estimated read time - 14 min
estimated read time - 14 min
Kava and kratom are often compared because they both claim to ease stress, anxiety, and pain. It's no wonder they've gained popularity for their potential mood-boosting and well-being benefits. We've covered a lot about kava in our previous blogs, but in this article, we're going to dive into kratom. We'll explore its history, effects, ways to consume it, and the potential side effects and risks. Plus, we'll touch on a few similarities it shares with kava and what sets them apart.
Kratom, scientifically known as "Mitragyna speciosa," is a tree indigenous to Southeast Asia, specifically Thailand, Indonesia, and Malaysia. Although the precise origin and history of kratom remain undocumented, it is believed that the native people of these regions have been incorporating it into their culture for centuries, holding a significant role in their daily lives.
In Thailand, kratom has traditionally been consumed by workers and farmers as a means to combat fatigue, enhance productivity, and induce stimulating effects. Meanwhile, in Indonesia and Malaysia, kratom has been sought after for its analgesic properties. The leaves are either chewed or brewed to alleviate pain, reduce discomfort, and boost stamina. Additionally, kratom has found use in religious ceremonies and social gatherings.
Presently, kratom has gained popularity beyond its country of origin, thanks to global trade and the increasing prevalence of unregulated online markets.
Mitragyna speciosa or kratom trees can grow up to 82 feet in height and its trunk may grow up to 3ft in diameter. The trunk is generally straight and slender with branching canopy. The leaves of kratom trees are characterized by their dark green and glossy appearance, featuring an ovate shape with 12 to 17 pairs of veins. These leaves can extend up to 8 inches in length and span 5 inches in width. Additionally, the kratom plant produces small, ball-shaped flowers as part of its reproductive process.
Kratom leaves contain a variety of active compounds, with alkaloids being the primary contributors to its effects. Among these alkaloids, the two main ones found in kratom are mitragynine and 7-hydroxymitragynine. These alkaloids interact with opioid receptors in the brain, resulting in effects similar to those produced by opioids. Opioids are a class of substances or drugs commonly used for pain relief, particularly for moderate to severe pain. Opioid receptors, on the other hand, are protein receptors that play a crucial role in the body's response to pain, reward, and other physiological processes.
Mitragynine is the most abundant alkaloid present in kratom and interacts with opioid receptors in the brain, producing effects such as pain relief, sedation, stimulation, and mood enhancement(1). On the other hand, 7-hydroxymitragynine, although less abundant than mitragynine, is considered to be more potent and exhibits stronger analgesic effects(2).
Additionally, kratom contains several other alkaloids in smaller concentrations, including paynantheine, speciociliatine, speciogynine, and ajmalicine (raubasine)(3). While these alkaloids are present in lower quantities, they may also contribute to the analgesic properties of kratom.
Kratom leaves can be consumed in various forms. In the past, fresh leaves were commonly chewed or brewed into a tea. Presently, kratom is available in dried, powdered, or crushed leaf form. It can be ingested by directly swallowing the powder, mixing it with food or beverages, or encapsulating it in a capsule. Some individuals even create kratom extracts to achieve more potent effects.
The effects of kratom can vary depending on factors such as dosage, individual tolerance, the specific strain of the plant, and other variables. It's important to note that not all individuals will have the same experience with kratom.
In general, kratom is known to produce stimulant-like effects. This can include increased energy, enhanced focus, sociability, and a boost in confidence. At higher doses, kratom may act as a sedative, providing pain relief and promoting relaxation. Here are some of the well-known effects associated with kratom:
Analgesia (Pain Relief): Kratom leaves are believed to have analgesic properties. The pain-relieving effects are attributed to kratom's interaction with opioid receptors in the brain. Many individuals use kratom to alleviate symptoms of chronic pain, muscle pain, and discomfort caused by conditions like arthritis.
Stimulation and Energy Boost: Certain strains of kratom, when consumed in smaller doses, are said to produce stimulating effects. Some individuals have reported increased alertness, motivation, and energy levels.
Relaxation and Sedation: Consuming higher doses of specific kratom strains, often referred to as "red vein" or "slow" strains, may induce relaxation and sedation. These strains are more likely to promote a calming effect that can aid with sleep.
