I refer to recent reports in the New Straits Times about seizures of ketum leaves in large quantities.
The use of ketum is a long-standing issue in our country. An indigenous plant in Southeast Asia, ketum has been popularly used as a folk remedy for generations among rural communities in Malaysia and neighbouring Thailand. It is often taken as an “energy boosting drink” by manual workers like farmers and fishermen. Moreover, its consumption during leisure hours, e.g. at social gatherings with friends, is perceived in many places as compatible with local traditions.
At the same time, ketum’s psychoactive properties also open the way for abuse, leading to legal restriction of its usage.
Ketum is listed as a controlled item under the Poisons Act 1952.
Illegal possession of ketum invites criminal charges under the act. Ketum functions as a stimulant if the dosage is low but has opiate-like effects when consumed in larger amounts.
It is a worrying trend that more drug addicts are using ketum in combination with other drugs.
Frequently purchased as homemade concoctions, ketum drink can be easily mixed with other substances such as cough syrups and stimulant pills in order to obtain stronger effect.
In the mental healthcare setting, the use of ketum may complicate and worsen the symptoms of addicts who have drug-related psychiatric problems such as delusions and hallucinations.
Moreover, the active ingredient of ketum, mitragynine, cannot be detected by standard drug screening kits.
Therefore, extra vigilance by clinicians is required to identify its presence in patients.
It is also more difficult to dissuade addicts as ketum use is often justified as socially acceptable.
In fact, time and again there have been efforts from various sectors to push for ketum’s legalisation and even large-scale cultivation for its purported benefits and commercial value.
While there are clinical observations and studies concerning the use of ketum as a substitute for other drugs among addicts, medical evidence is still insufficient to support this practice, especially given our knowledge of potential long-term negative consequences of heavy ketum use, both physical and psychological.
It is true that in recent years, ketum has been promoted as a less harmful “herbal” product, compared to synthetic drugs, in the drug user circles in some western countries.
However, there is also rising international concern about a possible threat to public health from ketum’s use. In some jurisdictions, including in many EU countries, its sale and importation have been restricted. A number of public health authorities, including the United States Food and Drug Administration, have also raised alerts regarding the marketing of ketum with unsubstantiated medical claims.
Before better evidence emerges to support medicinal use of ketum, it would be prudent for the government to carry on with current policies and law enforcement.
Some parties have also urged the government to consider penalising the use of ketum under the Dangerous Drugs Act, which will carry heavier penalties, instead of the Poisons Act, in order to curb its widespread abuse.
The public need to be better informed about the properties of ketum and all stakeholders have to be consulted before changes in the regulation of its use are made.
DR LUKE WOON SY-CHERNG
Psychiatry & Mental Health Unit, Hospital Bentong, Pahang