Title:Kratom Dependence and Treatment Options: A Comprehensive Review of the Literature
Volume: 21
Issue: 15
Author(s): Mohammad Farris Iman Leong Bin Abdullah*
Affiliation:
- Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, SAINS@BERTAM, 13200 Kepala Batas, Pulau Pinang,Malaysia
Keywords:
Kratom, kratom withdrawal, kratom dependence, neurobiology of kratom dependence, pathophysiology of kratom
dependence, treatment of kratom dependence, mitragynine, 7-hydroxymitragynine.
Abstract: Kratom, or Mitragyna speciosa Korth., is a tropical plant prevalent in Southeast Asia, and it
is utilized as a traditional remedy for symptomatic relief of various illnesses. It has been labeled as an
atypical opioid with significant narcotic-like properties, capable of inducing kratom dependence
among those who misuse or abuse it. The prevalence of kratom use has drastically increased worldwide,
raising concerns among healthcare providers, particularly regarding the availability of efficacious
treatment options for kratom dependence. This manuscript provides a comprehensive narrative
review of literature focusing on the psychoactive alkaloids of kratom, the possible neurobiological and
pathophysiological models underlying the occurrence of kratom dependence, and the clinical presentations
and effective treatment options available for kratom dependence. The psychoactive alkaloids of
kratom, such as mitragynine (MG) and 7-hydroxymitragynine (7-HMG), act as partial mu opioid agonists
and induce kratom dependence. As a result, regular kratom use leads to withdrawal symptoms on
abstinence, along with craving, tolerance, and cross-tolerance to morphine. The psychological withdrawal
symptoms reported include depressed mood, anxiety, restlessness, irritability, and feeling
tense, while the physical withdrawal symptoms are myalgia and body ache, joint pain, lacrimation,
running nose, yawning, insomnia, diarrhea, feverish sensation, loss of appetite, tremors, itching over
the body, loss of concentration, and chills. Neonatal withdrawal symptoms, such as oral intolerance,
restlessness, irritability, and vomiting, are also reported in newborns of women who are on regular
kratom use. Sublingual buprenorphine-naloxone (Suboxone) is reported as a promising treatment for
detoxification and maintenance replacement therapy for kratom-dependent users. Alternative treatments
for in-patient detoxification include intravenous clonidine and a combination of oral dihydrocodeine
and lofexidine. We conclude by adding a note on the research gap concerning kratom dependence,
which future studies should focus on.