Mood Enhancement: Kratom is known to possess mood-lifting properties, creating feelings of euphoria, happiness, and overall well-being. It may also help alleviate anxiety, tension, or depressive symptoms by enhancing mood and fostering a positive mindset.
Increased Sociability and Confidence: Moderate doses of kratom have been reported to boost confidence and sociability. Users have noted feeling more comfortable and at ease during social events.
Focus and Cognitive Enhancement: Some individuals claim that kratom enhances focus, concentration, and cognitive function. It may improve mental clarity and make it easier to complete tasks that require focus and mental acuity.
Additionally, kratom is often marketed as a potential aid for overcoming opioid withdrawal due to its interaction with opioid receptors in the brain. However, it's important to note that while some studies suggest kratom may help alleviate withdrawal symptoms, other research suggests it may worsen existing health issues rather than improve them.
When used responsibly, kratom can be considered relatively safe; however, it is important to be aware of the potential risks it carries. Prolonged and excessive use of kratom may lead to long-term side effects and the development of dependence and addiction.
Here are some potential side effects and risks associated with kratom:
Rare cases of liver injury have been associated with long-term use of kratom. A study examining patients with Drug-Induced Liver Injury (DILI) revealed a small number of cases linked to kratom use. These individuals reported symptoms such as jaundice, abdominal pain, itching, or fever(5). While some patients recovered from these symptoms, others required hospitalization.
In one particular case, a patient with a history of hepatic steatosis and opioid abuse, who had been using kratom for several years to manage opioid dependence, was eventually referred to a liver transplant center for further evaluation and guidance(5).
The exact mechanism by which kratom may cause liver damage remains unclear. However, it is believed that factors such as potential contamination in kratom products or the concurrent use of kratom with other substances could contribute to the adverse effects on the liver.
Excessive and prolonged use of kratom can result in gastrointestinal issues, including symptoms such as nausea, constipation, and decreased appetite. These effects are thought to be linked to the alkaloids in kratom binding to opioid receptors in the digestive system. This interaction can potentially slow down gastrointestinal motility and disrupt normal digestion processes.
Kratom has a lower likelihood of causing respiratory distress compared to opioids. However, it is important to note that consuming kratom in higher doses or combining it with other substances that have sedative properties, such as alcohol, opioids, or benzodiazepines, can potentially result in significant respiratory depression(9).
Furthermore, individuals with a history of respiratory disorders are more susceptible to experiencing respiratory depression triggered by kratom.
Kratom may interact with several medications such as opioids, benzodiazepines, and other central nervous system depressants. Interactions with these medications may intensify the effects of kratom, increase sedation and the risk of respiratory depression.
Let's explore how different medications can potentially interact with kratom:
Cytochrome P450 Enzyme System: Kratom alkaloids, particularly mitragynine, have been found to inhibit certain cytochrome P450 enzymes, which play a crucial role in drug metabolism in the liver. This interaction can affect the metabolism and clearance of certain drugs, potentially impacting their effectiveness and safety(16).
Opioid Medications: Kratom interacts with opioid receptors in the brain and shares similarities with opioid drugs. Combining kratom with other opioid medications like oxycodone, hydrocodone, or morphine may increase the risk of respiratory depression and other opioid-related side effects. Additionally, it can potentially lead to increased addictive effects.
Central Nervous System Depressants: Kratom has sedative effects, and combining it with central nervous system depressants such as benzodiazepines, alcohol, or medications for insomnia, anxiety, and panic attacks can intensify its effects. This combination may result in extreme sedation, respiratory depression, and impaired cognitive function(17).
Stimulants: The stimulating properties of kratom may interact with other stimulant medications like amphetamines (e.g., Adderall) or caffeine. This combination can potentially lead to overstimulation, an increase in heart rate, and elevated blood pressure.
Antidepressants and Anti-Anxiety Medications: Medications used to treat anxiety and depression, such as selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines, work by increasing serotonin levels in the brain. Kratom's alkaloid mitragynine may also have serotonergic activity. Combining kratom with such medications can significantly increase the risk of serotonin syndrome, characterized by excessive serotonin accumulation. Symptoms of serotonin syndrome include rapid heartbeat, high blood pressure, tremors, and, in severe cases, seizures or loss of consciousness(18).
It is crucial to consult with a healthcare professional or pharmacist before combining kratom with any other medications to ensure safe and appropriate use. They can provide personalized advice based on your specific situation and help minimize the risks associated with potential drug interactions.
