Journal of Psychoactive Drugs

ISSN: 0279-1072 (Print) 2159-9777 (Online) Journal homepage: https://www.tandfonline.com/loi/ujpd20

Public Perceptions toward Kratom (Mitragyna

Speciosa) Use in Malaysia

Darshan Singh, Suresh Narayanan, Shariffah Suraya, Azlin Saref, Oliver

Grundmann, Walter C. Prozialeck, Ornella Corazza, Marc T. Swogger, O.
Griffin & Vicknasingam Balasingam

To cite this article: Darshan Singh, Suresh Narayanan, Shariffah Suraya, Azlin Saref, Oliver
Grundmann, Walter C. Prozialeck, Ornella Corazza, Marc T. Swogger, O. Griffin & Vicknasingam
Balasingam (2020): Public Perceptions toward Kratom (Mitragyna�Speciosa) Use in Malaysia,
Journal of Psychoactive Drugs, DOI: 10.1080/02791072.2020.1738603

To link to this article: https://doi.org/10.1080/02791072.2020.1738603

Published online: 10 Mar 2020.

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JOURNAL OF PSYCHOACTIVE DRUGS
https://doi.org/10.1080/02791072.2020.1738603

Public Perceptions toward Kratom (Mitragyna Speciosa) Use in Malaysia

Darshan Singha, Suresh Narayananb, Shariffah Surayab, Azlin Sarefa, Oliver Grundmann c
, Walter C. Prozialeckd,
Ornella Corazza e, Marc T. Swoggerf, O. Griffin, IIIg, and Vicknasingam Balasingama
a
Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia; bSchool of Social Sciences, Universiti Sains Malaysia, Minden,
Malaysia; cDepartment of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, USA; dDepartment of
Pharmacology, College of Graduate Studies, Midwestern University, Downers Grove, IL, USA; eDepartment of Clinical and Pharmaceutical
Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK; fDepartment of Psychiatry, University of Rochester Medical Center,
Rochester, NY, USA; gDepartment of Criminal Justice, University of Alabama at Birmingham, Birmingham, AL, USA

ABSTRACT ARTICLE HISTORY

Kratom (Mitragyna speciosa), an indigenous medicinal plant of Southeast Asia, is believed to be Received 31 July 2019
harmful. We compared the perceptions toward kratom use among kratom users and non-users in Revised 8 October 2019
Malaysia. 356 respondents (137 kratom users and 219 non-users) were recruited for this cross- Accepted 19 November
2019
sectional study. The majority of respondents were male (60%, n = 212/356), Malays (88%), and
51% were ≥37 years old. Non-users showed higher unadjusted odds of reporting a perception KEYWORDS
that kratom use can cause addiction (OR = 6.72, CI: 3.91–11.54, p < .0001), withdrawal symptoms Kratom; mitragynine;
(OR = 7.58, CI: 4.62–12.42, p < .0001), illicit drug use problems (OR = 10.12, CI: 6.14–16.68, criminalization; perceptions
p < .0001), impaired social-functioning (OR = 12.05, CI: 7.24–20.05, p < .0001), and health problems
(OR = 10.44, CI: 6.32–17.24, p < .0001). Similarly, non-users viewed kratom policies differently from
kratom users, displaying increased odds of reporting the belief that kratom use and sales must be
regulated with stringent laws (OR = 5.75, CI: 3.61–9.18, p < .0001), and kratom should be regulated
instead under the Dangerous Drugs Act 1952 to overcome kratom use problems (OR = 8.26, CI:
4.94–13.82, p < .0001). Because of the disconnect in kratom use perceptions and personal
experiences between kratom users and non-users, hastily criminalizing kratom without investigat-
ing carefully its scientific merits can significantly impede future kratom research.

