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Bade R, Rousis N, Adhikari S, Baduel C, Bijlsma L, Bizani E, Boogaerts T, Burgard DA, Castiglioni S, Chappell A, Covaci A, Driver EM, Sodre FF, Fatta-Kassinos D, Galani A, Gerber C, Gracia-Lor E, Gracia-Marín E, Halden RU, Heath E, Hernandez F, Jaunay E, Lai FY, Lee HJ, Laimou-Geraniou M, Oh JE, Olafsdottir K, Phung K, Castro MP, Psichoudaki M, Shao X, Salgueiro-Gonzalez N, Feitosa RS, Gomes CS, Subedi B, Löve ASC, Thomaidis N, Tran D, van Nuijs A, Verovšek T, Wang D, White JM, Yargeau V, Zuccato E, Mueller JF. Three years of wastewater surveillance for new psychoactive substances from 16 countries. WATER RESEARCH X 2023; 19:100179. [PMID: 37143710 PMCID: PMC10151418 DOI: 10.1016/j.wroa.2023.100179] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/13/2023] [Accepted: 04/05/2023] [Indexed: 05/06/2023]
Abstract
The proliferation of new psychoactive substances (NPS) over recent years has made their surveillance complex. The analysis of raw municipal influent wastewater can allow a broader insight into community consumption patterns of NPS. This study examines data from an international wastewater surveillance program that collected and analysed influent wastewater samples from up to 47 sites in 16 countries between 2019 and 2022. Influent wastewater samples were collected over the New Year period and analysed using validated liquid chromatography - mass spectrometry methods. Over the three years, a total of 18 NPS were found in at least one site. Synthetic cathinones were the most found class followed by phenethylamines and designer benzodiazepines. Furthermore, two ketamine analogues, one plant based NPS (mitragynine) and methiopropamine were also quantified across the three years. This work demonstrates that NPS are used across different continents and countries with the use of some more evident in particular regions. For example, mitragynine has highest mass loads in sites in the United States, while eutylone and 3-methylmethcathinone increased considerably in New Zealand and in several European countries, respectively. Moreover, 2F-deschloroketamine, an analogue of ketamine, has emerged more recently and could be quantified in several sites, including one in China, where it is considered as one of the drugs of most concern. Finally, some NPS were detected in specific regions during the initial sampling campaigns and spread to additional sites by the third campaign. Hence, wastewater surveillance can provide an insight into temporal and spatial trends of NPS use.
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Affiliation(s)
- Richard Bade
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD 4102, Australia
| | - Nikolaos Rousis
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD 4102, Australia
| | - Sangeet Adhikari
- School of Sustainable Engineering and Built Environment, Arizona State University, Tempe, AZ, 85281, United States
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, 1001 S. McAllister Ave., Tempe, AZ 85281, United States
| | - Christine Baduel
- Université Grenoble Alpes, CNRS, IRD, Grenoble INP, IGE, Grenoble, France
| | - Lubertus Bijlsma
- Environmental and Public Health Analytical Chemistry, Research Institute for Pesticides and Water, University Jaume I, Avda, Sos Baynat s/n, E-12071 Castellón, Spain
| | - Erasmia Bizani
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771 Athens, Greece
| | - Tim Boogaerts
- Toxicological Centre, Department of Pharmaceutical Sciences, University of Antwerp, 2610 Wilrijk, Belgium
| | - Daniel A. Burgard
- Department of Chemistry and Biochemistry, University of Puget Sound, Tacoma, WA 98416, United States
| | - Sara Castiglioni
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Environmental Health Sciences, Via Mario Negri 2, 20156, Milan, Italy
| | - Andrew Chappell
- Institute of Environmental Science and Research Limited (ESR), Christchurch Science Centre: 27 Creyke Road, Ilam, Christchurch 8041, New Zealand
| | - Adrian Covaci
- Toxicological Centre, Department of Pharmaceutical Sciences, University of Antwerp, 2610 Wilrijk, Belgium
| | - Erin M. Driver
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, 1001 S. McAllister Ave., Tempe, AZ 85281, United States
- AquaVitas, LLC, Scottsdale, Arizona, 85251, United States
| | | | - Despo Fatta-Kassinos
- Nireas-International Water Research Centre and Department of Civil and Environmental Engineering, University of Cyprus, P.O. Box 20537, 1678, Nicosia, Cyprus
| | - Aikaterini Galani
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771 Athens, Greece
| | - Cobus Gerber
- Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide 5001, South Australia, Australia
| | - Emma Gracia-Lor
- Department of Analytical Chemistry, Faculty of Chemistry, Complutense University of Madrid, Avenida Complutense s/n, 28040 Madrid, Spain
| | - Elisa Gracia-Marín
- Environmental and Public Health Analytical Chemistry, Research Institute for Pesticides and Water, University Jaume I, Avda, Sos Baynat s/n, E-12071 Castellón, Spain
| | - Rolf U. Halden
- School of Sustainable Engineering and Built Environment, Arizona State University, Tempe, AZ, 85281, United States
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, 1001 S. McAllister Ave., Tempe, AZ 85281, United States
- AquaVitas, LLC, Scottsdale, Arizona, 85251, United States
- OneWaterOneHealth, Arizona State University Foundation, 1001 S. McAllister Avenue, Tempe, AZ 85287-8101, United States
| | - Ester Heath
- Jožef Stefan Institute and International Postgraduate School, Jamova 39, 1000 Ljubljana, Slovenia
| | - Felix Hernandez
- Environmental and Public Health Analytical Chemistry, Research Institute for Pesticides and Water, University Jaume I, Avda, Sos Baynat s/n, E-12071 Castellón, Spain
| | - Emma Jaunay
- Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide 5001, South Australia, Australia
| | - Foon Yin Lai
- Department of Aquatic Sciences and Assessment, Swedish University of Agricultural Sciences (SLU), SE-75007 Uppsala, Sweden
| | - Heon-Jun Lee
- Department of Civil and Environmental Engineering, Pusan National University, Jangjeon-dong, Geumjeong-gu, Busan 46241, Republic of Korea
| | - Maria Laimou-Geraniou
- Jožef Stefan Institute and International Postgraduate School, Jamova 39, 1000 Ljubljana, Slovenia
| | - Jeong-Eun Oh
- Department of Civil and Environmental Engineering, Pusan National University, Jangjeon-dong, Geumjeong-gu, Busan 46241, Republic of Korea
| | - Kristin Olafsdottir
- University of Iceland, Department of Pharmacology and Toxicology, Hofsvallagata 53, 107 Reykjavik, Iceland
| | - Kaitlyn Phung
- Institute of Environmental Science and Research Limited (ESR), Christchurch Science Centre: 27 Creyke Road, Ilam, Christchurch 8041, New Zealand
| | - Marco Pineda Castro
- Department of Chemical Engineering, McGill University, Montreal, QC, Abbreviation:
| | - Magda Psichoudaki
- Nireas-International Water Research Centre and Department of Civil and Environmental Engineering, University of Cyprus, P.O. Box 20537, 1678, Nicosia, Cyprus
| | - Xueting Shao
- College of Environmental Science and Engineering, Dalian Maritime University, No. 1 Linghai Road, Dalian, 116026, P. R. China
| | - Noelia Salgueiro-Gonzalez
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Environmental Health Sciences, Via Mario Negri 2, 20156, Milan, Italy
| | | | | | - Bikram Subedi
- Department of Chemistry, Murray State University, Murray, Kentucky 42071-3300, United States
| | - Arndís Sue Ching Löve
- University of Iceland, Department of Pharmacology and Toxicology, Hofsvallagata 53, 107 Reykjavik, Iceland
| | - Nikolaos Thomaidis
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771 Athens, Greece
| | - Diana Tran
- Department of Chemistry and Biochemistry, University of Puget Sound, Tacoma, WA 98416, United States
| | - Alexander van Nuijs
- Toxicological Centre, Department of Pharmaceutical Sciences, University of Antwerp, 2610 Wilrijk, Belgium
| | - Taja Verovšek
- Jožef Stefan Institute and International Postgraduate School, Jamova 39, 1000 Ljubljana, Slovenia
| | - Degao Wang
- College of Environmental Science and Engineering, Dalian Maritime University, No. 1 Linghai Road, Dalian, 116026, P. R. China
| | - Jason M. White
- Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide 5001, South Australia, Australia
| | - Viviane Yargeau
- Department of Chemical Engineering, McGill University, Montreal, QC, Abbreviation:
| | - Ettore Zuccato
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Environmental Health Sciences, Via Mario Negri 2, 20156, Milan, Italy
| | - Jochen F. Mueller
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD 4102, Australia
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25
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Roma K, Mohammed S, Sieck B, Naik K, Wahid S. Kratom Induced Acute Liver Injury: A Case Study and the Importance of Herbal Supplement Regulation. J Hepatol 2023:S0168-8278(23)00311-2. [PMID: 37121435 DOI: 10.1016/j.jhep.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Katerina Roma
- Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada.