The concerns surrounding the quality and safety of kratom primarily stem from the lack of regulation and quality control within the kratom industry. The absence of stringent standards has raised issues regarding the purity, potency, and potential contamination of kratom products.
Studies have shown that some kratom products may contain high levels of Lead(Pb). The presence of Lead(Pb) in kratom products may increase the risk of Lead poisoning, especially in heavy and persistent kratom users. Kratom producers are incourage to follow the good manufacturing practices (GMP) developed by the American Kratom Association to ensure the safety and quality of kratom products which includes testing for Lead(Pb), but they are not really required to do so. This may be on of the reason why there are neumerous kratom vendors in the US who sell low quality products, which may possibly contain high levels of Pb(19).
Kratom is often promoted for its potential to improve mood, boost energy, enhance focus and memory, and alleviate anxiety through its calming and sedating effects. However, it is important to note that kratom may have a negative impact on an individual's mental health and overall well-being(11). Reports suggest that kratom use can be associated with adverse effects such as anxiety, agitation, irritability, and even psychosis.
One notable case involved an individual with a history of post-traumatic stress disorder (PTSD) who consumed an entire bottle of liquid kratom in the week leading up to his admission. It was reported that he experienced sleep disturbances and began to have auditory and visual hallucinations five days after consuming kratom. Following a thorough assessment and diagnostic tests, it was determined that kratom was the most likely cause of his acute psychosis(12).
Furthermore, consuming excessive amounts of kratom can potentially lead to psychological dependence and addiction. It is important to exercise caution and moderation when using kratom to minimize the risks associated with its psychological effects.
The most dangerous effect that we believe people should be aware of is addiction. Heavy and prolonged use of kratom can result in both physical and psychological dependence and addiction, as well as the occurrence of kratom withdrawal symptoms upon discontinuation (24). From the experience we've had talking with users who were detoxing off kratom, it's very similar to heavier opiod based narcotics like heroin or fentanyl.
Here are some factors we've discovered while researching this article that contribute to the development of dependence and addiction related to kratom use:
It is crucial to be aware of the potential risks associated with kratom use, particularly heavy and long-term consumption, and to seek appropriate support and guidance when attempting to reduce or cease its use.
Kratom and kava share some similarities, particularly in their traditional use and potential effects on mood and relaxation. Here are a few key similarities between kava and kratom:
While kava and kratom share these similarities, it's important to note that they are very distinct botanical plants with different chemical compositions and effects. Below, we'll talk about their differences.
While there are a few similarities between kava and kratom, it's important to highlight that their differences outweigh their similarities. These differences can be seen in their classifications, active compounds, effects, and legal status. Let's explore these distinctions further:
Kava, scientifically known as Piper methysticum, is a plant belonging to the pepper family (Piperaceae). It is predominantly found in the South Pacific Islands and has been deeply ingrained in the culture of Pacific Islanders for centuries. Traditionally, kava has been used in ceremonial and social events, and it holds great cultural significance in these communities.
In contrast, kratom is a member of the coffee family (Rubiaceae) and originated in Southeast Asia. It is primarily found in countries such as Thailand, Malaysia, Indonesia, and Papua New Guinea. Kratom has been used in Southeast Asian cultures for various purposes, including traditional medicine and cultural practices.
Kava contains a group of active compounds known as kavalactones, primarily found in its roots. There are six main kavalactones present in kava, namely kavain, dihydrokavain, desmethoxyyangonin, yangonin, methysticin, and dihydromethysticin. These kavalactones are responsible for the psychoactive effects of kava. For a more in-depth understanding of kavalactones and their mechanisms of action, you can find detailed information on our blog here here.
Kratom contains two main alkaloids that contribute to its effects: mitragynine and 7-hydroxymitragynine. Mitragynine is the more abundant alkaloid and is responsible for the stimulating and pain-relieving properties of kratom. On the other hand, 7-hydroxymitragynine, although present in lesser amounts, possesses more potent opioid-like properties. Hence how heavy pro-longed use can end up having some pretty nasty detrimental effects.
These distinct compositions of active compounds in kava (kavalactones) and kratom (mitragynine and 7-hydroxymitragynine) play a crucial role in shaping their respective effects and therapeutic potential.
