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REVIEW article

Front. Pharmacol.
Sec. Experimental Pharmacology and Drug Discovery
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1403140

Revised following review For Frontiers in Pharmacology, Section: Experimental Pharmacology and Drug Discovery. Kratom Safety and Toxicology in the Public Health Context: Research Needs to Better Inform Regulation

Provisionally accepted
Jack E. Henningfield Jack E. Henningfield 1,2*Oliver Grundmann Oliver Grundmann 3Marilyn A. Huestis Marilyn A. Huestis 4Kirsten E. Smith Kirsten E. Smith 2
  • 1 Pinney Associates, Inc., Bethesda, United States
  • 2 School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
  • 3 College of Pharmacy, University of Florida, Gainesville, Florida, United States
  • 4 Thomas Jefferson University, Philadelphia, Pennsylvania, United States

The final, formatted version of the article will be published soon.

    Although kratom use has been part of life for centuries in Southeast Asia, the availability and use of kratom in the United States (US) increased substantially since the early 2000s when there was little information on kratom pharmacology, use patterns, and effects, all critical to guiding regulation and policy. Here we provide a synthesis of research with several hundred English-language papers published in the past five years drawing from basic research, epidemiological and surveillance data, and recent clinical research. This review of available literature aims to provide an integrated update regarding our current understanding of kratom's benefits, risks, pharmacology, and epidemiology, which may inform US-based kratom regulation. Recent surveillance indicates there are likely several million past-year kratom consumers, though estimates vary widely. Even without precise prevalence data, kratom use is no longer a niche, with millions of US adults using it for myriad reasons. Despite its botanical origins in the coffee tree family and its polypharmacy, kratom is popularly characterized as an opioid with presumed opioid-system-based risks for addiction or overdose. Neuropharmacology, toxicology, and epidemiology studies show that kratom is more accurately characterized as a substance with diverse and complex pharmacology. Taken together the work reviewed here provides a foundation for future scientific studies, as well as a guide for ongoing efforts to regulate kratom. This work also informs much-needed federal oversight, including by the US Food and Drug Administration. We conclude with recommendations for kratom regulation and research priorities needed to address current policy and knowledge gaps around this increasingly used botanical product.

    Keywords: A crosssectional, Ecological Momentary Assessment, and simulated driving study. Traffic Injury Prevention, mitragynine, abuse potential, dependence, Toxicology, Epidemiology

    Received: 18 Mar 2024; Accepted: 30 Apr 2024.

    Copyright: © 2024 Henningfield, Grundmann, Huestis and Smith. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Jack E. Henningfield, Pinney Associates, Inc., Bethesda, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.