Abstract：
Used in Southeast Asia for generations, kratom gained popularity in the United States and elsewhere over the past several decades. Derived from Mitragyna speciosa, kratom preparations including leaves, teas, powders, capsules, and extracts may yield stimulant, analgesic, and opioid-like effects that occur dose-dependently based on concentrations of kratom\'s key alkaloids, mitragynine and 7-hydroxymitragynine. Such effects are responsible for kratom\'s potential as a reduced-harm alternative to opiates and as a withdrawal treatment. But these properties are also associated with tolerance development and addictive potential. Given mitragynine and 7-hydroxymitragynine activity on cytochrome P450 isoforms and opioid receptors, adverse effects among polysubstance users are a concern. Current literature on the toxicology of kratom is reviewed, including product alkaloid concentrations, in vitro and in vivo data, epidemiological evidence, and human case data. The potential harms and benefits of kratom products are discussed within an exposure assessment framework, and recommendations for industry are presented. Current evidence indicates that kratom may have therapeutic potential in some persons and that products present few risks with typical, non-polysubstance use. However, few studies identified alkaloid doses at which adverse effects were expected in humans or animals. Such research is needed to inform future assessments of kratom\'s risks and benefits.
摘要：
在东南亚使用了几代人，在过去的几十年里，kratom在美国和其他地方越来越受欢迎。源自Mitragynaspeciosa,kratom制剂包括叶子，茶,粉末,胶囊,提取物可能会产生兴奋剂，镇痛药,以及基于kratom关键生物碱浓度的剂量依赖性发生的类阿片样作用，mitragynine和7-羟基mitragynine。这种影响是kratom作为阿片类药物的减害替代品和戒断治疗的潜力的原因。但这些特性也与耐受性发展和成瘾潜力有关。鉴于mitragynine和7-羟基mitragynine对细胞色素P450亚型和阿片受体的活性，多种物质使用者之间的不利影响是一个令人担忧的问题。综述了有关kratom毒理学的最新文献，包括产品生物碱浓度，体外和体内数据，流行病学证据,和人类病例数据。在暴露评估框架内讨论了kratom产品的潜在危害和好处，并提出了行业建议。目前的证据表明，kratom可能对某些人具有治疗潜力，并且产品具有典型的风险，非多物质使用。然而,很少有研究发现生物碱的剂量会对人或动物产生不良反应.需要这样的研究来为未来对kratom风险和收益的评估提供信息。
