From Bench to Bedside to Policy: Updating Our Understanding of Kratom

Use of kratom, a botanical indigenous to Southeast Asia, has increased dramatically in the U.S. since 2006 with products proliferating rapidly. This is noteworthy, as kratom leaves contain bioactive alkaloids of which at least four act as partial, seemingly biased, agonists at mu opioid receptors and with activity at other neurotransmitter receptors.  We are only just beginning to scientifically uncover kratom’s therapeutic and effect profile, primarily through preclinical studies, self-report, and case presentations. Accumulating evidence is beginning to reveal that kratom produces clinically relevant opioid-like effects that have implications for policy decisions. This translational symposium will feature four talks from kratom experts focused on unique aspects of this complex psychoactive plant and its heterogenous population of consumers. First,  trends in real-world kratom use derived from survey and social media data, that include dependence and misuse, as well as clinical anecdote on kratom’s use as an opioid  substitute among persons with substance use disorders, will be discussed. Second, an overview of kratom’s role as a self-treatment for psychiatric and pain symptoms will be presented using national and international survey findings. Third, the molecular structure of kratom’s best studied alkaloids, their pharmacological effects, and variability of kratom leaves and products will be reviewed. Lastly, kratom regulation and policy will be discussed in light of current scientific understanding and within the broader context of intersecting opioid, pain, and psychiatric health epidemics in the U.S. Discussion of key scientific and clinical considerations on kratom and attendee engagement will be
facilitated by the symposium’s moderator.