Fluyau Dimy, Revadigar Neelambika
Brain Health, Emory University, Atlanta, GA, USA.
Columbia University, New York, NY, USA.
Front Psychiatry. 2017 Apr 24;8:62. doi: 10.3389/fpsyt.2017.00062. eCollection 2017.
Kratom () is a tropical tree with a long history of traditional use in parts of Africa and Southeast Asia. Kratom is also known as Thom, Thang, and Biak. Its leaves and the teas brewed from them have long been used by people in that region to manage pain and opioid withdrawal and to stave off fatigue. Kratom is actually consumed throughout the world for its stimulant effects and as an opioid substitute (in form of tea, chewed, smoked, or ingested in capsules). Some case reports have associated kratom exposure with psychosis, seizures, intrahepatic cholestasis, other medical conditions, and deaths. The clinical manifestations of kratom effects are not well defined and the clinical studies are limited. Data research suggest that both stimulant and sedative dose-dependent effects do exist, in addition to antinociceptive, antidepressant activity, anxiolytic-like effects, and anorectic effects, but a growing concern for the drug's effects and safety of use has resulted in national and international attention primarily due to an increase in hospital visits and deaths in several countries that are believed to have been caused by extracts of the plant. There is a dearth of double blind controlled studies. In this study, we aim to use existing literature to clarify both benefits and risks of kratom as well as its diagnosis evaluation as kratom misuse is an emerging trend in the Western world.
Literature review using databases such as Embase, Medline, PubMed, Cochrane Library, and Mendeley from 2007 to 2017 were evaluated by all authors to analyze current state on benefits, risks, and diagnosis evaluation of kratom ().
Data analysis suggested that kratom possesses some benefits such as stimulant and sedative effects as wells as antinociceptive effects. It seems to inhibit pro-inflammatory mediator release and vascular permeability and can enhance immunity. In addition, it may be an antidepressant and anorectic. However, kratom can cause intrahepatic cholestasis, seizure, arrhythmia, impair memory function, coma, and death. Psychological manifestations described are euphoria and feeling relaxed to severe symptoms such as aggression, hostility, and psychosis. Medical manifestations described are polyuria, dry mouth, vomiting, and jerky movements. Currently, liquid chromatography/mass spectrometry and ion mobility spectrometry (IMS) are suggested as the most promising to rapidly screen kratom products providing a positive success rate.
Our data analysis has not determined if biochemical benefits of kratom may prove to outweigh its toxicity and risks. On the contrary, it seems that its potential side effects outweigh the benefits, and severe and real health hazards can, insidiously, lead to death. Kratom clinical, psychological, and medical manifestations can be disturbing. Kratom () use, among multiple compounds of the leaf, appear to be increasing in the Western world. Promising methods to accurately identify kratom compounds are still ongoing.
kratom是一种热带树木，在非洲和东南亚部分地区有着悠久的传统使用历史。kratom也被称为托姆、唐和比亚克。该地区的人们长期以来一直使用其树叶及其泡制的茶来缓解疼痛、戒除阿片类药物成瘾以及消除疲劳。实际上，世界各地的人们都因kratom的兴奋作用及其作为阿片类药物替代品（以茶、咀嚼、吸烟或胶囊形式摄入）而使用它。一些病例报告将kratom暴露与精神病、癫痫发作、肝内胆汁淤积、其他医疗状况及死亡联系起来。kratom作用的临床表现尚不明确，临床研究也很有限。数据研究表明，除了具有抗伤害感受、抗抑郁活性、抗焦虑样作用和厌食作用外，确实存在兴奋和镇静的剂量依赖性效应，但由于几个国家因该植物提取物导致的医院就诊人数和死亡人数增加，对该药物的作用和使用安全性的担忧日益增加，这已引起了国内和国际的关注。双盲对照研究匮乏。在本研究中，我们旨在利用现有文献阐明kratom的益处和风险以及其诊断评估，因为kratom滥用在西方世界是一种新兴趋势。
所有作者对2007年至2017年期间使用Embase、Medline、PubMed、Cochrane图书馆和Mendeley等数据库进行的文献综述进行评估，以分析kratom在益处、风险和诊断评估方面的现状。
数据分析表明，kratom具有一些益处，如兴奋和镇静作用以及抗伤害感受作用。它似乎能抑制促炎介质释放和血管通透性，并可增强免疫力。此外，它可能具有抗抑郁和厌食作用。然而，kratom可导致肝内胆汁淤积、癫痫发作、心律失常、损害记忆功能、昏迷及死亡。所描述的心理表现从轻快感和放松感到诸如攻击性、敌意和精神病等严重症状。所描述的医学表现有多尿、口干、呕吐和抽搐动作。目前，液相色谱/质谱联用和离子淌度质谱法（IMS）被认为是最有希望快速筛查kratom产品的方法，成功率较高。
我们的数据分析尚未确定kratom的生化益处是否可能超过其毒性和风险。相反，其潜在的副作用似乎超过了益处，严重且实际的健康危害可能会不知不觉地导致死亡。kratom的临床、心理和医学表现可能令人不安。在西方世界，kratom（在树叶的多种化合物中）的使用似乎在增加。准确鉴定kratom化合物的有前景的方法仍在研究中。