| | - Salman Mohammed
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Blake Sieck
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Katrina Naik
- Division of Gastroenterology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Shahid Wahid
- Division of Gastroenterology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
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26
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Smith KE, Rogers JM, Feldman JD. Kratom's Emergence and Persistence Within the US Polydrug Epidemic. CURRENT ADDICTION REPORTS 2023; 10:262-271. [PMID: 37266191 PMCID: PMC10111073 DOI: 10.1007/s40429-023-00476-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 06/03/2023]
Abstract
Purpose of Review Use of "kratom" products, derived from the bioactive botanical Mitragyna speciosa have increased amidst US polydrug use epidemics. Kratom alkaloids interact with opioid, serotonergic, adrenergic, and other receptors and regular users have described experiencing a wide range of effects. Some with polydrug use histories have reported using kratom as a substitute for other drugs or to nonmedically self-manage substance use disorder (SUD) symptoms. Data describing this remain scare and come from self-report. We review this literature describing kratom use as a drug substitute, or as a nonmedical "self-treatment" for attenuating dependence or SUD symptoms. Recent Findings Kratom products have been documented as being used as a licit and illicit opioid substitute. Use to reduce alcohol or stimulant consumption is less well documented. Although prior and current polydrug use appear common among a some kratom users, it is unclear if co-use is contemporaneous or concomitant. Temporal order of use initiation is typically undocumented. Use for energy and recreation are also increasingly reported. Summary Data on kratom consumption come primarily from self-report with significant limitations. Until controlled human laboratory studies have been conducted, we can presently only describe what is known about human kratom use based on self-report. Such data describe real-world kratom use, leaving unaddressed human abuse liability or therapeutic potential of kratom alkaloids. Clinicians should be mindful of use motivations among people with SUD histories, sensitively assessing use. The paucity of data highlights the urgent need to increase funding and research for understanding kratom's effects in humans.
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Affiliation(s)
- Kirsten Elin Smith
- Real-world Assessment, Prediction, and Treatment Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd., Suite 200, Room 01B340, Baltimore, MD 21224 USA
| | - Jeffrey M. Rogers
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA USA
| | - Jeffrey D. Feldman
- Real-world Assessment, Prediction, and Treatment Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd., Suite 200, Room 01B340, Baltimore, MD 21224 USA
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27
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Smith KE, Feldman JD, Schriefer D, Weiss ST, Grundmann O, Dunn KE, Singh D, McCurdy CR, Butera G, Epstein DH. Diagnostic Ambiguities and Underuse of Clinical Assessment Tools: A Systematic Review of Case Reports on Kratom Addiction and Physical Dependence. CURRENT ADDICTION REPORTS 2023. [DOI: 10.1007/s40429-023-00474-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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28
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Schotte C, Jiang Y, Grzech D, Dang TTT, Laforest LC, León F, Mottinelli M, Nadakuduti SS, McCurdy CR, O’Connor SE. Directed Biosynthesis of Mitragynine Stereoisomers. J Am Chem Soc 2023; 145:4957-4963. [PMID: 36883326 PMCID: PMC9999412 DOI: 10.1021/jacs.2c13644] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Indexed: 02/24/2023]
Abstract
Mitragyna speciosa ("kratom") is used as a natural remedy for pain and management of opioid dependence. The pharmacological properties of kratom have been linked to a complex mixture of monoterpene indole alkaloids, most notably mitragynine. Here, we report the central biosynthetic steps responsible for the scaffold formation of mitragynine and related corynanthe-type alkaloids. We illuminate the mechanistic basis by which the key stereogenic center of this scaffold is formed. These discoveries were leveraged for the enzymatic production of mitragynine, the C-20 epimer speciogynine, and fluorinated analogues.
