Kratom (Mitragyna speciosa): worldwide issues.

@article{Ramanathan2020KratomS,
  title={Kratom (Mitragyna speciosa): worldwide issues.},
  author={Surash Ramanathan and Christopher R. McCurdy},
  journal={Current Opinion in Psychiatry},
  year={2020}
}
PURPOSE OF REVIEW To inform readers about the increasingly popular Western dietary supplement, kratom (Mitragyna speciosa) and how the products are available in the Western world compared with traditional Southeast Asian use. Kratom has been traditionally used for increasing stamina of outdoor laborers (farmers), mood enhancement, pain, and opium addiction. Interestingly, kratom has been reported to have a paradoxical effect in that stimulant feelings, and sedative feelings can be obtained… 
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Eight different kratom products were legally purchased from various “head”/”smoke” shops in the Western Suburbs of Chicago and tested for microbial burden, a panel of metals, and levels of the main psychoactive alkaloid mitragynine, indicating that they were derived from kratom.
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Results suggest that MOR agonists with a G-protein efficacy profile similar to buprenorphine can be developed into opioids that are effective analgesics with greatly reduced liabilities.
Searching for a Signal: Self-Reported Kratom Dose-Effect Relationships Among a Sample of US Adults With Regular Kratom Use Histories
TLDR
The goal was to better understand kratom dosing, changes in routines, and perception of effects, including time to onset, duration, and variability of beneficial and adverse outcomes from use and cessation, to help inform the development of controlled observational and experimental studies needed to advance the public health understanding of kratom product use.

References

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TLDR
It is suggested that chronic kratom administration does not significantly impair social functioning of users in a natural context in Malaysia, despite being dependent on kratom for prolonged periods of time.
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TLDR
It is notable that Kratom can cause herb–drug interactions, especially with other central nervous system -active substances, and consumers may be exposed to adulterated or contaminated products, especially if purchased through websites or the darknet.
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TLDR
The results obtained in drug-naïve mice demonstrate weak behavioral effects mediated via μ and λ opioid receptors, indicating that the analgesic effect is mediated via κ opioid receptors.
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TLDR
It is found that mitragynine is converted in vitro in both mouse and human liver preparations to the much more potent mu-opioid receptor agonist 7-hydroxymitagynine and that this conversion is mediated by cytochrome P450 3A isoforms.
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TLDR
Both Kratom alkaloids are reported to activate supraspinal mu- and delta- opioid receptors, explaining their use by chronic narcotics users to ameliorate opioid withdrawal symptoms.
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