Diversification of Kratom in US Markets: Results from an Online Survey and Chemical Assay of Products

Kratom (<i>Mitragyna speciosa</i>) products in the US have diversified from dried leaf to now include edibles, extracts, teas, and tonics. Higher alkaloid content and/or greater oral exposure across formulations expose consumers to potentially greater amounts of alkaloids per serving in a shorter duration of time, thereby potentially increasing product effect and risk profiles. Six kratom vendors disseminated our anonymous online survey. Participants reported on products use patterns, perceived benefits, and adverse effects. Product samples were classified: powders, edibles, liquids, and teas and were analyzed for alkaloid content using UPLC-MS/MS. The final sample consisted of 421 participants, using 61 products. They were 61.8% male and 46.3% between 31 and 50 years. Whole-leaf powders were most popular and reported to provide more pain relief, energy, and improved sleep compared to other products. The most common adverse effect was constipation (73.4%). Edibles were associated with tolerance while liquids were associated with consuming more than intended. Alkaloid content was significantly higher in edibles and whole-leaf powders compared to teas and concentrated liquid extracts. Diversification of kratom products and higher alkaloid content per serving or dose expose consumers to inadvertent toxicity. Further clinical investigation of risk profiles for different formulations is needed.