Introduction
The leaves from Mitragyna speciosa trees, locally known as
ketum (biak) in Malaysia or kratom in Thailand have been
used for decades in a traditional rural context for various
reasons: as a folk remedy, to combat fatigue, suppress pain
and for mood rejuvenating effects (Saingam et al. 2012;
Singh, Narayanan, and Vicknasingam 2016; Suwanlert
1975). However, despite the fact that kratom use in
Southeast Asia has become embedded in local tradition,
it continues to be viewed as a “dangerous drug” in official
circles. Thus, regulatory agencies in Malaysia, for example,
consider kratom to be a substance similar to opioids,
cannabis and methamphetamine. Its use is therefore regu-
lated under the Poisons Act 1952 (Singh, Narayanan, and
Vicknasingam 2016). More recently, kratom use evolved
into a significant issue when enforcement agencies in
Southeast Asia and the West began to classify kratom as
a harmful substance with detrimental health conse-
quences, despite the paucity of scientific information sub-
stantiating this belief (Prozialeck et al. 2019). In contrast,
survey information from traditional settings do not indi-
cate that kratom use is associated with any significant
health risks (Singh et al. 2018; Suwanlert 1975). Even so,
based on reports that kratom has opioid-like effects, and
citing concerns regarding addiction and the risks of using
contaminated and unapproved kratom products, the
United States (US) Food and Drug Administration
(FDA) has classified several alkaloids present in kratom
as opioids and associated them with severe negative
effects, including death (FDA 2018).
In the US kratom is not currently regulated at the
federal level (FDA 2018; Henningfield, Fant, and Wang
2018). To date, there have been no rigorous clinical
studies of kratom that would meet the FDA’s standards
for safety. Nonetheless, observational studies and sur-
veys (see Grundmann 2017; Swogger and Walsh 2018)
indicate that those who have used kratom experienced
pain relief, enhanced mood and relief of opioid with-
drawal symptoms. Mainly because of its unique pain-
relieving and perceived medicinal benefits, kratom is
widely promoted on the internet and sold in retail
outlets unique to tobacco and cannabis (e.g., head or
smoke shop) in the US (Grundmann 2017) and
elsewhere.

