Objective: Lysergic-acid-diethylamide (LSD) users are the hidden population of drug users as they do not present to medical personal for treatment. The method of transporting the drug is usually by-pass the law enforcers’ monitoring. We describe a rare case of LSD use in Malaysia Novel Psychoactive Substances (NPS) which is difficult to capture as LSD users remained as a hidden population of drug users in the country. Methods: We reported a 23-year-old male with chronic use of Lysergic-acid-diethylamide (LSD) presented with retrospective history of acute intoxication. Later, he presented with depressive symptoms, occasional flashbacks and physical complications such as premature ejaculation (PE), urinary incontinence, reduced sweating and headache despite abstinence from LSD and other drugs. The reported physical complications remitted after 4 months of abstinence. Result: Our case report suggested that LSD use not only causes acute intoxication but leads to several complications, which may persist even after cessation of LSD use. Conclusion: This case-report had pointed out the importance of future studies to look into the complications of LSD and the case-report as well demonstrated the harmful psychological and physical effects of LSD use, which would warrant proper surveillance and interventions curbing the emergence of LSD use in Malaysia.

Introduction: Mitragyna speciosa (Korth.) or kratom is a native medicinal plant of Southeast Asia. Commonly used by hard labours in harsh working environment, the ingestion of brewed kratom decoction is reported to produce dose-dependent stimulant and opioid-like effects. Kratom is also regularly consumed as a pain killer and as traditional cure for common maladies such as fever and cough. However, it remains unknown whether regular consumption of kratom decoction is associated with brain abnormalities in regular users in traditional settings. Methods: A total of 14 subjects (7 regular kratom users and 7 non-kratom users) voluntarily participated in this cross-sectional study. Face-to-face interviews were conducted with kratom users to determine history of kratom use and later these respondents underwent brain magnetic resonance imaging (MRI). Results: There were no significant differences (p>0.05) in the intracranial volume (ICV), cortical volumes (frontal, parietal, temporal, occipital, or cingulate lobe), or subcortical volumes (striatum, hippocampus, or amygdala), as well as in the diffusion tensor imaging (DTI) metrics, fractional anisotropy (FA) and mean diffusivity (MD) between kratom users and the controls. Conclusion: This preliminary study showed long-term consumption of kratom decoction is not significantly associated with altered brain structures in regular kratom users in traditional settings. However, further study is needed to establish more data for kratom use and its effects.
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Introduction: Kratom (Mitragyna speciosa Korth) dependence is a common psychiatric complication associated with regular kratom use in Malaysia. Hence, it is important to assess the severity of kratom dependence among regular kratom users. The Kratom Dependence Scale (KDS) was introduced to evaluate the degree of severity of kratom dependence among users. This study aimed to translate the original English version of the KDS into Malay and examine the psychometric properties of the KDS (Malay) among Malaysian kratom users. Methods: Initially, parallel translation and back translation of the original English version of the KDS was performed. The KDS (Malay) then was administered to 20 active Malaysian kratom users to assess face and content validities in a pilot study. Finally, the final version was administered to 150 active kratom users to evaluate its internal consistency (Cronbach’s α), face and content validities, discriminative validity, and construct validity, i.e. via exploratory factor analysis (EFA). Results: The KDS (Malay) Cronbach’s α of 0.94 exhibited excellent internal consistency. It also demonstrated construct validity, as EFA showed that all items of the KDS (Malay) fit into a single domain, similar to the original English version. Discriminative validity was also demonstrated by the KDS (Malay), as it could differentiate kratom dependent users from non-kratom dependent users. Conclusion: The KDS (Malay) has acceptable psychometric properties and is suitable to assess severity of kratom dependence in Malaysian kratom users.

Introduction: Kratom or (Mitragyna speciosa) leaves are consumed as a folk remedy and opioid substitute in the Southeast Asian region. There is still a lack of information about the long-term or toxic-causing effects of kratom use. Methods: A total of thirteen regular kratom users, with long-term (>20 twenty years) kratom use history were recruited for this cross-sectional pilot study. Respondents were required to undergo a blood-test and laboratory anaysis was conducted to determine the mitragynine content in an acquired street sample of kratom. Results: The regular, longterm consumption of brewed kratom decoction did not cause any significant alterations in haematological, kidney, liver, thyroid, inflammatory and gastrointestinal analytes in a cohort of kratom users who had no history of substance misuse. However, those who had a higher intake (>3 glasses per day) of kratom exhibited higher lipid values (except for HDL-cholesterol), and a moderate elevation of homocysteine level. Conclusion: Long-term (>20 years with a daily intake of ≥87.54mg of mitragynine) kratom consumption was not associated with altered biochemical levels, although prolonged and heavy use (>3 glasses daily) may result in cardiovascular risks. The latter finding, however, requires further investigation.