Kratom Abuse Potential 2021: An Updated Eight Factor Analysis.

Area of Science:

• Pharmacology and Toxicology
• Public Health Policy
• Neuroscience

Background:

• The Controlled Substances Act (CSA) in the US regulates drugs based on abuse potential and public health risks.
• Kratom alkaloids, mitragynine (MG) and 7-hydroxymitragynine (7-OH-MG), were previously assessed for CSA listing.
• A 2018 assessment concluded MG had moderate abuse potential and no imminent public health risk, with Schedule I listing posing overdose risks.

Purpose of the Study:

• To provide an updated abuse potential assessment for kratom alkaloids, reviewing studies published since January 1, 2018.
• To evaluate the impact of potential CSA listing on public health, research, and consumer access.
• To recommend regulatory strategies for kratom products.

Main Methods:

• Systematic review of over 100 studies published post-January 1, 2018.
• Inclusion of animal studies on abuse potential and physical dependence/withdrawal.
• Analysis of in-vitro receptor binding, efficacy studies for pain and substance use disorders, pharmacokinetic/pharmacodynamic data, clinical studies on long-term users, and user surveys.

Main Results:

• Updated assessments indicate kratom alkaloids' abuse potential is comparable to many uncontrolled substances.
• Evidence does not support an imminent public health risk associated with kratom use.
• Kratom alkaloids are under development for therapeutic applications in pain, substance use disorders, and mood disorders.

Conclusions:

• CSA listing for kratom is not recommended due to potential adverse public health consequences, including increased overdose deaths.
• Continued consumer and researcher access to kratom products is advised.
• Regulation focusing on product safety (contamination, adulteration) and marketing is recommended over scheduling.