CONTACT Darshan Singh darshan@usm.my Centre for Drug Research, Universiti Sains Malaysia, Minden, Penang 11800, Malaysia
© 2020 Taylor & Francis Group, LLC
2 D. SINGH ET AL.
Despite its widespread use and purported medicinal
value, safety information pertaining to chronic and
regular kratom consumption remains poorly elucidated
(Corkery et al. 2019). Findings from a recent review
article indicated that kratom use has been associated
with various adverse health effects such as tachycardia,
liver toxicity, seizure and coma, adult respiratory dis-
tress syndrome, hypothyroidism, and generalized tonic-
clonic seizures (Corkery et al. 2019). Especially when
used in combination with other substances (e.g.,
diphenhydramine, ethanol, benzodiazepines, opioids
and stimulants), kratom has been said to contribute to
serious medical outcomes such as seizures, respiratory
depression, coma, increased bilirubin, bradycardia,
rhabdomyolysis, renal failure, respiratory arrest, cardiac
arrest and cyanosis (Post et al. 2019). While causation
cannot be inferred from these case studies and poison
control reports (Swogger and Walsh 2018), caution is
warranted until more and better data on potential
harms of kratom use are available.
According to the United Nations Office on Drugs and
Crime (UNODC), kratom is the most sold plant-based
Novel Psychoactive Substance (NPS) (Corazza and
Roman-Urrestarazu 2018; UNODC 2018). So far, kra-
tom-related products have been identified in 31 coun-
tries between 2009 and 2017 (UNODC 2018), where
these are often advertised as safe “herbal remedies” to
treat opioid withdrawals, chronic pain, or facilitate
weight loss, among other conditions. In 2016, over 500
tons of kratom were intercepted by international autho-
rities, triple the amount of the previous year, suggesting
an unprecedented increase in its popularity outside its
original geographical boundaries (UNODC 2018).
Although kratom is regulated in Malaysia, its wide-
spread and continued use in traditional settings sug-
gests that the general population holds an ambivalent
view about the use of kratom. Yet with sporadic, but
widely publicized reports on kratom seizures and
harms attributed to kratom use appearing in the
media, there have been calls to criminalize its use.
Not surprisingly, this group is mainly comprised of
enforcement agencies and people who have not used
kratom (non-kratom users). On the other side of the
divide, are researchers who have been studying kra-
tom use and see positive potential benefits from its
use. Those who have used kratom and benefited from
it are also a relevant voice that should be heard but
have remained a “silent minority” because of the fear
of being prosecuted should they come to the fore.
Since safety of kratom use is being fiercely debated
by policymakers and treatment providers despite user
testimonies supporting kratom’s therapeutic properties
this exploratory study examined the differences in
kratom use perceptions between kratom users and non-
users (those who have had no experience with kratom)
in the local context in Malaysia.
Methods
Study design, respondents and location
We enrolled 356 (n = 137 kratom users vs. n = 219 non-
users) respondents for this cross-sectional quantitative
study. First, purposive sampling was used to recruit
potential kratom users and non-users from the northern
peninsular states of Penang and Kedah (Malaysia) where
kratom use was reported to be prevalent. Next, we used
convenience sampling to recruit a sizable number of
respondents who were approached and identified in
public settings (e.g. coffee shops, fishing villages, farm-
land). To have a better understanding of attitudes
regarding kratom use among the local populace, both
kratom users and non-users were recruited from the
same study location. An attempt was made to identify
more kratom users, but its illegal status precluded many
users from taking part in the survey.
Study inclusion and exclusion criteria
The study inclusion criteria were: 1) 18 years and
above, 2) must have some understanding about kratom
use and its associated risks, and 3) live in a community
where kratom use was reported to be prevalent. Kratom
users who self-reported current kratom use history
were recruited for the study, while non-users com-
prised those who have never tried kratom before. We
excluded those who were unwilling to provide written-
informed consent.
Data collection
Interviews were conducted from January 2019 to
April 2019. Prior to data collection, we approached key-
informants in various targeted study locations. We
briefed the key-informants about study objectives.
Eligible respondents were then interviewed individually
by the researcher in the community. A self-developed
questionnaire consisting of qualitative and dichotomous
variables was used to collect: 1) socio-demographic char-
acteristics, 2) perceptions regarding kratom use, 3) kra-
tom use problems and 4) views regarding kratom
decriminalization. Respondents were assured participa-
tion anonymity and data confidentiality. All the inter-
views were conducted in the local Malay language, and
each interview session lasted about 20 to 25 minutes.
The study was approved by the Human Ethics and
 JOURNAL OF PSYCHOACTIVE DRUGS 3

Research Committee of Universiti Sains Malaysia. As Reasons for kratom use

a token of appreciation, respondents were compensated
with RM20 (USD = 5) for their time. All gave their
written-informed consent.
Data analysis
Data were analyzed with the Statistical Package for Social
Sciences (SPSS) software version 25. First, we used
descriptive statistics to describe the socio-demographic
characteristics, reasons for kratom use, problems asso-
ciated with kratom use, and views regarding kratom
decriminalization. Next, we computed Chi-square analy-
sis to compare kratom users and non-kratom users’
perceptions toward kratom use problems and decrimina-
lization. The utility calculator that was available at www.
Vassarstats.com was used to calculate the unadjusted
Odds Ratios (OR) and 95% Confidence Intervals (CI).
Results
Respondents socio-demographic characteristics
Demographic characteristics are shown in Table 1.
A majority were males (60%, n = 212/356), Malays,
and above 37 years old. More than two-thirds were
married, 56% had more than 13 years of education,
and 90% were employed. More than one-third (38%)
were kratom users, while 62% were non-users. Results
from Chi-square analysis in Table 1 show that kratom
users had significantly higher odds of being male, and
of being Malay than non-users. Non-users, on the other
hand, had higher odds of having had more than
13 years of education as compared to users.
Those who used kratom claimed various reasons for
using. Kratom was commonly used to increase energy
(70%), as a folk remedy (61%), treat health problems
(58%), and improve mood/mitigate stress (52%). It was
also relied upon to treat pain, increase sexual perfor-
mance, and to treat drug use and mental health pro-
blems (Table 2).
Problems arising from kratom use: differences in
perceptions of kratom users and non-users
Results in Table 3 show differences in the perceptions of
users and non-users regarding the effects of kratom con-
sumption, with proportionally lower figures among users
who agree that kratom was addictive, causes withdrawal
symptoms, can add to the existing drug use problems,
impairs social functioning and results in health problems,
as compared to non-users. To illustrate, while only 25%
of users agreed that kratom use impaired social function-
ing, an overwhelming 80% of non-users held the same
view. Similarly, while only 31% of kratom users believed
it would result in health problems, 82% of non-users
believed this would be the case.
Table 2. Reasons for kratom use among kratom users.
N (%)
Increase energy 96 (70)
As a folk remedy 83 (61)
Treat health problems 80 (58)
Improve mood/mitigate stress 71 (52)
Treat pain 66 (48)
Increase sexual performance 52 (38)
Treat drug use problem 42 (30)
Treat mental health problem 15 (11)
Total users 137 (100)