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Affiliation(s)
- Carsten Schotte
- Department
of Natural Product Biosynthesis, Max Planck
Institute for Chemical Ecology, Hans-Knöll-Straße 8, 07745 Jena, Germany
| | - Yindi Jiang
- Department
of Natural Product Biosynthesis, Max Planck
Institute for Chemical Ecology, Hans-Knöll-Straße 8, 07745 Jena, Germany
| | - Dagny Grzech
- Department
of Natural Product Biosynthesis, Max Planck
Institute for Chemical Ecology, Hans-Knöll-Straße 8, 07745 Jena, Germany
| | - Thu-Thuy T. Dang
- Department
of Natural Product Biosynthesis, Max Planck
Institute for Chemical Ecology, Hans-Knöll-Straße 8, 07745 Jena, Germany
| | - Larissa C. Laforest
- Plant
Molecular and Cell Biology Program, University
of Florida, Gainesville, Florida 32606, United States
| | - Francisco León
- Department
of Medicinal Chemistry, 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
| | - Satya Swathi Nadakuduti
- Plant
Molecular and Cell Biology Program, University
of Florida, Gainesville, Florida 32606, United States
- Department
of Environmental Horticulture, University
of Florida, Gainesville, Florida 32606, United
States
| | - Christopher R. McCurdy
- Department
of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
| | - Sarah E. O’Connor
- Department
of Natural Product Biosynthesis, Max Planck
Institute for Chemical Ecology, Hans-Knöll-Straße 8, 07745 Jena, Germany
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29
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Feldman JD, Schriefer D, Smith KE, Weiss ST, Butera G, Dunn KE, Grundmann O, McCurdy CR, Singh D, Epstein DH. Omissions, Ambiguities, and Underuse of Causal Assessment Tools: a Systematic Review of Case Reports on Patients Who Use Kratom. CURRENT ADDICTION REPORTS 2023. [DOI: 10.1007/s40429-023-00466-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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30
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Li X, Ndungu P, Taneja SB, Chapin MR, Egbert SB, Akenapalli K, Paine MF, Kane-Gill SL, Boyce RD. An evaluation of adverse drug reactions and outcomes attributed to kratom in the US Food and Drug Administration Adverse Event Reporting System from January 2004 through September 2021. Clin Transl Sci 2023. [PMID: 36861661 DOI: 10.1111/cts.13505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/03/2023] Open
Abstract
Kratom is a widely used Asian botanical that has gained popularity in the United States due to a perception that it can treat pain, anxiety, and opioid withdrawal symptoms. The American Kratom Association estimates 10-16 million people use kratom. Kratom-associated adverse drug reactions (ADRs) continue to be reported and raise concerns about the safety profile of kratom. However, studies are lacking that describe the overall pattern of kratom-associated adverse events and quantify the association between kratom and adverse events. ADRs reported to the US Food and Drug Administration Adverse Event Reporting System from January 2004 through September 2021 were used to address these knowledge gaps. Descriptive analysis was conducted to analyze kratom-related adverse reactions. Conservative pharmacovigilance signals based on observed-to-expected ratios with shrinkage were estimated by comparing kratom to all other natural products and drugs. Based on 489 deduplicated kratom-related ADR reports, users were young (mean age 35.5 years), and more often male (67.5%) than female patients (23.5%). Cases were predominantly reported since 2018 (94.2%). Fifty-two disproportionate reporting signals in 17 system-organ-class categories were generated. The observed/reported number of kratom-related accidental death reports was 63-fold greater than expected. There were eight strong signals related to addiction or drug withdrawal. An excess proportion of ADR reports were about kratom-related drug complaints, toxicity to various agents, and seizures. Although further research is needed to assess the safety of kratom, clinicians and consumers should be aware that real-world evidence points to potential safety threats.
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Affiliation(s)
- Xiaotong Li
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Patrick Ndungu
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sanya B Taneja
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maryann R Chapin
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan B Egbert
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Krishi Akenapalli
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary F Paine
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA.,Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Sandra L Kane-Gill
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard D Boyce
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Sengnon N, Vonghirundecha P, Chaichan W, Juengwatanatrakul T, Onthong J, Kitprasong P, Sriwiriyajan S, Chittrakarn S, Limsuwanchote S, Wungsintaweekul J. Seasonal and Geographic Variation in Alkaloid Content of Kratom ( Mitragyna speciosa (Korth.) Havil.) from Thailand. PLANTS (BASEL, SWITZERLAND) 2023; 12:949. [PMID: 36840297 PMCID: PMC9966779 DOI: 10.3390/plants12040949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
The objective of this study was to obtain data on the distribution of alkaloids in kratom plants grown in Thailand. Two collections were performed, covering the southern, central, and northern regions of Thailand and different seasons. The contents of alkaloids, including mitragynine (MG), paynantheine (PAY), and speciogynine (SG), were determined using the validated HPLC method. The 134 samples in the first collection were collected from Nam Phu subdistrict, Ban Na San, Surat Thani, Thailand, during June and October 2019 and January 2020. The maximum mitragynine content was 4.94% w/w in June (late summer), and the minimum content was 0.74% w/w in October (rainy season). To expand the study area after kratom decriminalization, 611 samples were collected in June-August 2021, October-December 2021, and January-April 2022. The accumulation of MG ranged from 0.35 to 3.46% w/w, 0.31 to 2.54% w/w, and 0.48 to 2.81% w/w, respectively. The meteorological data supported the climate's effect on alkaloid production. Soil analysis revealed the importance of Ca and Mg in promoting alkaloid production. Geographical locations played a role in the variation of MG in kratom leaves, but did not affect the color of leaf veins. In conclusion, the present study suggested that the alkaloid content in kratom diverges based on seasonal and geographical origin.
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Affiliation(s)
- Narumon Sengnon
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai Campus, Songkhla 90112, Thailand
| | - Phanita Vonghirundecha
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai Campus, Songkhla 90112, Thailand
| | - Wiraphon Chaichan
- Narcotic Crops Survey and Monitoring Institute, Office of the Narcotics Control Board, City Hall, Muang, Chiang Mai 50303, Thailand
| | - Thaweesak Juengwatanatrakul
- Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Warinchamrab District, Ubon Ratchathani 34190, Thailand
| | - Jumpen Onthong
- Agricultural Innovation and Management Division, Faculty of Natural Resources, Prince of Songkla University, Hat Yai Campus, Songkhla 90110, Thailand
| | - Pongmanat Kitprasong
- Agricultural Innovation and Management Division, Faculty of Natural Resources, Prince of Songkla University, Hat Yai Campus, Songkhla 90110, Thailand
| | - Somchai Sriwiriyajan
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai Campus, Songkhla 90110, Thailand
| | - Somsmorn Chittrakarn
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai Campus, Songkhla 90110, Thailand
| | - Supattra Limsuwanchote
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai Campus, Songkhla 90110, Thailand
| | - Juraithip Wungsintaweekul
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai Campus, Songkhla 90112, Thailand
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32
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Veeramohan R, Zamani AI, Azizan KA, Goh HH, Aizat WM, Razak MFA, Yusof NSM, Mansor SM, Baharum SN, Ng CL. Comparative metabolomics analysis reveals alkaloid repertoires in young and mature Mitragyna speciosa (Korth.) Havil. Leaves. PLoS One 2023; 18:e0283147. [PMID: 36943850 PMCID: PMC10030037 DOI: 10.1371/journal.pone.0283147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
The fresh leaves of Mitragyna speciosa (Korth.) Havil. have been traditionally consumed for centuries in Southeast Asia for its healing properties. Although the alkaloids of M. speciosa have been studied since the 1920s, comparative and systematic studies of metabolite composition based on different leaf maturity levels are still lacking. This study assessed the secondary metabolite composition in two different leaf stages (young and mature) of M. speciosa, using an untargeted liquid chromatography-electrospray ionisation-time-of-flight-mass spectrometry (LC-ESI-TOF-MS) metabolite profiling. The results revealed 86 putatively annotated metabolite features (RT:m/z value) comprising 63 alkaloids, 10 flavonoids, 6 terpenoids, 3 phenylpropanoids, and 1 of each carboxylic acid, glucoside, phenol, and phenolic aldehyde. The alkaloid features were further categorised into 14 subclasses, i.e., the most abundant class of secondary metabolites identified. As per previous reports, indole alkaloids are the most abundant alkaloid subclass in M. speciosa. The result of multivariate analysis (MVA) using principal component analysis (PCA) showed a clear separation of 92.8% between the young and mature leaf samples, indicating a high variance in metabolite levels between them. Akuammidine, alstonine, tryptamine, and yohimbine were tentatively identified among the many new alkaloids reported in this study, depicting the diverse biological activities of M. speciosa. Besides delving into the knowledge of metabolite distribution in different leaf stages, these findings have extended the current alkaloid repository of M. speciosa for a better understanding of its pharmaceutical potential.
