Omissions, Ambiguities, and Underuse of Causal Assessment Tools: a Systematic Review of Case Reports on Patients Who Use Kratom

Purpose of review In this systematic review, we examined case reports of patients who use kratom and evaluated their rigor based on reporting of clinically relevant information. Recent findings Millions of people use kratom in the USA each year. Despite its prevalence, there is little peer-reviewed clinical literature available on kratom, and clinicians must predominantly rely on case reports for guidance in the assessment, diagnosis, and treatment of patients who use kratom. Summary We found considerable variation in reported information and in the thoroughness of the case reports. Reports tended to be inadequate in full assessment of the patient’s kratom use. As kratom use continues to increase in the USA, consistent and detailed reporting, usage of biospecimen testing and kratom product assays, consultation of experts to aid with patient workup, usage of causality assessment tools, and acknowledgement of limitations will improve the quality of case reports.