Table 1. Socio-demographic characteristics of respondents.

Total
Sample Kratom User Non-user
(N = 356) (N = 137) (N = 219)
N (%) N (%) N (%) OR (95%CI) P-value
Age
18–36 years 176 (49) 61 (44) 115 (52) 1.37(0.89–2.12) .143
≥37 years 180 (51) 76 (56) 104 (48)
Gender
Male 212 (60) 123 (90) 89 (41) 12.83 (6.94–23.74) <.0001*
Female 144 (40) 14 (10) 130 (59)
Ethnicity
Malay 313 (88) 128 (93) 185 (85) 2.61 (1.21–5.64) .011*
Non-Malay 43 (12) 9 (7) 34 (15)
Marital status
Single 105 (29) 42 (31) 63 (29) 1.09 (0.69–1.74) .708
Married 251 (71) 95 (69) 156 (71)
Education
≤13 years 156 (44) 97 (71) 59 (27) 6.57 (4.09–10.56) <.0001*
>13 years 200 (56) 40 (29) 160 (73)
Employment
Employed 322 (90) 127 (93) 195 (89) 0.6 4(0.29–1.38) .252
Unemployed 34 (10) 10 (7) 24 (11)
4 D. SINGH ET AL.

Table 3. Problems associated with kratom use: perceptions of kratom users and non-users.
Total
Sample Kratom user Non-user
(N = 356) (N = 137) (N = 219)
N (%) N = (%) N (%) OR (95% CI) P-value
Causes addiction
Yes 270 (76) 75 (55) 195 (89) 6.72 (3.91–11.54) <.0001*
No 86 (24) 62 (45) 24 (11)
Causes withdrawal effects
Yes 238 (67) 55 (40) 183 (84) 7.58 (4.62–12.42) <.0001*
No 118 (33) 82 (60) 36 (16)
Increases the drug use problem
Yes 221 (62) 42 (31) 179 (82) 10.12 (6.14–16.68) <.0001*
No 134 (38) 95 (69) 40 (18)
Impairs social-functioning
Yes 209 (59) 34 (25) 175 (80) 12.05 (7.24–20.05) <.0001*
No 147 (41) 103 (75) 44 (20)
Causes health problems
Yes 222 (62) 42 (31) 180 (82) 10.44 (6.32–17.24) <.0001*
No 134 (38) 95 (69) 39 (18)
Will encourage students to use kratom
Yes 275 (77) 71 (52) 204 (93) 12.64 (6.78–23.55) <.0001*
No 81 (23) 66 (48) 15 (7)

