Abstract
BACKGROUND: As interest in human enhancement continues to rise in Europe, kratom (Mitragyna speciosa) products have raised significant public health concerns. Kratom, which is used for its dose-dependent stimulant and sedative effects, has grown in popularity to enhance mood and self-manage pain or opioid withdrawal symptoms. This study aimed to assess the East-Central European online kratom market, evaluate product quality, and analyze potential toxicological risks to inform evidence-based harm reduction strategies. METHODS: A comprehensive approach was employed, including online market surveillance, detailed content analysis of vendor websites, test purchase of products, followed by chemical analysis. Google search engine results were used to identify vendors shipping to Hungary. A total of 59 web shops were identified, and 25 distributors were selected for further analysis. Eight online sellers were included in test purchases. Mitragynine content was analyzed using supercritical fluid chromatography coupled with tandem mass spectrometry (SFC-MS/MS) and high-performance liquid chromatography with diode-array detection (HPLC-DAD). Toxicovigilance data were extracted from the United States Food and Drug Administration Adverse Event Reporting System (FAERS) and the Center for Food Safety and Applied Nutrition Adverse Event Reporting System (CAERS). RESULTS: The online kratom market in East-Central Europe is extensive and accessible, with many sellers identified in Hungary, the Czech Republic, Slovakia, and the Netherlands. While 68% (n/N = 17/25) of the evaluated web shops promoted enhancement effects, only 32% (n/N = 8/25) presented any information on potential adverse effects. Analysis of the products revealed highly variable mitragynine content, with mean concentrations ranging between 14.16 and 18.41 mg/g in powder form, and 42.60-210.20 µg/mL in prepared teas. Vigilance databases revealed 1090 cases in FAERS and 630 in CAERS associated with kratom use, with high rates of serious outcomes, including 592 deaths reported in FAERS. CONCLUSIONS: The online kratom market in East-Central Europe poses a significant public health threat, particularly to individuals seeking its enhancement effects. The significant variability in the mitragynine content, combined with the lack of safety information creates a high-risk environment. Toxicological data revealed a high incidence of serious adverse reactions, particularly in cases of polysubstance use. These findings highlight the urgent need for regulatory oversight and harm reduction strategies.