From the Real-world Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD (KES, JMR, DHE); and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (KED, AGR, JCS).
J Addict Med. 2022;16(6):666-670. doi: 10.1097/ADM.0000000000000986.
Since 2007, kratom use in the United States has increased, centered around nonmedical self-treatment of pain, psychiatric, and substance use disorder symptoms. Reports of kratom withdrawal have emerged amidst description of therapeutic effects, yet we know little about disordered use. Our objective was to assess Diagnostic and Statistical Manual-5 substance use disorder for kratom ("kratom use disorder," KUD) and examine kratom withdrawal symptoms among those who ever used regularly. We also sought to identify clinical characteristics of respondents who qualified for current, remitted, or never KUD.
Between April and May 2021, we re-recruited online respondents who reported lifetime kratom use on an unrelated survey into our cross-sectional kratom survey study, permitting a diverse sample of current and former kratom-using persons.
A total of 129/289 (44.6%) evaluable surveys were obtained. Over half (52.7%) of respondents never met KUD diagnostic criteria; 17.8% were assessed remitted, and 29.5% met current (past-year) KUD threshold. For past-year KUD, severity was: 14.0% mild, 7.0% moderate, and 8.5% severe. Pain, psychiatric symptoms, and polydrug use were found across all groups. KUD symptoms reflected increased use, tolerance, withdrawal, unsuccessful quit attempts, and craving; 9.3% reported decreases in important social, occupational, or recreational activities because of use. Withdrawal symptoms were moderate and included gastrointestinal upset, restlessness, anxiety, irritability, fatigue/low energy, and craving.
As assessed here, tolerance and withdrawal are primary KUD features rather than psychosocial impairments. As kratomis often used among persons with a myriad of health conditions, clinicians should be aware of and assess for kratom use and withdrawal.
自 2007 年以来，美国的咔特（kratom）使用量有所增加，主要集中在非医疗性自我治疗疼痛、精神疾病和物质使用障碍症状上。在描述治疗效果的同时，也出现了咔特戒断的报告，但我们对滥用情况知之甚少。我们的目的是评估《精神障碍诊断与统计手册-5》中咔特的物质使用障碍（“咔特使用障碍”，KUD），并检查那些曾经经常使用咔特的人的咔特戒断症状。我们还试图确定符合当前、缓解或从未出现 KUD 的受访者的临床特征。
在 2021 年 4 月至 5 月期间，我们重新招募了在一项无关调查中报告有终生咔特使用史的在线受访者，参加我们的咔特横断面调查研究，允许有不同样本的当前和以前的咔特使用者。
共获得了 129/289（44.6%）可评估的调查。超过一半（52.7%）的受访者从未符合 KUD 的诊断标准；17.8%被评估为缓解，29.5%符合当前（过去一年）KUD 标准。过去一年的 KUD 严重程度为：14.0%轻度，7.0%中度，8.5%重度。疼痛、精神症状和多药使用在所有组中都有发现。KUD 症状反映了使用增加、耐受、戒断、不成功的戒断尝试和渴望；9.3%的人因使用而减少了重要的社会、职业或娱乐活动。戒断症状为中度，包括胃肠道不适、不安、焦虑、易怒、疲劳/低能量和渴望。
正如这里评估的那样，耐受和戒断是 KUD 的主要特征，而不是心理社会障碍。由于咔特通常被用于患有多种健康状况的人群中，临床医生应该意识到并评估咔特的使用和戒断情况。