Regulating kratom: perceptions between kratom
users and non-users
Respondents were also asked about their views on var-
ious aspects of regulating kratom use.
A majority of non-users wanted kratom to be regu-
lated (74%) while the majority of users (66%) did not
want regulation. Interestingly, the majority of both users
and non-users agree that attempts at regulating kratom
use can worsen the illicit drug use situation in the
country. While 65% of non-users wanted kratom to be
regulated under the Dangerous Drugs Act (DDA) 1952,
the legal consequences of which could subject a person
to the death penalty for kratom possession and supply,
only 18% of users shared a similar view (Table 4).
A large proportion of both users and non-users
expressed the need for more studies on the potential
medical benefits of kratom and its ability to substitute
for opioids. The majority, in both groups, did not think
that decriminalizing kratom use can help address the
problem of illicit drug use in the country.
Chi-square analyzes, however, indicated significant
differences in the views held by users and non-users
only with respect to 4 items. Non-users had signifi-
cantly higher odds of suggesting that kratom be

Table 4. Regulating kratom: perceptions of kratom users and non-users.

Total Kratom
Sample user Non-user
(N = 356) (N = 137) (N = 219)
N (%) N (%) N (%) OR (95% CI) P-value
Kratom use and sale must be regulated with stringent laws
Yes 209 (59) 46 (34) 163 (74) 5.75 (3.61–9.18) <.0001*
No 147 (41) 91 (66) 56 (26)
Media has influenced my perception regarding kratom use danger
Yes 178 (50) 61 (44) 117 (53) 1.42 (0.93–2.19) .102
No 178 (50) 76 (56) 102 (47)
Regulating kratom like heroin/cannabis can worsen the illicit drug use situation
Yes 219 (61) 94 (69) 125 (57) 1.64 (1.05–2.58) .029*
No 137 (39) 43 (31) 94 (43)
To overcome problems of kratom use, it has to be regulated under DDA 1952
Yes 167 (47) 25 (18) 142 (65) 8.26 (4.94–13.82) <.0001*
No 189 (53) 112 (82) 77 (35)
Kratom’s medicinal benefits and its potential as a substitute for illicit drugs need to be
investigated
Yes 303 (85) 121 (88) 182 (83) 1.54 (0.82–2.89) .178
No 53 (15) 16 (12) 37 (17)
Decriminalization of kratom can help address illicit drug use problems
Yes 128 (36) 55 (40) 73 (33) 1.34 (0.86–2.09) .192
No 228 (64) 82 (60) 146 (67)
Do you condone kratom use in the community?
Yes 113 (32) 88 (64) 25 (11) 13.94 (8.09–24.00) <.0001*
No 243 (68) 49 (36) 194 (89)

