Is kratom hepatoxic?

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Kratom and Hepatotoxicity: An Overview

Introduction to Kratom and Its Uses

Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia, known for its opioid-like properties. It has gained popularity for its stimulant and analgesic effects, and is often used for self-treatment of pain, opioid withdrawal management, and recreational purposes . The primary active compounds in kratom are mitragynine and 7-hydroxymitragynine, which interact with opioid receptors in the brain .

Evidence of Kratom-Induced Hepatotoxicity

Case Reports and Clinical Findings

Several case reports and clinical studies have documented instances of liver injury associated with kratom use. These reports often describe significant elevations in liver enzymes, such as total bilirubin and alkaline phosphatase, and histological findings indicative of liver damage. Common histological features include canalicular cholestasis, mixed portal inflammation, and perivenular necrosis .

Patterns and Mechanisms of Liver Injury

The latency period for the onset of liver injury symptoms after kratom use varies, with a median of approximately 20 days. Symptoms commonly reported include abdominal discomfort, jaundice, pruritus, and dark urine. The liver injury associated with kratom is predominantly cholestatic, although biochemical presentations can be heterogeneous or mixed.

Epidemiological and Mechanistic Insights

Epidemiological data and animal studies support the potential hepatotoxic effects of kratom. The US Drug-Induced Liver Injury Network and FDA databases have reported multiple cases of liver injury linked to kratom use. Mechanistic studies suggest that the hepatotoxicity may be related to the active alkaloids in kratom, which can cause liver cell damage through various pathways .

Risk Factors and Safety Concerns

Concurrent Use with Other Substances

The risk of liver injury may be heightened when kratom is used in conjunction with other hepatotoxic substances, including over-the-counter medications, herbal supplements, and prescription drugs. This potential for additive liver toxicity necessitates careful monitoring of patients using kratom, especially those with pre-existing liver conditions or those taking other medications.

Regulatory and Public Health Implications

Despite its potential for liver injury, kratom remains widely available and unregulated in many regions. The lack of standardized analytical screening techniques for detecting kratom use further complicates efforts to monitor and manage its safety. Public health authorities are increasingly concerned about the safety of kratom, leading to discussions about potential regulations to mitigate its risks.

Conclusion

In summary, while kratom is used for its stimulant and analgesic effects, there is growing evidence that it can cause liver injury. Case reports and clinical studies have documented significant liver enzyme elevations and histological damage in kratom users. The risk of hepatotoxicity may be exacerbated by concurrent use with other substances. Given the increasing popularity of kratom and its potential health risks, further research and regulatory measures are needed to ensure public safety.