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Affiliation(s)
- Rubashiny Veeramohan
- Institute of Systems Biology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, Malaysia
| | - Arief Izzairy Zamani
- Institute of Systems Biology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, Malaysia
- Leave a Nest Malaysia Sdn Bhd, Cyberjaya, Selangor, Malaysia
| | - Kamalrul Azlan Azizan
- Institute of Systems Biology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, Malaysia
| | - Hoe-Han Goh
- Institute of Systems Biology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, Malaysia
| | - Wan Mohd Aizat
- Institute of Systems Biology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, Malaysia
| | - Mohd Fauzi Abd Razak
- Institute of Systems Biology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, Malaysia
| | | | | | | | - Chyan Leong Ng
- Institute of Systems Biology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, Malaysia
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Muacevic A, Adler JR, Stevanovic N. Adverse Drug Interaction Between Kratom and Amitriptyline With Gastrointestinal and Mild Hepatic Effects. Cureus 2023; 15:e33809. [PMID: 36819306 PMCID: PMC9929492 DOI: 10.7759/cureus.33809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/18/2023] Open
Abstract
Kratom (Mitragyna speciosa) is a tropical evergreen plant native to Southeast Asia, where it has been used historically for its various psychoactive and analgesic properties. In recent years, the popularity of kratom has surged in the United States as a supplement for treating opioid withdrawal/addiction, anxiety, depression, and chronic pain, among others. However, much of Kratom processing and sales remain largely unregulated, with little clinical research to demonstrate the effects of kratom on physiologic processes such as potential drug interactions. Here, we present a case of Kratom interaction with Amitriptyline in a patient recovering from Opioid Use Disorder.
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Garmon EH, Olson K. Narrative Review of Kratom, an Emerging Psychoactive Substance With Perianesthetic Implications. Anesth Analg 2022; 135:1180-1188. [PMID: 35986675 DOI: 10.1213/ane.0000000000006177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Opioid overprescribing, with resultant overdose and death, has led to a national focus on alternative treatments for pain. With the decline in legal access to opioids, kratom has gained popularity as a legal, "natural," and easily accessible nonprescription analgesic for consumers wishing to self-medicate for pain, opioid use disorder, and other mental health conditions. While implications of kratom use in patients with chronic pain and/or opioid use disorder have been published, information on perianesthetic implications is lacking. Anesthesiologists should be informed about kratom, including the potential for unexpected physiologic derangements and adverse drug interactions resulting from complex pharmacologic activity, cytochrome P450 interactions, and common adulterations of the drug that may result in unpredictable clinical effects. This article explores the relevance of kratom to perioperative anesthetic care, including suggestions for anesthesiologists extrapolated from published information in nonoperative settings that may improve patient safety in individuals using kratom.
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Affiliation(s)
- Emily H Garmon
- From the Baylor Scott and White Temple Department of Anesthesiology, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Kandice Olson
- Mountain West Anesthesia, Provo, Utah.,Department of Anesthesiology, Utah Vallery Hospital, Provo, Utah
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Basheer M, Khudhair Jasim R, Harn GL. Controversial usages of kratom ( Mitragyna speciosa): For good or for evil. World J Pharmacol 2022; 11:16-26. [DOI: 10.5497/wjp.v11.i3.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/04/2022] [Accepted: 11/23/2022] [Indexed: 11/28/2022] Open
Abstract
Kratom (Mitragyna speciosa) is a plant that grows well in tropical climates such as in Southeast Asia. Traditionally, people discovered it possessed a stimulating effect that relieved tiredness. Furthermore, it contains analgesic and medicinal properties for the treatment of pain, diarrhea, muscle discomfort, and blood pressure and to enhance stamina. Nevertheless, long term or regular consumption of kratom leads to addiction. This is because the main alkaloid of kratom, mitragynine, binds to opioid receptors and exerts a euphoric effect similar to that of morphine, which may lead to death. Due to this reason, kratom has been listed as a regulated substance in many countries including the United States, Thailand, Malaysia, Bhutan, Finland, Lithuania, Denmark, Poland, Sweden, Australia, and Myanmar. Usages of kratom carry two pharmacological effects depending on dosage. Low-dose kratom exerts a stimulating effect that refreshes the user. High-dose kratom exerts sedative effects that can lead to addiction similar to that of morphine. Despite the euphoric effect of kratom, the beneficial values of kratom to human health is indisputable. Therefore, a complete banning of kratom may cause a loss to pharmaceutical industry. Rather, a controlled or selective usage of kratom will be a better choice.
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Affiliation(s)
- Murtadha Basheer
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden 11800, Penang, Malaysia
| | - Rana Khudhair Jasim
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden 11800, Penang, Malaysia
| | - Gam Lay Harn
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden 11800, Penang, Malaysia
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Leksungnoen N, Andriyas T, Ngernsaengsaruay C, Uthairatsamee S, Racharak P, Sonjaroon W, Kjelgren R, Pearson BJ, McCurdy CR, Sharma A. Variations in mitragynine content in the naturally growing Kratom ( Mitragyna speciosa) population of Thailand. FRONTIERS IN PLANT SCIENCE 2022; 13:1028547. [PMID: 36388525 PMCID: PMC9648690 DOI: 10.3389/fpls.2022.1028547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
We analyzed the content of mitragynine (MG) found in kratom leaves (Mitragyna speciosa) and the influence of different environmental conditions (air and soil variables) on the yield in various regions of Thailand. The content of MG in kratom leaves ranged from 7.5 - 26.6 mg g-1 of dry leaf weight. Canonical correspondence analysis showed that the most significant environmental variables affecting the MG content among the various regions were light intensity, relative humidity, soil volumetric water content (VW), soil pH, and calcium. This study is a first step towards providing information about environmental conditions suitable to maximize the quality and quantity of bioactive alkaloids in kratom. Future studies should focus on leaf collection and the post-harvest processes in order to assure the desired alkaloidal content in finished products, when produced under suitable environmental conditions identified in this study.
