Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, SAINS@BERTAM, 13200 Kepala Batas, Pulau Pinang, Malaysia.
Curr Drug Targets. 2020;21(15):1566-1579. doi: 10.2174/1389450121666200719011653.
Kratom, or Mitragyna speciosa Korth., is a tropical plant prevalent in Southeast Asia, and it is utilized as a traditional remedy for symptomatic relief of various illnesses. It has been labeled as an atypical opioid with significant narcotic-like properties, capable of inducing kratom dependence among those who misuse or abuse it. The prevalence of kratom use has drastically increased worldwide, raising concerns among healthcare providers, particularly regarding the availability of efficacious treatment options for kratom dependence. This manuscript provides a comprehensive narrative review of literature focusing on the psychoactive alkaloids of kratom, the possible neurobiological and pathophysiological models underlying the occurrence of kratom dependence, and the clinical presentations and effective treatment options available for kratom dependence. The psychoactive alkaloids of kratom, such as mitragynine (MG) and 7-hydroxymitragynine (7-HMG), act as partial mu opioid agonists and induce kratom dependence. As a result, regular kratom use leads to withdrawal symptoms on abstinence, along with craving, tolerance, and cross-tolerance to morphine. The psychological withdrawal symptoms reported include depressed mood, anxiety, restlessness, irritability, and feeling tense, while the physical withdrawal symptoms are myalgia and body ache, joint pain, lacrimation, running nose, yawning, insomnia, diarrhea, feverish sensation, loss of appetite, tremors, itching over the body, loss of concentration, and chills. Neonatal withdrawal symptoms, such as oral intolerance, restlessness, irritability, and vomiting, are also reported in newborns of women who are on regular kratom use. Sublingual buprenorphine-naloxone (Suboxone) is reported as a promising treatment for detoxification and maintenance replacement therapy for kratom-dependent users. Alternative treatments for in-patient detoxification include intravenous clonidine and a combination of oral dihydrocodeine and lofexidine. We conclude by adding a note on the research gap concerning kratom dependence, which future studies should focus on.
背景：咔特（Kratom），即 Mitchellia speciosa Korth.，是一种流行于东南亚地区的热带植物，被用作多种疾病对症治疗的传统药物。咔特被贴上了非典型阿片类药物的标签，具有显著的类阿片特性，可导致滥用咔特的人出现咔特依赖。咔特的使用在全球范围内迅速普及，引起了医疗保健提供者的关注，特别是关于咔特依赖的有效治疗方案。本文对咔特的精神活性生物碱、咔特依赖发生的可能神经生物学和病理生理学模型以及咔特依赖的临床表现和有效治疗方案进行了全面的文献综述。
咔特的精神活性生物碱：咔特的精神活性生物碱，如 Mitragynine (MG) 和 7-Hydroxymitragynine (7-HMG)，作为部分 μ 阿片受体激动剂，可导致咔特依赖。因此，规律使用咔特会导致戒断时出现戒断症状，以及渴望、耐受和对吗啡的交叉耐受。报告的心理戒断症状包括情绪低落、焦虑、不安、易怒和紧张感，而身体戒断症状包括肌痛和全身疼痛、关节痛、流泪、流鼻涕、打哈欠、失眠、腹泻、发热感、食欲不振、震颤、全身瘙痒、注意力不集中和发冷。也有报道称，在定期使用咔特的女性新生儿中，会出现口腔不耐受、不安、易怒和呕吐等新生儿戒断症状。舌下丁丙诺啡纳洛酮（Suboxone）被报道为治疗咔特依赖者的解毒和维持替代治疗的有希望的方法。住院患者戒毒的替代治疗包括静脉注射可乐定和口服二氢可待因和洛非西定的联合用药。
结论：我们最后提到了咔特依赖的研究空白，并指出未来的研究应该关注这一问题。
