july CPE Article Kratom: An Emerging Herbal Supplement with Opioidlike Properties Authors: Anisa Moore, PharmD and Karen Blumenschein, PharmD, MS The authors declare that there are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity #0143-0000-21-007-H08-P &T Contact Hour 1.0
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Learning Objectives: At the conclusion of this knowledge-based article, the reader should be able to: 1.
Describe kratom and its origins of use
2. Identify kratom use patterns in the United States 3. List adverse health effects that may result from kratom use 4. Review the current regulatory challenges posed by kratom 5. Identify the pharmacist’s role in caring for patients who use kratom
Introduction Kratom is an herbal supplement with growing popularity in the United States due to its unique pharmacologic activity with both stimulant and opioid-like properties. The broad range of activity for this natural product is largely due to the compound mitragynine and the analog 7-hydroxymitragynine[1]. These compounds are indole alkaloids that are partial agonists for mu-opioid receptors, competitive antagonists at kappa- and delta-opioid receptors, and have activity on the adrenergic, serotonergic, and dopaminergic receptors [2,3,4]. Kratom comes from leaves of Mitragyna speciosa, a tree a native to Southeast Asia [1]. It has been consumed medicinally in Indonesia, Malaysia, and Thailand for hundreds of years, where kratom leaves were chewed by labor workers for the stimulant effects to combat fatigue and brewed into tea for the relaxing effects [1]. There is also documented use of this herbal product in Malaysia and Thailand as an opioid alternative [2]. Given the current opioid epidemic, the opioid-like activity of kratom creates a valid concern for the potential of abuse liability. In addition to its stimulant and analgesic properties, kratom is thought to have antidepressant, antidiarrheal, euphoriant, antispasmodic, and muscle relaxant activity [2,3]. The effects of kratom largely depend on the dose that is ingested and can vary from one person to another. At low to moderate doses of 1-5 grams, kratom produces mild stimulant effects [1]. At higher doses of 5-15 grams, kratom produces opioid-like effects including analgesia, constipation, euphoria, and sedation [1].
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