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Affiliation(s)
- Nisa Leksungnoen
- Department of Forest Biology, Faculty of Forestry, Kasetsart University, Bangkok, Thailand
- Kasetsart University Research and Development Institute (KURDI), Kasetsart University, Bangkok, Thailand
- Center for Advance Studies in Tropical Natural Resources, National Research University-Kasetsart University, Kasetsart University, Bangkok, Thailand
| | - Tushar Andriyas
- Department of Forest Biology, Faculty of Forestry, Kasetsart University, Bangkok, Thailand
| | | | - Suwimon Uthairatsamee
- Department of Forest Biology, Faculty of Forestry, Kasetsart University, Bangkok, Thailand
| | - Phruet Racharak
- Department of Forest Biology, Faculty of Forestry, Kasetsart University, Bangkok, Thailand
| | | | - Roger Kjelgren
- The University of Florida (UF)/Institute of Food and Agricultural Sciences (IFAS) Department of Environmental Horticulture, Mid-Florida Research and Education Center, Institute of Food and Agricultural Sciences, University of Florida, Apopka, FL, United States
| | - Brian J. Pearson
- The University of Florida (UF)/Institute of Food and Agricultural Sciences (IFAS) Department of Environmental Horticulture, Mid-Florida Research and Education Center, Institute of Food and Agricultural Sciences, University of Florida, Apopka, FL, United States
| | - Christopher R. McCurdy
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Abhisheak Sharma
- Department of Pharmaceutics, University of Florida, Gainesville, FL, United States
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Pootakham W, Yoocha T, Jomchai N, Kongkachana W, Naktang C, Sonthirod C, Chowpongpang S, Aumpuchin P, Tangphatsornruang S. A Chromosome-Scale Genome Assembly of Mitragyna speciosa (Kratom) and the Assessment of Its Genetic Diversity in Thailand. BIOLOGY 2022; 11:biology11101492. [PMID: 36290398 PMCID: PMC9598492 DOI: 10.3390/biology11101492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 12/05/2022]
Abstract
Mitragyna speciosa (Kratom) is a tropical narcotic plant native to Southeast Asia with unique pharmacological properties. Here, we report the first chromosome-scale assembly of the M. speciosa genome. We employed PacBio sequencing to obtain a preliminary assembly, which was subsequently scaffolded using the chromatin contact mapping technique (Hi-C) into 22 pseudomolecules. The final assembly was 692 Mb with a scaffold N50 of 26 Mb. We annotated a total of 39,708 protein-coding genes, and our gene predictions recovered 98.4% of the highly conserved orthologs based on the BUSCO analysis. The phylogenetic analysis revealed that M. speciosa diverged from the last common ancestors of Coffea arabica and Coffea canephora approximately 47.6 million years ago. Our analysis of the sequence divergence at fourfold-degenerate sites from orthologous gene pairs provided evidence supporting a genome-wide duplication in M. speciosa, agreeing with the report that members of the genus Mitragyna are tetraploid. The STRUCTURE and principal component analyses demonstrated that the 85 M. speciosa accessions included in this study were an admixture of two subpopulations. The availability of our high-quality chromosome-level genome assembly and the transcriptomic resources will be useful for future studies on the alkaloid biosynthesis pathway, as well as comparative phylogenetic studies in Mitragyna and related species.
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Affiliation(s)
- Wirulda Pootakham
- National Omics Center, National Science and Technology Development Agency (NSTDA), Pathum Thani 12120, Thailand
| | - Thippawan Yoocha
- National Omics Center, National Science and Technology Development Agency (NSTDA), Pathum Thani 12120, Thailand
| | - Nukoon Jomchai
- National Omics Center, National Science and Technology Development Agency (NSTDA), Pathum Thani 12120, Thailand
| | - Wasitthee Kongkachana
- National Omics Center, National Science and Technology Development Agency (NSTDA), Pathum Thani 12120, Thailand
| | - Chaiwat Naktang
- National Omics Center, National Science and Technology Development Agency (NSTDA), Pathum Thani 12120, Thailand
| | - Chutima Sonthirod
- National Omics Center, National Science and Technology Development Agency (NSTDA), Pathum Thani 12120, Thailand
| | - Srimek Chowpongpang
- National Biobank of Thailand, National Science and Technology Development Agency (NSTDA), Pathum Thani 12120, Thailand
| | - Panyavut Aumpuchin
- National Biobank of Thailand, National Science and Technology Development Agency (NSTDA), Pathum Thani 12120, Thailand
| | - Sithichoke Tangphatsornruang
- National Omics Center, National Science and Technology Development Agency (NSTDA), Pathum Thani 12120, Thailand
- Correspondence:
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38
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Tobacyk J, Parks BJ, Lovelady N, Brents LK. Qualitative content analysis of public responses to an FDA inquiry on the impact of scheduling changes to kratom. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103817. [PMID: 35952436 PMCID: PMC10243221 DOI: 10.1016/j.drugpo.2022.103817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The legal status of kratom in the United States is complex and varies by state. The U.S. Food and Drug Administration (FDA) and the U.S. Drug Enforcement Administration have repeatedly subjected kratom to regulatory review. However, there hasn't been a systematic review of the public's perception of kratom. The present study analyzed open-ended responses from the public to an FDA solicitation for information regarding kratom with the goal of providing a comprehensive assessment of motives for kratom use. METHODS To guide decisions regarding kratom regulation, the FDA solicited comments regarding kratom abuse potential, medical usefulness, and impact of scheduling changes from July through August 2021 and posted them to the Federal Register website. We analyzed comments posted during the first 6 weeks of comment solicitation (6,353) using an inductive approach via qualitative content analysis. RESULTS Respondents reported 106 independent health-related reasons for kratom use, with most categorized as mental health, pain management, substance use disorder, or miscellaneous purposes that included increasing focus, treating insomnia, and decreasing fatigue. Neurological diseases and digestive disorders were also reported. Relatively few (< 2%) responses reported recreational use, abuse potential, or adverse effects of kratom. CONCLUSIONS Although kratom is not approved as a safe and effective therapy for any indication, individuals use kratom for a broad spectrum of health-related purposes. Limitations of this study include potential bias for respondents with perceived positive experiences using kratom, lack of demographics data, and lack of independent verification of claims made by respondents. Regardless, this study reflects perceptions regarding the therapeutic uses of kratom and provides insight into potential individual-level consequences of regulating kratom in the U.S. It is important to study the public's perception of kratom use, which can aid regulatory purposes and provide clinically important information on individuals' use and valuation of kratom.