The kavalactones in kava are known to produce sedative and anti-anxiety properties. Kavalactones interact with certain neurotransmitter in the brain which may include GABA, dopamine, and serotonin. These interactions may result in the reduction of anxiety and stress symptoms.
The primary active compounds in kratom, mitragynine and 7-hydroxymitragynine, act as partial agonists at the mu-opioid receptors in the brain. These alkaloids bind to the opioid receptors, resulting in pain relief, sedation, and euphoria. In addition kratom's alkaloids may interact with other receptors, such as adrenergic and serotonergic receptors, which may contribute to its stimulant effects at lower doses.
Kava is renowned for its anxiolytic and calming properties, often used to alleviate symptoms of stress and anxiety and promote a state of relaxation and tranquility. Its effects primarily focus on inducing mental and physical relaxation, creating a sense of peace and serenity. Kava may also produce sedating and euphoric properties but it is not normally associated with dependence and adddiction.
More on the effects of kava on our blog here.
In contrast, the effects of kratom can vary depending on the specific strain and dosage. At lower doses, kratom tends to provide energizing benefits, enhancing energy levels, focus, and sociability. However, at larger doses, kratom exhibits sedative and analgesic effects, aiding in pain relief and inducing a state of relaxation. Additionally, kratom's interaction with opioid receptors in the brain can produce opioid-like properties, further contributing to its diverse range of effects.
Lastly, excessive and pro-longed use of kratom may lead to dependence and addiction.
The legal status of kava varies from country to country. There was a big kava scare in the early 2000's that inspired the United States to immediately put a ban on future use of kava until they figured out what happened. Most countries followed suit, however after the United States lifted the kava ban as more information about the incidents became readily available, the other countries were slow to change. Kava is now legal and considered to be a safer alternative to alcohol, but some countries still have not lifted their ban on kava, mostly because they see no real need for kava being around. Knowing many people who struggle with alcohol addiction and have overcome it with kava, I find this to be an absurd course of action. Kava is considered legal and is regulated as a dietary supplement rather than a controlled substance. However, it's important to note that specific regulations may vary at the state level.
In other countries, such as Australia and certain European countries, the distribution and sale of kava are more strictly controlled by government regulations. These regulations are often in place due to concerns regarding potential liver toxicity associated with kava consumption, as well as the potential for negative interactions with other substances.
To determine the legality of kava in your country, we recommended to refer to local laws and regulations or consult relevant authorities. Additionally, you can find more information on the legality of kava in different countries on our blog here.
Kratom’s legal status varies from country to country. In certain nations like Malaysia and Thailand, although it originated from these countries, the usage and possession of kratom have been outlawed due to its potential for abuse and addiction(23).
In the United States, kratom remains legal in some areas, but other states such as Alabama, Wisconsin, Arkansas and Tennessee were said to have submitted a legislation to ban the sale and possession of kratom. Due to increasing adverse effects related to kratom and the lack of regulation and quality control, the issue of legality of kratom in the US remains contorversial(22).
It's important to be aware that the laws regarding kratom are subject to change, and it is crucial to understand the regulations specific to your location.
This question is subjective and depends on the person's preference and needs. Kava and kratom have different effects and mechanism of action and they may not work the same for everyone.
We strongly recommend against combining kratom and kava. Both kava and kratom interact with receptors in the brain which may produce relaxing and sedating effects. Combining the two may produce synergistic effects that may be harmful for the consumer.
In summary, kava and kratom have gained popularity for their potential benefits in relieving stress, anxiety, and pain, but they are distinct in their origins, effects, and mechanisms of action.
Kratom, originating from Southeast Asia, has been used for centuries for its stimulating effects and pain-relieving properties. Its alkaloids, mitragynine and 7-hydroxymitragynine, interact with opioid receptors in the brain, producing effects similar to opioids. However, it's important to note that kratom carries a higher risk of dependence and addiction due to its opioid-like properties.
Kava, originating from the Pacific Islands, is primarily consumed for its GABA-ergic calming and relaxing properties. The kavalactones in kava interact with various neurotransmitters in the brain involved in regulating mood, anxiety, stress, and pain. Kava is generally considered safe, with few reported risks and side effects.