regulated and that it be regulated under the DDA 1952.
They also had significantly higher odds of not condon-
ing the use of kratom in the community. Kratom users,
on the other hand, had higher odds of believing that
regulating kratom will worsen the illicit drug use pro-
blem in the country (Table 4).
Discussion
Our results showed significant differences in percep-
tions regarding kratom use between users and non-
users. Non-users tended to have more negative views
about the effects or problems associated with kratom
use than users. A larger proportion of non-users asso-
ciated kratom use with an array of problems (e.g.,
addiction, withdrawal, drug use and other health
related risks). Despite the belief of non-users that kra-
tom consumption can further aggravate the illicit drug
use problem, to the best of our knowledge, there has
been no evidence in the Southeast Asian context to
suggest that this might be the case. In fact, kratom
use carries little risks when compared to the use of
other illicit drugs (Ahmad and Aziz 2012;
Assanangkornchai et al. 2007; Saingam et al. 2012;
Tanguay 2011). In rural areas in Malaysia, out-of-
treatment opioid users commonly perceive kratom as
a safe alternative to opioids, and use it to reduce their
dependence on illicit opioids (Ahmad and Aziz 2012;
Tanguay 2011; Vicknasingam et al. 2010). These find-
ings, however, often remain hidden in academic
research papers not widely accessed by the general
public. In contrast, negative health incidents associated
with kratom use gain publicity through the mass media.
As a result, individuals may continue to regard kratom
negatively without weighing its utility, particularly
among those struggling with their illicit drug use pro-
blem. Since kratom is being used to self-treat opioid
dependence, researchers have opined that kratom can
be used as a harm-reduction tool (Swogger and Walsh
2018), particularly to treat pain and withdrawal among
opioid users (Coe et al. 2019; Grundmann 2017).
Kratom users in our sample relied largely on their
own subjective experiences to come to their conclu-
sions, while non-users may probably have their own
views on kratom, which could have been framed nega-
tively based on different sources of unsolicited infor-
mation (e.g. newspaper highlights, personal
observations, family members with kratom use history,
etc.). Yet, the lived experience with kratom will go
unheard in the debate regarding the advantages and
disadvantages of criminalizing kratom use. This poses
the danger that the combined opposition of the enfor-
cement agencies and non-users, whose views have often
JOURNAL OF PSYCHOACTIVE DRUGS 5
been negatively influenced by media and other specu-
lative and non-evidence-based sources, will prevail in
the debate. Such a possibility was clearly demonstrated
in the US when in 2016 the Drug Enforcement
Administration (DEA) announced its intention to tem-
porarily place kratom’s main alkaloids, mitragynine and
7-hydroxymitargynine into Schedule I of the Controlled
Substances Act (CSA) as an emergency measure.
Among the key arguments used by DEA to lobby for
kratom’s scheduling included the incremental surge in
kratom seizures and increased calls to poison control
centers concerning kratom (Anwar, Law, and Schier
2016; Griffin and Webb 2017). It was advocacy groups
that came to the rescue; groups such as the American
Kratom Association (AKA) mounted an effective resis-
tance against the proposal.
A similar situation must be avoided in Malaysia. The
sharp difference in opinions regarding the status of
kratom between users and non-users is evident from
our sample. While an overwhelming 82% of kratom
users opposed placing kratom under the purview of
DDA of 1952 (which currently prescribes the death
penalty for possession or sale of drugs and long jail
terms or exorbitant fines for users), 65% of non-users
were in support of such a move. Even so, the findings
show that it is unlikely that kratom users will be as
vocal as users in the US because, most kratom users in
Malaysia are poorly educated (only 29% had more than
13 years of education) and are rural-based users who
are likely unable to defend their kratom use practice.
Moreover, the fear of stigmatization or possible prose-
cution will likely prevent them from taking a public
stance in support of kratom. Thus, the responsibility to
meet the challenge falls on kratom researchers who
have access to the views of users, who understand the
potential benefits of the plant and whose education and
knowledge will withstand public scrutiny. They must
approach public advocacy via three initiatives: be an
advocacy group themselves; foster the growth of non-
governmental organizations (NGOs) to support the
cause through the dissemination of research findings;
and finally, propagate unbiased scientific research on
kratom by simplifying the results and making them
accessible to the general public through the press or
other approaches.
In the West, advocacy groups, as well as kratom
researchers have urged the relevant agencies to regulate
kratom distribution, as this would minimize unscrupu-
lous traders from distributing dubious kratom products
which could cause deleterious health consequences
(Henningfield, Fant, and Wang 2018). This is because
most of the adverse kratom use health problems in the
