Traditional and non-traditional uses of Mitragynine (Kratom): A survey of the literature

Highlights

• Kratom is bought in local coffee shops (Asean) compared to online (West).

• In both regions, kratom users have shifted to recreational purposes.

• Its legal status differs from countries within each region.

• Side-effects reported in case reports (West) and not in surveys (South East Asia).

Abstract

Introduction

The objective of the paper was to highlight the differences in the traditional and non-traditional users of kratom in the South East Asian and Western contexts.

Method

A literature survey of published kratom studies among humans was conducted. Forty published studies relevant to the objective were reviewed.

Results

Apart from the differences in the sources of supply, patterns of use and social acceptability of kratom within these two regions, the most interesting finding is its evolution to a recreational drug in both settings and the severity of the adverse effects of kratom use reported in the West. While several cases of toxicity and death have emerged in the West, such reports have been non-existent in South East Asia where kratom has had a longer history of use. We highlight the possible reasons for this as discussed in the literature. More importantly, it should be borne in mind that the individual clinical case-reports emerging from the West that link kratom use to adverse reactions or fatalities frequently pertained to kratom used together with other substances. Therefore, there is a danger of these reports being used to strengthen the case for legal sanction against kratom. This would be unfortunate since the experiences from South East Asia suggest considerable potential for therapeutic use among people who use drugs.

Conclusion

Despite its addictive properties, reported side-effects and its tendency to be used a recreational drug, more scientific clinical human studies are necessary to determine its potential therapeutic value.

Introduction

Mitragyna speciosa is a tree that has been reportedly found in the Philippines islands, Borneo and New Guinea (Lee, 1957).¹ However, most published works in the past have focussed on its use in Thailand and Northern Malaya. More recently, reports of kratom use in the West have emerged.

Mitragyna speciosa Korth (M. speciosa) from the Rubiaceae family is a tropical plant and mitragynine and 7-hydroxymitragynine are the active compounds of M. speciosa. Both these alkaloids produce dose-dependent narcotic effects, stimulant effects at lower doses and sedative-like effects at higher doses (Babu et al., 2008). There have been other studies that have reviewed the properties of kratom in detail (Jansen and Prast, 1988a, Hassan et al., 2013, Babu et al., 2008, Adkins et al., 2011, Rosenbaum et al., 2012, Prozialeck et al., 2012 and Cinosi et al., 2015). The tree has been known variously as Katawan, Kratawm, Tawn, in Thailand and as Ketum, Kutum, Bia or Biak in Malaysia (Burkill, 1935). In this paper we will use the widely used name, Kratom, derived from the Thai names for the tree.

This paper provides a broad survey of the well documented traditional uses of kratom and the less well known, non-traditional uses of kratom in Thailand and the northern states of peninsula Malaysia (collectively referred to as South East Asia for convenience) and the US and Europe (collectively termed Western countries). In doing so, we highlight the major differences in the use of kratom in these two different regional contexts.