While both kava and kratom claim to improve mood and well-being, it is crucial to recognize that they are two different plant species with distinct mechanisms of action. Caution should be exercised when using kratom due to its potential for dependence and addiction, whereas kava is generally regarded as safer. Consulting with a healthcare professional is recommended before using either substance.
Hopefully you enjoyed this and was able to pickup something useful. We're trying to present an unbiased opinion based off facts. Let us know if we missed anything. Mahalo!
Reference:
Karunakaran T, Ngew KZ, Zailan AAD, Mian Jong VY, Abu Bakar MH. The Chemical and Pharmacological Properties of Mitragynine and Its Diastereomers: An Insight Review. Front Pharmacol. 2022 Feb 24;13:805986. doi: 10.3389/fphar.2022.805986. PMID: 35281925; PMCID: PMC8907881. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8907881/
Kruegel AC, Uprety R, Grinnell SG, Langreck C, Pekarskaya EA, Le Rouzic V, Ansonoff M, Gassaway MM, Pintar JE, Pasternak GW, Javitch JA, Majumdar S, Sames D. 7-Hydroxymitragynine Is an Active Metabolite of Mitragynine and a Key Mediator of Its Analgesic Effects. ACS Cent Sci. 2019 Jun 26;5(6):992-1001. doi: 10.1021/acscentsci.9b00141. Epub 2019 May 29. PMID: 31263758; PMCID: PMC6598159.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598159/
Hanapi NA, Chear NJ, Azizi J, Yusof SR. Kratom Alkaloids: Interactions With Enzymes, Receptors, and Cellular Barriers. Front Pharmacol. 2021 Nov 17;12:751656. doi: 10.3389/fphar.2021.751656. PMID: 34867362; PMCID: PMC8637859.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8637859/
Boyer EW, Babu KM, Adkins JE, McCurdy CR, Halpern JH. Self-treatment of opioid withdrawal using kratom (Mitragynia speciosa korth). Addiction. 2008 Jun;103(6):1048-50. doi: 10.1111/j.1360-0443.2008.02209.x. PMID: 18482427; PMCID: PMC3670991.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670991/
Botejue M, Walia G, Shahin O, Sharma J, Zackria R. Kratom-Induced Liver Injury: A Case Series and Clinical Implications. Cureus. 2021 Apr 25;13(4):e14679. doi: 10.7759/cureus.14679. PMID: 34055525; PMCID: PMC8148389.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8148389/
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Kratom. [Updated 2020 Apr3]. https://www.ncbi.nlm.nih.gov/books/NBK548231/
Khan MZ, Saleh MA, Alkhayyat M, Roberts DE, Lindenmeyer CC. Multiorgan Dysfunction Related to Kratom Ingestion. ACG Case Rep J. 2021 Aug 25;8(8):e00647. doi: 10.14309/crj.0000000000000647. PMID: 34476274; PMCID: PMC8389947.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8389947/
Somsmorn Chittrakarn, Kitja Sawangjaroen, Supaporn Prasettho, Benjamas Janchawee, Niwat Keawpradub.Inhibitory effects of kratom leaf extract (Mitragyna speciosa Korth.) on the rat gastrointestinal tract. Journal of Ethnopharmacology. Volume 116, Issue 1, 2008,Pages 173-178, ISSN 0378-8741.https://www.sciencedirect.com/science/article/abs/pii/S0378874107006083
Chinnappan J, Navari Y, Casini D, Palanisamy N, Parikh N, Seedahmed E. Kratom-Induced Acute Respiratory Distress Syndrome (ARDS). Eur J Case Rep Intern Med. 2023 Mar 29;10(4):003835. doi: 10.12890/2023_003835. PMID: 37051477; PMCID: PMC10084802.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084802/
Swogger MT, Walsh Z. Kratom use and mental health: A systematic review. Drug Alcohol Depend. 2018 Feb 1;183:134-140. doi: 10.1016/j.drugalcdep.2017.10.012. Epub 2017 Dec 7. PMID: 29248691. https://pubmed.ncbi.nlm.nih.gov/29248691/
Marc T. Swogger, Zach Walsh. Kratom use and mental health: A systematic review, Drug and Alcohol Dependence, Volume 183, 2018, Pages 134-140, ISSN 0376-8716,. https://www.sciencedirect.com/science/article/abs/pii/S0376871617305586?via%3Dihub
