Examining the paradoxical effects of kratom: a narrative inquiry
Introduction: Surveys and case reports have documented kratom use in the United States (US) for over a decade. However, those reports have generally not examined in depth the role kratom plays in the lives of those who use it regularly for sustained periods. Until there are controlled studies of the...
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Pharmacology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2023.1174139/full |
| _version_ | 1827953654366208000 |
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| author | Kirsten E. Smith Jeffrey D. Feldman Kelly E. Dunn Christopher R. McCurdy Stephanie T. Weiss Oliver Grundmann Albert Garcia-Romeu Janeen Nichels David H. Epstein |
| author_facet | Kirsten E. Smith Jeffrey D. Feldman Kelly E. Dunn Christopher R. McCurdy Stephanie T. Weiss Oliver Grundmann Albert Garcia-Romeu Janeen Nichels David H. Epstein |
| author_sort | Kirsten E. Smith |
| collection | DOAJ |
| description | Introduction: Surveys and case reports have documented kratom use in the United States (US) for over a decade. However, those reports have generally not examined in depth the role kratom plays in the lives of those who use it regularly for sustained periods. Until there are controlled studies of the pharmacology and subjective effects of kratom alkaloids in humans, one of the best sources of insight on kratom-product use remains qualitative data with nuanced descriptions of kratom effects from those who use it regularly.Method: We conducted semistructured qualitative interviews with adults who regularly use kratom products, as part of a laboratory study of kratom-product self-administration. This qualitative component of the study was conducted as a narrative case-report series (n = 10).Results: Despite some differences among participants, all experienced acute combination effects that were largely, even simultaneously, analgesic and stimulatory. Most participants had decreased their dosages over time, and one planned to quit. Five of the 10 participants met DSM-5-based criteria for kratom-use disorder (3 mild, 1 moderate, 1 severe, by symptoms counts). When kratom was inadvertently taken in larger than intended doses, participants described a constellation of symptoms that they called “the wobbles” (a jittery feeling accompanied by what seemed to be nystagmus); this was rare, but could be of scientific and clinical interest as a possible manifestation of serotonin syndrome. Most participants described tolerance but considered kratom generally safe at low-moderate doses, providing perceived benefits with less potential risk for adverse effects compared to pharmaceuticals or illicit drugs.Discussion: In-depth interview data like these help confirm and clarify findings from larger survey studies and clinician-driven case reports. They are needed to inform the policy practice regarding kratom and may also help inform future experimental designs. |
| first_indexed | 2024-04-09T14:16:56Z |
| format | Article |
| id | doaj.art-0143ccc329074b3a935050842eb0952c |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-04-09T14:16:56Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-0143ccc329074b3a935050842eb0952c2023-05-05T05:54:56ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122023-05-011410.3389/fphar.2023.11741391174139Examining the paradoxical effects of kratom: a narrative inquiryKirsten E. Smith0Jeffrey D. Feldman1Kelly E. Dunn2Christopher R. McCurdy3Stephanie T. Weiss4Oliver Grundmann5Albert Garcia-Romeu6Janeen Nichels7David H. Epstein8Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United StatesReal-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United StatesDepartment of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDepartment of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United StatesDepartment of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United StatesDepartment of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United StatesDepartment of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesReal-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United StatesReal-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United StatesIntroduction: Surveys and case reports have documented kratom use in the United States (US) for over a decade. However, those reports have generally not examined in depth the role kratom plays in the lives of those who use it regularly for sustained periods. Until there are controlled studies of the pharmacology and subjective effects of kratom alkaloids in humans, one of the best sources of insight on kratom-product use remains qualitative data with nuanced descriptions of kratom effects from those who use it regularly.Method: We conducted semistructured qualitative interviews with adults who regularly use kratom products, as part of a laboratory study of kratom-product self-administration. This qualitative component of the study was conducted as a narrative case-report series (n = 10).Results: Despite some differences among participants, all experienced acute combination effects that were largely, even simultaneously, analgesic and stimulatory. Most participants had decreased their dosages over time, and one planned to quit. Five of the 10 participants met DSM-5-based criteria for kratom-use disorder (3 mild, 1 moderate, 1 severe, by symptoms counts). When kratom was inadvertently taken in larger than intended doses, participants described a constellation of symptoms that they called “the wobbles” (a jittery feeling accompanied by what seemed to be nystagmus); this was rare, but could be of scientific and clinical interest as a possible manifestation of serotonin syndrome. Most participants described tolerance but considered kratom generally safe at low-moderate doses, providing perceived benefits with less potential risk for adverse effects compared to pharmaceuticals or illicit drugs.Discussion: In-depth interview data like these help confirm and clarify findings from larger survey studies and clinician-driven case reports. They are needed to inform the policy practice regarding kratom and may also help inform future experimental designs.https://www.frontiersin.org/articles/10.3389/fphar.2023.1174139/fullkratomemerging drugsnovel substanceskratom toleranceopioids |
| spellingShingle | Kirsten E. Smith Jeffrey D. Feldman Kelly E. Dunn Christopher R. McCurdy Stephanie T. Weiss Oliver Grundmann Albert Garcia-Romeu Janeen Nichels David H. Epstein Examining the paradoxical effects of kratom: a narrative inquiry Frontiers in Pharmacology kratom emerging drugs novel substances kratom tolerance opioids |
| title | Examining the paradoxical effects of kratom: a narrative inquiry |
| title_full | Examining the paradoxical effects of kratom: a narrative inquiry |
| title_fullStr | Examining the paradoxical effects of kratom: a narrative inquiry |
| title_full_unstemmed | Examining the paradoxical effects of kratom: a narrative inquiry |
| title_short | Examining the paradoxical effects of kratom: a narrative inquiry |
| title_sort | examining the paradoxical effects of kratom a narrative inquiry |
| topic | kratom emerging drugs novel substances kratom tolerance opioids |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2023.1174139/full |
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