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ochemicals like alkaloids, flavonoids, terpenoid, polyphenols and glycosides have been isolated from kratom plant. The main psychoactive components are mitragynine and 7-hydroxymitragynine, which involve opioid receptors and are responsible for stimulant effects and sedative-narcotic effects (1). They are selective agonist of the ?-subtype opioid receptor (MOR) and ?-opioid receptors which trait to its analgesia and reduced GI motility (2).  Studies shown that 5-HT2a, postsynaptic ?2-adrenergic receptors, as well as neuronal Ca2+ channels are also involved in the mitragynine unique pharmacological and behavioral activities(1). Mitragynine stimulant effect can cause motor excitement, loss of motor coordination, giddiness and tremors even in small doses (50 mg) and sweating, nausea, dysphoria followed by euphoria and a dreamlike state up to 6 hours in larger doses (10-25g) (1). Business insider India in Nov 15 2017 reported the use of kratom as a concentration booster, workout enhancer, and replacement to opioid painkillers and to treat opioid addiction. REPORTED ADVERSE EFFECTS OF KRATOM                Short time use of kratom can result in nausea, constipation, sleep problems, temporary erectile dysfunction, itching, or sweating. Long time use effects are anorexia, dry mouth, diuresis, darker skin, and hair loss. For some people kratom can be a habit forming drug and can cause withdrawal symptoms such as hostility, aggression, aching of muscles and bones, jerky movements of the limbs, anorexia and weight loss(3). Mitragynine tend to increase the production of melanocytes-stimulating substance and this can cause skin pigmentation in long term addicts. (4)                 Some studies reported that intrahepatic cholecystitis can occur due to kratom abuse, after cessation of the drug patients developed fever, chills followed by abdominal pain and concomitant brown discoloration of urine. Their bilirubin levels were elevated and alkaloids of M.speciosa was detected in the urine.(5)(9) Studies has revealed elevation in glutathione-S-transferase in mice after administration of M.speciosa extracts which can be the possible factor causing strain in liver.(6) Another report shown that seizure and coma can also be the result of kratom exposure. This is possibly due to adenosine binding or stimulation of adrenergic or serotonergic receptors by the alkaloid (7). A case report by Sergey V. MD et al, from the Cleveland Clinic Alcohol and Drug Recovery Center, suggested a probable association between kratom overuse and hypothyroidism. They observed high dose of indole alkaloid mitragynine might reduce the normal response of the thyroid gland to thyroid-stimulating hormone resulting in primary hypothyroidism. (8)  Regulations concerning Kratom                Kratom is also largely uncontrolled in the US at a federal level so it not illegal to cultivate kratom and can distribute without a license and when sold as a supplement, sales must conform to US supplement laws (10). So it became possible for the public to purchase it online, in “head shops,” or in convenience stores (11). Mitragyna speciosa are currently controlled only in a small number of EU Member States (1). To control its widespread abuse, kratom was banned in Malaysia and regulated under the Poisons Act 1952. The Malaysian government is in the midst of regulating kratom under the Dangerous Drugs Act 1952, which will consider the substances as harmful (12).                In 2008, internet surveys conducted by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) indicated that kratom was one of the most widely offered “legal highs” in 44% of the investigated 27 online shops across the EU (1).  In July 2011, a more extensive EMCDDA Internet survey showed that kratom was the most widely offered product with 128 out of 631 (or 20%) of online retailers shipping it to the EU. In 2012 the term “kratom” was found in more than two million results. Of the first 100 websites listed in the search results, 78 were primarily focused on the sale of kratom, while 22 were focused on disseminating information about kratom through the use of discussion boards. (13)A Matter of concernThe FDA has been aware of the 36 death reports linked to kratom use and the FDA commissioner Scott Gottlieb released a warning statement on November 16 2017 about kratom use. The Centers for Disease Control and Prevention has been notified about the 10 fold increase in enquires concerning about kratom to the poison control. Accordingly in 2012 FDA had put kratom on alert list and in 2014, FDA issued “Import Alert 54-15” to provide customs and border agents broad authority to seize kratom products from a number of suppliers outside the US. (10)Contrary statementsIn 2017, the American Kratom Association hav

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