West may stem from the use of adulterated kratom
6 D. SINGH ET AL.
products or drug interactions (Anwar, Law, and Schier
2016; Lydecker et al. 2016; Olsen et al. 2019). To prevent
kratom use health threats, some states in the US have
already introduced the “Kratom Consumer Protection
Act” to safeguard consumers from avoidable health con-
sequences (Henningfield, Fant, and Wang 2018).
A similar approach should be applied in Malaysia, but
should also ensure adequate protection to kratom users.
Our results indicated that non-users want kratom use
and sales to be regulated with stringent laws compared
to kratom users. Though reports on kratom use health
consequences are rarely reported in Malaysia, it cannot
be denied that kratom can be abused as a readily avail-
able product (Singh, Narayanan, and Vicknasingam
2016). In nearby, Thailand, concocting kratom cocktails
to experience legal highs is becoming a trend among the
young (Tungtananuwat and Lawanprasert 2010).
Therefore, regulation to prevent abuse may be necessary,
but it should not amount to a ban on kratom use. One of
the immediate consequences of a ban is to propel former
opioid users to relapse to opioid use due to the unavail-
ability of kratom (Henningfield, Fant, and Wang 2018).
There were attempts to bring the kratom issue to the
attention of cabinet ministers in 2014 and 2017, with
a proposal to ban its use and regulate it under the DDA
1952. Both attempts failed and there was a call for investiga-
tion of the benefits and dangers of kratom use. Researchers
in the West maintain that criminalizing kratom or placing it
in Schedule I of the Controlled Substances Act (CSA) can
gravely aggravate the opioid use crisis (as noted earlier)
(Henningfield, Fant, and Wang 2018). Our findings indi-
cate that kratom users, moreso than kratom non-users,
believed that regulating kratom like heroin/cannabis can
worsen the illicit drug use situation in the country. About
40% of kratom users in this study used kratom to treat their
drug use problem. It can be inferred that kratom users,
especially those who used kratom to overcome their illicit
drug use problem, have a better understanding on the
usefulness of kratom in curtailing the illicit drug use pro-
blem, and can foresee how a ban on kratom use could
compound the illicit drug use situation in the country.
Findings from two US studies showed kratom is being
used as a mitigation strategy by opioid use disorder patients
(Coe et al. 2019; Smith and Lawson 2017)
Compared to non-users, kratom users supported
kratom using habit in their community. The reason
behind this can be attributed to kratom’s therapeutic
effects that have been experienced and understood by
the community over generations. Kratom users hold
jobs, function well socially, do not engage in illicit
drug use, or risky HIV drug using behaviors. Thus,
they are not stigmatized and function as useful mem-
bers of society (Singh et al. 2015). Any move to
criminalize kratom use will drive users underground
to escape arrest and punishment and disrupt the social
balance prevailing in these communities.
We found that the majority of non-users and users
believed that kratom’s medicinal benefits and potential as
a substitute for opioids should be investigated. This agree-
ment should be highlighted by pro-kratom advocacy
groups and researchers to make their case for keeping
kratom legal. Kratom researchers should work closely
with regulatory agencies to provide them evidence-based
responses instead of relying on perceptions fashioned by
sensationalized news articles. Kratom’s medicinal qualities
remain scantily investigated, although, kratom’s main
alkaloid mitragynine has been shown to be a partial opioid-
receptor agonist with unique pharmacological properties
and limited abuse potential (Hemby et al. 2018). Further
clinical studies are needed, particularly to assess kratom’s
therapeutic efficacy in managing opioid dependence.
This study has some limitations. First, the study
respondents were largely recruited from northern states
of peninsular Malaysia, limiting generalizability Second,
there are inherent recall and social desirability biases.
Finally, there is a need to recruit a sizable number of
female kratom users, as they might have different views
regarding kratom use than male kratom users.
In conclusion, we found non-users tended to have
more negative perceptions toward kratom use than kra-
tom users. Our findings show kratom use perceptions
differed significantly between kratom users and non-
users. Criminalizing kratom without weighing its poten-
tial benefits will impede efforts to research its medicinal
and therapeutic value, aggravate opioid use, and result in
driving kratom users underground to escape prosecution.
Acknowledgments
This work was supported by the Universiti Sains Malaysia (USM)
(Research University Grant: 1001/PSOSIAL/8016015), and
Higher Institution Centres of Excellence (HICoE) grant. We
thank Muhammad Eshal Bin Dzulkapli for his kind assistance
in the data collection process and for coordinating the field work.
Disclosure Statement
All the authors have no conflict of interest.
Funding
This work was supported by the Universiti Sains Malaysia.
ORCID
Oliver Grundmann http://orcid.org/0000-0003-2302-8949
Ornella Corazza http://orcid.org/0000-0001-7371-319X

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