Kratom-labeled Products in the US Compared With Traditionally Consumed Natural Kratom in Southeast Asia

Kratom-labeled products consumed in the United States and natural kratom consumed in Southeast Asia (SEA) are very different in their chemistry and safety profiles. Water-based decoction, frequently consumed in SEA, is prepared using freshly harvested, not dried leaves of Mitragyna speciosa tree, indigenous to the SEA region. Our research demonstrates that the decoction contains mitragynine and its congeners in organic, water-soluble salts form, not in the pure base alkaloids form. In addition, our preliminary evaluation has not detected 7-hydroxymitragynine, a highly potent oxidative derivative of mitragynine, in the decoction prepared from the freshly harvested and unprocessed leaves. The differences in the products' chemistry may be responsible for the observed differences in safety profiles between the products consumed in the United States and in the SEA countries. Kratom-labeled products in the United States are sold under the false promises that they reflect the natural kratom products consumed in SEA. Consumers of these products and health care practitioners in the United States may not be aware that the natural kratom products traditionally consumed in SEA (ie, freshly harvested unprocessed whole leaves and a water-based decoction prepared from such leaves) have different chemistry and are consumed differently than the US products, including kratom-leaf-derived US products (ie, capsules, powders, or tea bags claiming to contain dried natural kratom leaves), as well as the highly concentrated or semisynthetic products. The traditional natural products consumed in the SEA countries may also have a different safety profile and pharmacological effects.