Cutlip HA, Bushman E, Thottumari L, Mogallapu R, Ang-Rabanes M. A Case Report of Kratom-Induced Psychosis. Cureus. 2021 Jun 30;13(6):e16073. doi: 10.7759/cureus.16073. PMID: 34367743; PMCID: PMC8330393.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330393/
Vanani NB, Stevanovic SG, Stevanovic N. Adverse Drug Interaction Between Kratom and Amitriptyline With Gastrointestinal and Mild Hepatic Effects. Cureus. 2023 Jan 15;15(1):e33809. doi: 10.7759/cureus.33809. PMID: 36819306; PMCID: PMC9929492.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9929492/
Brogdon HD, McPhee MM, Paine MF, Cox EJ, Burns AG. A Case of Potential Pharmacokinetic Kratom-drug Interactions Resulting in Toxicity and Subsequent Treatment of Kratom Use Disorder With Buprenorphine/Naloxone. J Addict Med. 2022 Sep-Oct 01;16(5):606-609. doi: 10.1097/ADM.0000000000000968. Epub 2022 Feb 14. PMID: 35165231; PMCID: PMC9375773https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375773/
Dhaliwal A, Gupta M. Physiology, Opioid Receptor. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.https://www.ncbi.nlm.nih.gov/books/NBK546642/
Hanapi NA, Ismail S, Mansor SM. Inhibitory effect of mitragynine on human cytochrome P450 enzyme activities. Pharmacognosy Res. 2013 Oct;5(4):241-6. doi: 10.4103/0974-8490.118806. PMID: 24174816; PMCID: PMC3807987.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3807987/
Singh D, Narayanan S, Grundmann O, Boyer EW, Vicknasingam B. The Use of Benzodiazepines among Kratom (Mitragyna Speciosa Korth.) Users. J Psychoactive Drugs. 2020 Jan-Mar;52(1):86-92. doi: 10.1080/02791072.2019.1632505. Epub 2019 Jun 20. PMID: 31218929.https://pubmed.ncbi.nlm.nih.gov/31218929/
Eudaley ST, Brooks SP, Hamilton LA. Case Report: Possible Serotonin Syndrome in a Patient Taking Kratom and Multiple Serotonergic Agents. J Pharm Pract. 2022 Jul 15:8971900221116009. doi: 10.1177/08971900221116009. Epub ahead of print. PMID: 35840540.https://pubmed.ncbi.nlm.nih.gov/35840540/
Prozialeck W, Fowler A, Edwards J. Public Health Implications and Possible Sources of Lead (Pb) as a Contaminant of Poorly Regulated Kratom Products in the United States. Toxics. 2022 Jul 19;10(7):398. doi: 10.3390/toxics10070398. PMID: 35878303; PMCID: PMC9320411.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9320411/
Prozialeck WC, Jivan JK, Andurkar SV. Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc. 2012 Dec;112(12):792-9. PMID: 23212430.https://pubmed.ncbi.nlm.nih.gov/23212430/
Eastlack SC, Cornett EM, Kaye AD. Kratom-Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review. Pain Ther. 2020 Jun;9(1):55-69. doi: 10.1007/s40122-020-00151-x. Epub 2020 Jan 28. PMID: 31994019; PMCID: PMC7203303.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203303/
Prozialeck WC. Update on the Pharmacology and Legal Status of Kratom. J Am Osteopath Assoc. 2016 Dec 1;116(12):802-809. doi: 10.7556/jaoa.2016.156. PMID: 27893147.https://pubmed.ncbi.nlm.nih.gov/27893147/
Khalil@Halim, S., John Abdullah, S. A., & Ahmad, R. (2020). ENFORCEMENT STATUS OF THE POISON ACT 1952 AGAINST OFFENCES RELATED TO KRATOM (MITRAGYNA SPECIOSA KORTH) MISUSE IN MALAYSIA. UUM Journal of Legal Studies, 11(1), 75–93.https://ejournal.uum.edu.my/index.php/uumjls/article/view/uumjls.11.1.2020.6928
Settle AG, Yang C. A Case of Severe Kratom Addiction Contributing to a Suicide Attempt. Cureus. 2022 Sep 28;14(9):e29698. doi: 10.7759/cureus.29698. PMID: 36321032; PMCID: PMC9616552. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616552/
Comments will be approved before showing up.