Traditional and non-traditional uses of Mitragynine (Kratom): A survey of the literature

•Kratom is bought in local coffee shops (Asean) compared to online (West).•In both regions, kratom users have shifted to recreational purposes.•Its legal status differs from countries within each region.•Side-effects reported in case reports (West) and not in surveys (South East Asia).

IntroductionThe objective of the paper was to highlight the differences in the traditional and non-traditional users of kratom in the South East Asian and Western contexts.MethodA literature survey of published kratom studies among humans was conducted. Forty published studies relevant to the objective were reviewed.ResultsApart from the differences in the sources of supply, patterns of use and social acceptability of kratom within these two regions, the most interesting finding is its evolution to a recreational drug in both settings and the severity of the adverse effects of kratom use reported in the West. While several cases of toxicity and death have emerged in the West, such reports have been non-existent in South East Asia where kratom has had a longer history of use. We highlight the possible reasons for this as discussed in the literature. More importantly, it should be borne in mind that the individual clinical case-reports emerging from the West that link kratom use to adverse reactions or fatalities frequently pertained to kratom used together with other substances. Therefore, there is a danger of these reports being used to strengthen the case for legal sanction against kratom. This would be unfortunate since the experiences from South East Asia suggest considerable potential for therapeutic use among people who use drugs.ConclusionDespite its addictive properties, reported side-effects and its tendency to be used a recreational drug, more scientific clinical human studies are necessary to determine its potential therapeutic value.