Exploration of Kratom’s Introduction to the United States: A Historical and Pharmacological Review

Kratom, a plant native to Southeast Asia, has a long history of use in traditional medicine, where its leaves were ground into a paste for treating wounds and skin infections or combined with other herbs for various ailments. It also held cultural and religious significance, often used in ceremonies to facilitate communication with the spirit world or to attain deeper meditative states​​ [“”]. The Western world’s encounter with kratom began in the 19th century when European explorers documented its use among indigenous communities in Indonesia, Malaysia, and Thailand. By the mid-20th century, kratom had garnered interest for its potential therapeutic benefits, leading to its gradual spread to Europe and the United States​​ [“”].

Scientific interest in kratom grew in the 20th century, focusing on its pharmacological properties and potential applications. It wasn’t until the early to mid-2000s that kratom use became noted in the United States, with widespread popularity emerging around 2015. Today, kratom is available in various forms, such as loose leaf, powder, capsules, and concentrates, in 46 US states​​ [“”]. Users often report using kratom to self-manage conditions like chronic pain, fatigue, anxiety, depression, and symptoms related to substance use disorders, including opioid withdrawal​​ [“”].

The introduction of kratom to the Western world highlights a complex journey from traditional use in Southeast Asia to scientific curiosity and eventual commercial availability in the US and Europe. Despite the growing popularity and reported benefits, the debate over kratom’s legality and regulation continues, with its status varying by country and within the US by state​​ [“”]. This underscores the ongoing need for further research to fully understand kratom’s potential benefits and risks, as well as to inform policy decisions and guide responsible use​​ [“”]

Doctors and researchers have raised concerns about the safety and efficacy of kratom. According to the Mayo Clinic, while some users believe in kratom’s benefits, studies have found its side effects and safety issues outweigh potential benefits. Reports to poison control centers from 2011 through 2017 include serious outcomes like seizures and high blood pressure, with some cases resulting in death. Side effects can range from weight loss and liver damage to more severe impacts like dizziness, depression, and breathing suppression. Research has yet to show clear benefits of kratom, with some studies indicating it could cause abnormal brain function when combined with prescription medicines and withdrawal symptoms similar to opioids. The use of kratom, particularly during pregnancy, can also lead to withdrawal symptoms in newborns​​ [“”].

To enrich the discussion on kratom use in the United States, it’s crucial to consider case studies that shed light on its impacts and treatment approaches. One such case involved the successful management of kratom use disorder using telehealth followed by unobserved home induction of buprenorphine-naloxone in patients consuming around 35g of kratom per day. This approach, leveraging telehealth for initial consultations and home induction for medication, highlights the potential for alternative treatment methodologies where traditional access to care is limited. The cases demonstrated that, despite the daily high doses of kratom use, factors such as the duration of use and individual psychological considerations played a significant role in determining the effective dose of buprenorphine-naloxone​​ [“”].

Another case study highlighted the potential dangers associated with kratom use, detailing instances where kratom-related deaths occurred. Often, these deaths were linked to the simultaneous use of kratom with other substances. For example, a 20-year-old man’s death was associated with propylhexedrine and kratom, though kratom was not determined to be the cause. In Sweden, nine deaths were reported in one year involving the co-ingestion of mitragynine and O-desmethyltramadol. These cases underscore the risks associated with kratom use, particularly when mixed with other substances, challenging the perception of safety often propagated online. Furthermore, cases of kratom withdrawal treated with gabapentin and clonidine, and the successful use of buprenorphine-naloxone maintenance for kratom withdrawal, indicate the complex nature of kratom use disorder and the variety of treatment approaches that may be required​​ [“”].

These case studies illuminate the complex and multifaceted nature of kratom use, dependence, and treatment. They underscore the importance of considering individual patient factors in treatment plans and the potential risks associated with kratom use, especially when combined with other substances. For healthcare professionals, these cases provide valuable insights into the challenges and considerations in treating kratom use disorder and highlight the need for further research and standardized treatment guidelines.

Bibliography on Kratom Use in the United States

• Mayo Clinic – “Kratom: Unsafe and ineffective.” This article discusses the side effects and safety concerns associated with kratom use, including serious negative outcomes and potential for dependence and overdose. It emphasizes the lack of clear benefits and the safety issues outweighing any potential benefits. Mayo Clinic
• Cape, M.C., & Streltzer, J.M. (2023). “Kratom use disorder: case reports on successful treatment with home induction of buprenorphine-naloxone.” Family Practice, 40(4), 596–598. This case study highlights successful management of kratom use disorder using telehealth followed by unobserved buprenorphine-naloxone home induction. Oxford Academic
• Frontiers in Psychiatry – “Case Report: Treatment of Kratom Use Disorder With a Classical Tricyclic Antidepressant.” This case study explores kratom-related deaths and the potential dangers of kratom use, especially when combined with other substances. It also discusses cases of kratom withdrawal treated with gabapentin, clonidine, and buprenorphine-naloxone maintenance. Frontiers

These sources provide a comprehensive overview of kratom use, its associated risks, and treatment approaches for kratom use disorder in the United States. They highlight the importance of caution and the need for further research into the effects and safe treatment of kratom dependency.

10 FAQs on When Did Kratom Come to the US?

1. When was Kratom first introduced to the United States?

Kratom was noted in the United States in the early to mid-2000s, with its popularity surging around 2015 due to its potential therapeutic benefits.

2. What led to Kratom’s introduction in the US?

Kratom’s introduction to the US can be attributed to growing interest in its use for self-managing chronic pain, anxiety, depression, and particularly, opioid withdrawal symptoms.

3. Are there any specific events that marked Kratom’s entry into the US market?

While no specific event marks Kratom’s entry, its rise in popularity was influenced by the digital age, with online forums and vendors facilitating its spread.

4. How was Kratom traditionally used before coming to the US?

In Southeast Asia, Kratom was traditionally used for its stimulant and opioid-like effects, aiding in laborious tasks and as a substitute for opium.

5. What are the legal statuses of Kratom across the US?

The legal status of Kratom varies by state, with some states banning it while others have imposed regulations or have it freely available.

6. How did public and scientific opinion on Kratom evolve in the US?

Public and scientific opinions have been divided, with some advocating for its benefits in pain management and opioid withdrawal, while others caution against potential abuse and safety concerns.

7. What research has been conducted on Kratom’s effects since its arrival in the US?

Research has focused on understanding Kratom’s pharmacological properties, potential therapeutic uses, and safety profile, with mixed findings on its efficacy and risks.

8. Have there been any significant regulatory actions against Kratom in the US?

Yes, the FDA and DEA have taken steps to warn against the use of Kratom, citing safety concerns and potential for abuse, though no federal ban has been enacted.

9. How do cultural perceptions of Kratom in the US compare to its traditional use in Southeast Asia?

Cultural perceptions in the US often view Kratom through a medical or substance abuse lens, contrasting with its traditional use in Southeast Asia as a natural remedy and part of daily life.

10. What are the future prospects for Kratom’s legal status and scientific research in the US?

The future of Kratom in the US involves ongoing debates over its legal status, with advocates pushing for regulation rather than prohibition, alongside continued research into its safety and therapeutic potential.

Jaden

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