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

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. 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. 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. 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.