Informal Use of Kratom for the Self-treatment of Heroin and Amphetamine-Type Stimulant (ATS): Findings from a Sample of People Who Use Drugs (PWUDs) in Malaysia

Abstract

Introduction: Malaysia has harsh drug laws and continue to jail people who use drugs (PWUDs). This study aims to describe the use of kratom among PWUDs in Malaysia. Methods: A total of 331 convicted PWUDs with kratom use history were randomly recruited from three penitentiaries for this cross-sectional study. Prison counsellors helped to conduct the surveys with a semi-structured questionnaire. Results: All males (n=331), 94% Malays, and 91% held employments prior to their incarceration. The samples mean age was 32.9 years (SD=7.3). The majority (59%, n=194/331) were amphetamine-type stimulant (ATS) users, only 41% had co-used heroin and ATS. Almost one-third (32%, n=105/331) had used drugs between 1 to 5 years, while 68% had used drugs for ≥6 years. Most (99%, n=321/331) have been jailed before, and 86% (n=284/331) had no formal drug rehabilitation history. Kratom decoction is separately and intermittently consumed with illicit drugs, though 61% (n=202/331) used ≤1 litter of brewed solution daily, it is commonly ingested to enhance energy, to abstain from illicit drug consumption, to reduce the frequency of methamphetamine use, as a substitute to heroin, to maintain abstinence, to suppress heroin withdrawal, and to reduce heroin use frequency, though a few claimed using it to enhance sexual performance, and obtain euphoria. In addition, 48% claimed that it takes approximately one-month to reduce or stop heroin use, while 57% of ATS users claimed the same after initiating kratom. Heroin users rated their withdrawal pain severity as no pain (23%), mild (43%), moderate (27%), and strong (7%) after kratom use. Conclusions: Though kratom has been banned, the infamous indigenous medicinal plant is widely used as a substitute to illicit substances, since it helps PWUDs to self-manage their substance use disorder (SUD). Hence, further clinical studies are needed to support kratom's medicinal use among PWUDs.