Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Real-World Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States.
Drug Alcohol Depend. 2024 Nov 1;264:112460. doi: 10.1016/j.drugalcdep.2024.112460. Epub 2024 Oct 10.
Using ecological momentary assessment (EMA), we undertook a natural experiment wherein kratom-product variability was a tool to assess kratom dose-response relationships based on product form and alkaloid level.
Between July-November 2022, 357 US kratom consumers (56.6 % male, 90.2 % non-Hispanic white) completed 15 days of EMA; 348 participants submitted samples of the products used most often during EMA. These were assayed for ten alkaloids using ultra-performance liquid chromatography-tandem mass spectrometry. Self-reported kratom effects were modeled as a function of kratom amount and alkaloid content.
Participants used over 220 brands. The most-reported product forms were loose powder (55.8 %) and encapsulated powder (26.8 %); extracts were used less (419 uses across 9.48 % of participants). Of the 12,244 use-event entries, 7726 had follow-up data (15-180minutes after use) on felt effects. Effects were stronger in participants with a higher average amount per use. Within-person dose-response relationships were obscured by highly-consistent within-person dosages. Effects of loose powder decreased over three hours; effects of extracts started higher but decreased more rapidly. Dose-response relationships for specific alkaloids could not be reliably established because total alkaloid content and relative levels of specific alkaloids showed limited variability between products. Higher levels of corynoxine alkaloids were associated with slightly stronger effects, possibly an artifact of modeling data with low alkaloid variability.
Alkaloid content was surprisingly consistent across kratom products, and participants were consistent in the amount they used across events. Firm conclusions about alkaloid-effect relationships for kratom will require experimenter-controlled manipulations of agent and dose.
我们采用生态瞬时评估（EMA）进行了一项自然实验，在此实验中，根据产品形式和生物碱水平的不同，利用咔特产品的可变性来评估咔特的剂量反应关系。
在 2022 年 7 月至 11 月期间，357 名美国咔特使用者（56.6%为男性，90.2%为非西班牙裔白人）完成了 15 天的 EMA；348 名参与者提交了在 EMA 期间最常使用的产品样本。这些样本使用超高效液相色谱-串联质谱法分析了十种生物碱。使用咔特量和生物碱含量来模拟自我报告的咔特效应。
参与者使用了超过 220 个品牌。报告最多的产品形式是松散粉末（55.8%）和胶囊粉末（26.8%）；提取物的使用较少（9.48%的参与者中有 419 次使用）。在 12244 次使用事件条目，7726 次有后续数据（使用后 15-180 分钟）关于感觉效果。每次使用的平均量较高的参与者效果更强。个体内剂量反应关系被高度一致的个体内剂量所掩盖。松散粉末的效果在三个小时内逐渐减弱；提取物的效果开始较高，但下降更快。由于产品之间总生物碱含量和特定生物碱的相对水平变化有限，因此无法可靠地建立特定生物碱的剂量反应关系。较高水平的 Corynoxine 生物碱与稍强的效果相关，这可能是由于使用低生物碱可变性来建模数据的人为因素。
咔特产品中的生物碱含量惊人地一致，参与者在每次使用的用量上也保持一致。要确定咔特生物碱-效应关系的结论，需要对药物和剂量进行实验者控制的操作。