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Affiliation(s)
- Julia Tobacyk
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Mail Slot 611, Little Rock, AR 72205, USA.
| | - Brian J Parks
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Mail Slot 611, Little Rock, AR 72205, USA
| | - Nakita Lovelady
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Mail Slot 820, Little Rock, AR 72205, USA
| | - Lisa K Brents
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Mail Slot 611, Little Rock, AR 72205, USA
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Schwensohn C, Nsubuga J, Cronquist L, Jose G, Mastel L, McCullough L, Smith L, Powell M, Booth H, Allen K, Classon A, Gieraltowski L. A Multiple-Serotype Outbreak of Salmonella Infections Linked to Kratom, United States, 2017-2018. Foodborne Pathog Dis 2022; 19:648-653. [PMID: 35917511 PMCID: PMC10961741 DOI: 10.1089/fpd.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In early 2018, we investigated a large national multiple-serotype Salmonella outbreak linked to contaminated kratom, a raw minimally processed botanical substance. Kratom is a plant consumed for its stimulant effects and as an opioid substitute. A case was defined as a laboratory-confirmed Salmonella infection with one of the outbreak strains (serotypes I 4,[5],12:b:-, Heidelberg, Javiana, Okatie, Weltevreden, or Thompson) with illnesses onset during January 11, 2017-May 8, 2018. State and local officials collected detailed information on product consumption and sources. Suspected products were tested for Salmonella and traceback was conducted to determine product distribution chains and suppliers. We identified 199 cases from 41 states; 54 patients were hospitalized. Early interviews indicated kratom was an exposure of interest. Seventy-six (74%) of 103 people interviewed reported consuming kratom in pills, powders, or teas. Multiple serotypes of Salmonella were detected in samples of kratom collected from the homes of the patients and from retail locations. Several companies issued recalls of kratom products due to Salmonella contamination. To the authors' knowledge, this investigation is the first to establish kratom as a vehicle for Salmonella infection. Our findings underscore the serious safety concerns regarding minimally processed botanical substances intended for oral consumption and the challenges in investigating outbreaks linked to novel outbreak vehicles.
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Affiliation(s)
- Colin Schwensohn
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Johnson Nsubuga
- Coordinated Outbreak Response and Evaluation Network, Food and Drug Administration, College Park, Maryland, USA
| | - Laura Cronquist
- North Dakota Department of Health, Bismarck, North Dakota, USA
| | - Gino Jose
- North Dakota Department of Health, Bismarck, North Dakota, USA
| | - Laura Mastel
- North Dakota Department of Health, Bismarck, North Dakota, USA
| | | | - Lori Smith
- Utah Department of Health, Salt Lake City, Utah, USA
| | | | - Hillary Booth
- Oregon Public Health Division, Portland, Oregon, USA
| | - Krisandra Allen
- Washington State Department of Health, Shoreline, Washington, USA
| | - Andrew Classon
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Gieraltowski
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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40
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Powell LR, Ryser TJ, Morey GE, Cole R. Kratom as a novel cause of photodistributed hyperpigmentation. JAAD Case Rep 2022; 28:145-148. [PMID: 36187435 PMCID: PMC9523091 DOI: 10.1016/j.jdcr.2022.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Landon R. Powell
- Department of Biology, Whitworth University, Spokane, Washington
| | - Ted J. Ryser
- Dermatology and Laser Center of Canyon County, Nampa, Idaho,Correspondence to: Ted J. Ryser, MD, Dermatology and Laser Center of Canyon County, 318 2nd St. S., Nampa, ID 83651.
| | | | - Ryan Cole
- Cole Diagnostics, Garden City, Idaho
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Manwill PK, Flores-Bocanegra L, Khin M, Raja HA, Cech NB, Oberlies NH, Todd DA. Kratom (Mitragyna speciosa) Validation: Quantitative Analysis of Indole and Oxindole Alkaloids Reveals Chemotypes of Plants and Products. PLANTA MEDICA 2022; 88:838-857. [PMID: 35468648 PMCID: PMC9343938 DOI: 10.1055/a-1795-5876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Many consumers are turning to kratom (Mitragyna speciosa) to self-manage pain and opioid addiction. In the United States, an array of capsules, powders, and loose-leaf kratom products are readily available. Additionally, several online sites supply live kratom plants. A prerequisite to establishing quality control and quality assurance standards for the kratom industry, or understanding how alkaloid levels effect clinical outcomes, is the identification and quantitation of major and minor alkaloid constituents within available products and preparations. To this end, an ultra-high performance liquid chromatography-high resolution mass spectrometry method was developed for the analysis of 8 indole alkaloids (7-hydroxymitragynine, ajmalicine, paynantheine, mitragynine, speciogynine, isopaynantheine, speciociliatine, and mitraciliatine) and 6 oxindole alkaloids (isomitraphylline, isospeciofoleine, speciofoline, corynoxine A, corynoxeine, and rhynchophylline) in US-grown kratom plants and commercial products. These commercial products shared a qualitatively similar alkaloid profile, with 12 - 13 detected alkaloids and high levels of the indole alkaloid mitragynine (13.9 ± 1.1 - 270 ± 24 mg/g). The levels of the other major alkaloids (paynantheine, speciociliatine, speciogynine, mitraciliatine, and isopaynantheine) and the minor alkaloids varied in concentration from product to product. The alkaloid profile of US-grown M. speciosa "Rifat" showed high levels of the indole alkaloid speciogynine (7.94 ± 0.83 - 11.55 ± 0.18 mg/g) and quantifiable levels of isomitraphylline (0.943 ± 0.033 - 1.47 ± 0.18 mg/g). Notably, the alkaloid profile of a US-grown M. speciosa seedling was comparable to the commercial products with a high level of mitragynine (15.01 ± 0.20 mg/g). This work suggests that there are several M. speciosa chemotypes.
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Affiliation(s)
- Preston K. Manwill
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Laura Flores-Bocanegra
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Manead Khin
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Huzefa A. Raja
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Nadja B. Cech
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Nicholas H. Oberlies
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC, USA
- Dr. Nicholas H. Oberlies University of North Carolina at GreensboroDepartment of Chemistry and
Biochemistry301 McIver St. – Sullivan Science Building27402 Greensboro
NCUSA+ 1 33 63 34 54 74+ 1 33 63 34 54 02
| | - Daniel A. Todd
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC, USA
- Correspondence Dr. Daniel A Todd University of North Carolina at GreensboroDepartment of Chemistry and
Biochemistry301 McIver St. – Sullivan Science Building27402 Greensboro
NCUSA+ 1 33 63 34 47 68+ 1 33 63 34 54 02
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Public Health Implications and Possible Sources of Lead (Pb) as a Contaminant of Poorly Regulated Kratom Products in the United States. TOXICS 2022; 10:toxics10070398. [PMID: 35878303 PMCID: PMC9320411 DOI: 10.3390/toxics10070398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
Kratom (Mitragyna speciosa) is a tropical tree that is indigenous to Southeast Asia. Kratom leaf products have been used in traditional folk medicine for their unique combination of stimulant and opioid-like effects. Kratom is being increasingly used in the West for its reputed benefits in the treatment of pain, depression, and opioid use disorder (OUD). Recent studies from the United States Food and Drug Administration (FDA, Silver Spring, MD, USA) and our laboratory have shown that many kratom products being sold in the United States are contaminated with potentially hazardous levels of lead (Pb). In this commentary, we discuss the public health implications of the presence of Pb in kratom products, particularly as they relate to the predicted levels of Pb exposure among kratom users. We also considered the specific toxic effects of Pb and how they might relate to the known physiologic and toxicologic effects of kratom. Finally, we consider the possible sources of Pb in kratom products and suggest several areas for research on this issue.
