Kratom is scientifically known as Mitragyna Speciosa. Methods: In the current study, the in vitro and in vivo effects of M. speciosa methanolic, aqueous and total alkaloid leaves extracts on drug metabolizing enzymes, namely, cytochrome P450s (CYP450s) and UDP-glucuronosyl transferase (UGT) had been evaluated in rat liver cytosolic fraction and microsomes.

Potential users who tend to self-medicate and health professionals working with them should be clearly aware of the risks associated with kratom consumption 92 As it emerged from this and other previous studies 93 , kratom is advertised and sold online as cheaper alternative" to traditional opioid replacement therapies, as a painkiller for chronic pain, or as an anxiolytic remedy in psychiatric population, with no need of medical prescription or supervision.

People use kratom for withdrawal from heroin, morphine, and other opioid drugs, as well as cough, depression, anxiety, and many other conditions, but there is no good scientific evidence to support these uses. Kratom products are usually supplied as crushed or powdered dried leaves that are light to dark green in colour.

Whilst kratom metabolites could have the potential to be developed as new therapeutic agents, for example for pain and narcotic withdrawal treatment, there are of course possible serious adverse effects of these materials including potential addiction 79. Despite the increasing use of kratom, reports of severe toxicity in the literature are rare and its adverse effects are not well understood 71. A report of liver toxicity 80 and a combination of mitragynine and -desmethyltramadol have been published 81 as has a case of seizure and coma recently reported following Kratom Wholesale use 75.

Figure 14.8. Mitragynine and related indole alkaloids are the main psychoactive constituents of kratom. Kratom can be ingested as crushed dried leaves by taking powder, drinking as a tea or by smoking the leaves or the extract 71. Mitragynine (Fig. It is important to develop simple, inexpensive, and effective methods for Mitragyna speciosa analysis so that more information about toxicity, interactions with other drugs, metabolic actions, and pharmacology can be understood.