Need for clarity and context in case reports on kratom use, assessment, and intervention

Abstract

This Letter to the Editor is a response to Broyan and colleagues who recently published a Case Report presenting data on 28 patients in the United States who identified kratom as their primary substance of use and who were subsequently induced on buprenorphine/naloxone for a reported diagnosis of kratom use disorder. We applaud the authors for helping to advance the science on kratom and recognize the difficulties in conducting kratom-related clinical assessment and research. However, a number of inconsistences and generalizations were identified in this Case Report, which also lacked some critical context. Importantly, such inconsistencies and generalizations can be observed throughout kratom-specific case reports. We feel this is now an important opportunity to highlight these issues that are present in the Broyan and colleagues Case report but emphasize that they are not unique to it. We do this with the hope that by acknowledging these issues it can help inform editors, clinicians, and researchers who may not be familiar with kratom and, as a result of this unfamiliarity, may inadvertently present findings in a manner that could confuse readers and even misinform clinical researchers and practitioners.

Keywords:

• Kratom
• clinical assessment
• clinical diagnosis
• kratom use disorder
• kratom intervention

Disclosure statement

In the past 3 years, KED has served as a consultant for Beckley-Canopy Therapeutics, Canopy Corporation, and Grünenthal, Inc. AGR is a scientific advisor to ETHA Natural Botanicals and NeonMind Biosciences. Through PinneyAssociates, JEH provides scientific and regulatory consulting to support new drug applications for diverse CNS active substances, new drugs, dietary product, and noncombustible tobacco/nicotine products for FDA regulation. This includes advising the American Kratom Association and its affiliate, the Center for Plant Science and Health, on kratom science and regulation. All other authors report no financial disclosures.

Additional information

Funding

Support was provided by the Intramural Research Program of the NIH NIDA.