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Kamble SH, Berthold EC, Kanumuri SRR, King TI, Kuntz MA, León F, Mottinelli M, McMahon LR, McCurdy CR, Sharma A. Metabolism of Speciociliatine, an Overlooked Kratom Alkaloid for its Potential Pharmacological Effects. AAPS J 2022; 24:86. [PMID: 35854066 PMCID: PMC9932950 DOI: 10.1208/s12248-022-00736-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/05/2022] [Indexed: 01/21/2023] Open
Abstract
Speciociliatine, a diastereomer of mitragynine, is an indole-based alkaloid found in kratom (Mitragyna speciosa). Kratom has been widely used for the mitigation of pain and opioid dependence, as a mood enhancer, and/or as an energy booster. Speciociliatine is a partial µ-opioid agonist with a 3-fold higher binding affinity than mitragynine. Speciociliatine has been found to be a major circulating alkaloid in humans following oral administration of a kratom product. In this report, we have characterized the metabolism of speciociliatine in human and preclinical species (mouse, rat, dog, and cynomolgus monkey) liver microsomes and hepatocytes. Speciociliatine metabolized rapidly in monkey, rat, and mouse hepatocytes (in vitro half-life was 6.6 ± 0.2, 8.3 ± 1.1, 11.2 ± 0.7 min, respectively), while a slower metabolism was observed in human and dog hepatocytes (91.7 ± 12.8 and > 120 min, respectively). Speciociliatine underwent extensive metabolism, primarily through monooxidation and O-demethylation metabolic pathways in liver microsomes and hepatocytes across species. No human-specific or disproportionate metabolites of speciociliatine were found in human liver microsomes. The metabolism of speciociliatine was predominantly mediated by CYP3A4 with minor contributions by CYP2D6.
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Affiliation(s)
- Shyam H. Kamble
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, USA,Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, FL, USA
| | - Erin C. Berthold
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Siva Rama Raju Kanumuri
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, USA,Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, FL, USA
| | - Tamara I. King
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, USA,Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, FL, USA
| | - Michelle A. Kuntz
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, USA,Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, FL, USA
| | - Francisco León
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Marco Mottinelli
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | | | - Christopher R. McCurdy
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, USA,Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, FL, USA,Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, USA,Corresponding Author Abhisheak Sharma, M. Pharm., Ph.D., UF CTSI, Translational Drug Development Core, Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA. , Phone: 352-294-8690, Christopher R. McCurdy, Ph.D., FAAPS, UF CTSI, Translational Drug Development Core, Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA. , Phone: 352-294-8691
| | - Abhisheak Sharma
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, 32610, USA. .,Translational Drug Development Core, Clinical and Translational Sciences Institute, University of Florida, Gainesville, FL, 32610, USA.
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The Reshaping of the E-Cigarette Retail Environment: Its Evolution and Public Health Concerns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148518. [PMID: 35886373 PMCID: PMC9319677 DOI: 10.3390/ijerph19148518] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 02/04/2023]
Abstract
E-cigarette use represents a public health controversy in the US and globally. Despite the potential of e-cigarettes to support cigarette cessation, their use increases health risks and risk for addiction, particularly in young people. Various federal, state, and local laws have impacted tobacco retail in general and e-cigarettes in particular. In the US, 2019–2020 federal laws increased in the minimum legal sales age for tobacco to 21 and banned flavored cartridge-based e-cigarettes. Many states and localities were early adopters of Tobacco 21 and implemented more comprehensive flavor restrictions than the federal ban. Meanwhile, cannabis retail is increasingly being legalized in the US—while cannabis-based product regulation has notable gaps at the federal, state, and local levels. These regulatory complexities have impacted specialized retailers selling e-cigarettes, including “vape shops” that exclusively sell e-cigarettes, “smoke shops” that sell e-cigarettes and other tobacco (and potentially CBD/THC and other un- or under-regulated products), and online retail. This commentary outlines public health concerns related to: (1) youth access; (2) consumer exposure to a broader range of tobacco products and marketing in retail settings where they may seek products to aid in cigarette cessation (i.e., such broad product exposure could hinder cessation attempts); (3) consumer exposure to un-/under-regulated products (e.g., delta-8-THC, kratom); and (4) federal, state, and local regulations being undermined by consumer access to prohibited products online and via the mail. These concerns underscore the need for ongoing surveillance of how retailers and consumers respond to regulations.
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Reich N, Salvo G, Leong D, Wan V, Kosatsky T. Kratom exposures managed by the British Columbia poison centre, 2012-2019: a descriptive analysis. CMAJ Open 2022; 10:E755-E761. [PMID: 35973710 PMCID: PMC9388216 DOI: 10.9778/cmajo.20210252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Kratom, a plant indigenous to Southeast Asia, which has been used both recreationally and in the treatment of pain and opioid dependence, has received little scrutiny in the United States and almost none in Canada. We analyzed calls to the British Columbia poison centre to describe caller-declared exposures to kratom and the acute health effects of these exposures. METHODS For this descriptive analysis, we accessed electronic records, including transcriptions and extracted variables, of calls specifying kratom exposure managed by the BC Drug and Poison Information Centre (DPIC) from 2012 to 2019. We describe changes in case numbers, reasons for exposure, concurrent drug exposures and clinical outcomes over the study period. RESULTS We identified 32 cases during the study period. In 23 cases (72%), the DPIC was consulted by a health care worker. Case numbers increased from 0 in 2012 to 9 in 2019. Numbers were highest for males in their 20s (n = 17, 53%). A total of 27 cases (84%) involved ingestion, with online distributors and local stores named as sources of procurement. A concurrent drug exposure was identified in 13 (41%) cases. There were no deaths; in 1 case, the exposed individual was intubated to manage agitation following kratom withdrawal. INTERPRETATION We observed a steady increase in kratom-related poison centre calls from 2012 to 2019, especially in young adult males. Rising call numbers may reflect increasing availability of kratom and may be a consequence of BC's opioid crisis, with kratom used by some to lessen symptoms of opioid withdrawal.
