Background: Kratom (mitragyna speciosa) is a tree indigenous to Thailand and other Southeast Asian countries. The tree belongs to the same botanical family as the coffee tree. The leaves of the tree contain many alkaloids that have long been used for medicinal purposes. The active compounds are mitragynine and 7-OH mitragynine. Kratom has recently become very popular in the United States as an herbal remedy known for its stimulant as well as sedative properties.

At low doses, mitragynine produces stimulant effects but at higher doses it possesses many pharmacologic properties similar to opioids. While it is legal in the United States, some states, such as Tennessee, Vermont, Louisiana, and Indiana have banned the drug. The U.S. Drug Enforcement Administration has, however, classified kratom as a “drug of concern” because of its abuse potential. It has no legitimate medical use. Reports of death from combined use of kratom with other opioids have been published.

According to the Food and Drug Administration (FDA), kratom is a botanical that qualifies as a dietary ingredient under section 210(ff)(1) of the Federal Food, Drug, and Cosmetic Act. The FDA considers kratom to be a new dietary ingredient for which there is inadequate information to provide reasonable assurance that such an ingredient does not present a significant or unreasonable risk of illness or injury.

Street Names: Thang, Kakuam, Ketum, herbal speedball, Biak.

Mode(s) of Use: The fresh leaves may be chewed, but kratom is also available as a dry powder, capsules and in liquid form and is often made into a tea.

Physiological effects: Kratom’s effects on the body include nausea, itching, sweating, dry mouth, constipation, increased urination, and loss of appetite. Long-term users of kratom have experienced anorexia, weight loss, insomnia, skin darkening, dry mouth, frequent urination, and constipation.

Psychological effects: The psychological effects range from aggression to nervousness, to hallucinations and sleeplessness.

Interpretation of Results: A targeted screening test for mitragynine and 7-OH mityragynine using LC-MS/MS may be used to screen for the drugs. All positive screening tests should be followed with a more sensitive and specific confirmatory test.

Detection Time in Urine: 1–7 days

Detection Time in Oral Fluid: 1–2 days