Understanding Kratom: A Look at a Prohibitionist Stance from a decade ago

“Kratom: A New Product in an Expanding Substance Abuse Market“

An article with a prohibitionist tone published in PUBMED in 2016 titled “Kratom: A New Product in an Expanding Substance Abuse Market” sheds light on various aspects of kratom, including its rising popularity and the challenges it presented. It was published in 2016 just as the DEA decided to back down on the prohibition of Kratom at a federal level. Almost a decade later, it's worth reading and comparing the predictions it made with the reality we see on the ground.

The article emphasizes the potential dangers and concerns surrounding kratom’s increasing use. It highlights the substance’s opioid-like effects and the risks associated with its unregulated status, pointing out that much of the available information and anecdotal evidence came from online sources rather than formal research. The tone of the article is distinctly cautionary, focusing on the substance’s potential for abuse and the need for healthcare providers to be aware of its effects and withdrawal symptoms.

It presents protocols for treating Kratom intoxication at low and high doses:

At moderate-to-high doses (5 g–15 g of raw crushed leaves), it is believed that the μ opiate receptor agonism overtakes the stimulant effects, leading to the euphoria, relaxation, and analgesia seen with conventional opioid use and abuse.^2,10 In light of the drug’s substantial binding and agonism of all opioid receptors, constipation and itching also are seen.² As such, if an individual is intoxicated, he or she should be managed symptomatically with judicious use of benzodiazepines and continuous monitoring of heart rate, blood pressure, respiratory rate, and oxygen saturation.^2,10 Kratom intoxication can precipitate psychotic episodes similar to those caused by opiate intoxication, so monitoring for agitation or psychotic behaviors is also indicated.^9,10The medical management of an acute kratom overdose (typically requiring ingestion of > 15 g of crushed leaves) begins with addressing airway blockage, breathing, and circulation along with continuous vital sign monitoring and laboratory testing, including point-of-care glucose, complete blood count, electrolytes, lactate, venous blood gas, and measurable drug levels (ethanol, acetaminophen, tricyclic antidepressants, etc).¹¹ If it is determined that kratom was the intoxicant, the greatest concern of death is similar to that of opioid overdose: respiratory depression. Although there are no large-scale human studies demonstrating efficacy, multiple authors suggest the use of naloxone in kratom-related hypoventilation.^9,10

It is crucial to approach discussions around substances like kratom with an open mind. While this article presents a perspective that highlights potential harms and regulatory concerns, it’s equally important to acknowledge that there are various viewpoints and experiences. Hearing both sides of the discussion, including user testimonials and different scientific or sociological analyses, is vital for a comprehensive understanding of kratom’s role and impact. Engaging with diverse perspectives allows for a more nuanced and informed conversation about the substance, its uses, and its regulation.