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Affiliation(s)
- Noah Reich
- Faculty of Medicine (Reich), University of British Columbia, Vancouver, BC; Faculty of Medicine (Salvo), University of Calgary, Calgary, Alta.; British Columbia Drug and Poison Information Centre (Leong); British Columbia Centre for Disease Control (Wan, Kosatsky), Vancouver, BC
| | - Grazia Salvo
- Faculty of Medicine (Reich), University of British Columbia, Vancouver, BC; Faculty of Medicine (Salvo), University of Calgary, Calgary, Alta.; British Columbia Drug and Poison Information Centre (Leong); British Columbia Centre for Disease Control (Wan, Kosatsky), Vancouver, BC
| | - Dennis Leong
- Faculty of Medicine (Reich), University of British Columbia, Vancouver, BC; Faculty of Medicine (Salvo), University of Calgary, Calgary, Alta.; British Columbia Drug and Poison Information Centre (Leong); British Columbia Centre for Disease Control (Wan, Kosatsky), Vancouver, BC
| | - Victoria Wan
- Faculty of Medicine (Reich), University of British Columbia, Vancouver, BC; Faculty of Medicine (Salvo), University of Calgary, Calgary, Alta.; British Columbia Drug and Poison Information Centre (Leong); British Columbia Centre for Disease Control (Wan, Kosatsky), Vancouver, BC
| | - Tom Kosatsky
- Faculty of Medicine (Reich), University of British Columbia, Vancouver, BC; Faculty of Medicine (Salvo), University of Calgary, Calgary, Alta.; British Columbia Drug and Poison Information Centre (Leong); British Columbia Centre for Disease Control (Wan, Kosatsky), Vancouver, BC
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46
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Grundmann O, Hendrickson RG, Greenberg MI. Kratom: History, pharmacology, current user trends, adverse health effects and potential benefits. Dis Mon 2022; 69:101442. [PMID: 35732553 DOI: 10.1016/j.disamonth.2022.101442] [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: 11/30/2022]
Abstract
Kratom (Mitragyna speciosa Korth.) is a tree native to Southeast Asia with dose-dependent stimulant and opioid-like effects. Dried, powdered leaf material is among the kratom products most commonly consumed in the US and Europe, but other formulations also exist including enriched extracts, resins, tinctures, and edibles. Its prevalence in the US remains debated and the use pattern includes self-treatment of mood disorders, pain, and substance use disorders. Most of the adverse effects of kratom and its alkaloid mitragynine have been reported in the literature as case reports or part of surveys necessitating confirmation by clinical trials. Toxicities associated with kratom consumption have focused on hepatic, cardiac, and CNS effects with the potential to cause fatalities primarily as part of polydrug exposures. Kratom may also present with drug-drug interactions primarily through CYP 3A4 and 2D6 inhibition, although the clinical significance remains unknown to date. The variability in composition of commercially available kratom products complicates generalization of findings and requires further investigation by employing clinical trials. Healthcare professionals should remain cautious in counseling patients on the use of kratom in a therapeutic setting.
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Affiliation(s)
- Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, 1345 Center Drive, Room P3-20, Gainesville, FL 32611, United States.
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Striley CW, Hoeflich CC, Viegas AT, Berkowitz LA, Matthews EG, Akin LP, Iheanyi-Okeahialam C, Mansoor U, McCurdy CR. Health Effects Associated With Kratom ( Mitragyna speciosa) and Polysubstance Use: A Narrative Review. Subst Abuse 2022; 16:11782218221095873. [PMID: 35645563 PMCID: PMC9130800 DOI: 10.1177/11782218221095873] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/01/2022] [Indexed: 11/15/2022]
Abstract
Background Kratom (Mitragyna speciosa) consumption and associated health effects have raised debates in the United States. Although most people using this herb do not experience adverse health effects associated with kratom use, medical providers should be knowledgeable of emerging substances and concurrent, sequential, or simultaneous use of other drugs which may impact healthcare recommendations and prescribing practices. Methods The objective of this narrative review was to elucidate selected health effects associated with using kratom-either alone or with other substances. Since scientifically controlled human subjects research on kratom use is still limited, relevant case reports were also described. Results Cardiovascular, gastrointestinal, neurological, and psychiatric effects associated with kratom use were especially notable, and in-utero exposure accompanied concern regarding a neonate's risk for developing neonatal abstinence syndrome. Our ability to identify and understand the role of this herb in kratom-associated fatalities is complicated since kratom is not routinely screened for in standard forensic toxicology. If a screening is performed, it is usually for the major alkaloid, mitragynine, as a surrogate for kratom use. In addition to lacking a standard practice of screening decedents for kratom alkaloids, the association between mortality and kratom use may be confounded by polysubstance use, adulteration of kratom products, and drug-herb interactions. Conclusions Increasing medical awareness of this herb is vital to ensuring prompt administration of best-practice medical advice or treatment for people seeking information related to kratom use or for patients experiencing an adverse health effect that may be associated with using or withdrawing from kratom. Knowledge gained from continued surveillance and study of kratom and its associated health effects may assist in guiding clinical decision-making and preventing development of adverse health effects among people using kratom.
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Affiliation(s)
- Catherine W Striley
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Carolin C Hoeflich
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Andrew T Viegas
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.,College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Lindsey A Berkowitz
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Occupational Therapy, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Emily G Matthews
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Leyla P Akin
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Anthropology, London School of Economics and Political Science, London, England, UK
| | - Chidinma Iheanyi-Okeahialam
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Urmeen Mansoor
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.,College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Christopher R McCurdy
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, USA
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Hughes S, van de Klashorst D, Veltri CA, Grundmann O. Acute, Sublethal, and Developmental Toxicity of Kratom ( Mitragyna speciosa Korth.) Leaf Preparations on Caenorhabditis elegans as an Invertebrate Model for Human Exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6294. [PMID: 35627831 PMCID: PMC9140534 DOI: 10.3390/ijerph19106294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022]
Abstract
Kratom (Mitragyna speciosa Korth.) is a tree native to Southeast Asia with stimulant and opioid-like effects which has seen increased use in Europe and North America in recent years. Its safety and pharmacological effects remain under investigation, especially in regard to developmental and generational toxicity. In the current study, we investigated commercial kratom preparations using the nematode Caenorhabditis elegans as a translational model for toxicity and pharmacological effects. The pure alkaloids mitragynine and 7-hydroxymitragynine as well as aqueous, ethanolic, and methanolic extracts of three commercial kratom products were evaluated using a battery of developmental, genotoxic, and opioid-related experiments. As determined previously, the mitragynine and 7-hydroxymitragynine content in kratom samples was higher in the alcoholic extracts than the aqueous extracts. Above the human consumption range equivalent of 15-70 µg/mL, kratom dose-dependently reduced brood size and health of parent worms and their progeny. 7-hydroxymitragynine, but not mitragynine, presented with toxic and developmental effects at very high concentrations, while the positive control, morphine, displayed toxic effects at 0.5 mM. Kratom and its alkaloids did not affect pumping rate or interpump interval in the same way as morphine, suggesting that kratom is unlikely to act primarily via the opioid-signalling pathway. Only at very high doses did kratom cause developmental and genotoxic effects in nematodes, indicating its relative safety.
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Affiliation(s)
- Samantha Hughes
- A-LIFE Amsterdam Institute for Life and Environment, Section Environmental Health and Toxicology, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | | | - Charles A. Veltri
- Department of Pharmaceutical Sciences, College of Pharmacy, Midwestern University, Glendale, AZ 85308, USA;
| | - Oliver Grundmann
- Department of Pharmaceutical Sciences, College of Pharmacy, Midwestern University, Glendale, AZ 85308, USA;
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
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Association between kratom (Mitragyna speciosa) use and metabolic syndrome. Heliyon 2022; 8:e09468. [PMID: 35615431 PMCID: PMC9124704 DOI: 10.1016/j.heliyon.2022.e09468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/20/2022] [Accepted: 05/13/2022] [Indexed: 11/20/2022] Open
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50
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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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