What is kratom: an emerging alternative to opioids

31 July 2020
What is kratom: an emerging alternative to opioids

Kratom is an opioid-like herbal supplement with potential medical applications, but with many dangerous side effects.

Kratom (Mitragyna Speciosa) is a tropical tree in the coffee family. Found in Southeast Asia (Thailand, Indonesia, Malaysia, and Vietnam), natives have been using Kratom medicinally for thousands of years. Those who stand by kratom claim that it can improve mood, enhance concentration, relieve pain, and increase energy.

Traditionally, kratom leaves are chewed, brewed into tea, or ground to cook with food. Nowadays, kratom is either smoked or taken orally in pill form.

Most recently, kratom is being regarded as a wonder treatment to help opioid users kick their addiction. Although there is limited evidence in the scientific literature that kratom is effective at treating withdrawal caused by heroin or prescription opioid drugs, anecdotal evidence abounds.

Kratom is typically sold as a herbal extract supplement in powdered form. The plant’s leaves can also be chewed and dry kratom can be swallowed or brewed.

However, medical professionals warn that kratom users may be trading one addiction for another. Kratom can also cause serious side effects, which is why several countries have banned kratom products.

Officially, kratom is a controlled substance in Thailand, Malaysia, Australia, and some European countries. At the moment, kratom is legal in most of the United States, but it may not be for very long. In 2016, the Drug Enforcement Administration (DEA) proposed banning kratom, a proposal that is currently pending review until more research surfaces that may provide more information about the pros and cons of kratom use.


What are the effects of kratom ?

Chemical compounds in kratom interact with receptors in the brain to trigger effects similar to both opioids and stimulants.


At low doses, kratom is a stimulant that makes users feel like they have more energy. In the United States, there are now many so-called kratom bars and cafes where people ingest the drug recreationally as if it were coffee.

However, at high doses, kratom makes you sleepy, with users reporting feeling like they are in a dream-like state.

Two chemicals in kratom leaves, mitragynine and 7-α-hydroxymitragynine, interact with opioid receptors in the brain, triggering sedation, pleasure, and decreased pain. The stimulant effect is owed to mitragynine that also interacts with other receptor systems in the brain.

Additionally, kratom has over 20 alkaloids, some of which may be involved in pain-relieving action, according to a systematic review of over 35 scientific articles published prior to 2012.

The effects of kratom kick in after 5-10 minutes and last two to five hours. They can vary wildly depending on the dose and from person to person.

What are the side effects of kratom and is it safe?

Kratom is known to frequently cause nausea and constipation, as well as muscle tremors, itching, sweating, dizziness, dry mouth, seizures, hallucinations, and even liver damage. In extreme cases, kratom may trigger seizures, coma, and death. All these side effects are quite similar to opioid withdrawal.

“The acute adverse effects of kratom experienced by many users appear to be a direct result of kratom’s stimulant and opioid activities. Stimulant effects may manifest themselves in some individuals as anxiety, irritability, and increased aggression. Opioid-like effects include sedation, nausea, constipation, and itching. Again, these effects appear to be dose-dependent and to vary markedly from one individual to another. Chronic, high-dose usage has been associated with several unusual effects. Hyperpigmentation of the cheeks, tremor, anorexia, weight loss, and psychosis have been observed in individuals with long-term addiction. Reports of serious toxic effects are rare and have usually involved the use of relatively high doses of kratom (>15 g). Of particular concern, there have been several recent reports of seizures occurring in individuals who have used high doses of kratom, either alone or in combination with other drugs, such as modafinil,” wrote researchers in a study published in The Journal of the American Osteopathic Association.

As of 2019, the FDA has reported 44 deaths associated with kratom use, although most of these fatalities also involved other drugs or used kratom that was contaminated with other substances or bacteria, such as diphenhydramine (an antihistamine), alcohol, caffeine, benzodiazepines, fentanyl, and cocaine. At least one case investigated by the FDA seems to be associated with the use of pure kratom.

Between 2011 and 2017, poison control centers in the U.S. received around 1,800 calls involving kratom, some of which resulted in death. A 2019 analysis by the FDA of 30 different kratom products sold online found traces of heavy metals in some, including lead and nickel in toxic doses. “Based on these test results, the typical long-term kratom user could potentially develop heavy metal poisoning, which could include nervous system or kidney damage, anemia, high blood pressure, and/or increased risk of certain cancers,” according to the FDA report.

“We have issued numerous warnings about the serious risks associated with the use of kratom, including warnings about the contamination of kratom products with high rates of salmonella that put people using kratom products at risk, and resulted in numerous illnesses and recalls,” acting FDA Commissioner Dr. Ned Sharpless said in a statement. “Despite our warnings, companies continue to sell this dangerous product and make deceptive medical claims that are not backed by science or any reliable scientific evidence.”

Is kratom addictive?

Images of kratom products purchased at a “smoke shop” in suburban Chicago. The images show chopped leaves (A), which are typically brewed into “kratom tea”, capsules containing finely chopped leaves (B), and compressed tablets containing leaves or resin (C).

Although many turn to the drug in order to beat their opioid addiction, kratom can cause an addiction in its own right. Common withdrawal symptoms include pain, trouble sleeping, diarrhea, mood disorders, and fever.

Since kratom is still poorly studied, there is no specific medical treatment for kratom addiction.

Although many people use kratom to control withdrawal symptoms caused by opioid addiction or other addictive drugs like alcohol, there is no scientific evidence that kratom is actually effective for this purpose.

However, a survey of more than 2,700 self-reported users of the herbal supplement performed by Johns Hopkins concluded that “the psychoactive compound somewhat similar to opioids likely has a lower rate of harm than prescription opioids for treating pain, anxiety, depression and addiction.”

According to the survey, about 41% of survey responders said they took kratom to treat opioid withdrawal, and of those people who took it for opioid withdrawal, 35% reported going more than a year without taking prescription opioids or heroin.

“These findings suggest that kratom doesn’t belong in the category of a Schedule I drug, because there seems to be relatively low rate of abuse potential, and there may be medical applications to explore, including as a possible treatment for pain and opioid use disorder,” said Albert Garcia-Romeu, instructor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.

“There has been a bit of fearmongering,” he adds, “because kratom is opioidlike, and because of the toll of our current opioid epidemic.”

Is kratom legal?

In most of the United States, kratom is for the time being still legal. The Food and Drug Administration (FDA) has not approved kratom and actually voiced concerns over its use, but since it is marketed as a supplement it can be sold legally.

On August 31, 2016, the DEA published a notice that it was planning to place kratom in Schedule I, the most restrictive classification of the Controlled Substances Act. The scheduling did not occur, however, after dozens of members of Congress, as well as kratom advocates, argued that kratom’s potential medical benefits deserve more time for deliberation.

It is, however, illegal to purchase, possess, or use kratom in Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin. Other states and municipalities have classed kratom as “illegal for human consumption,” which is why you’ll find it listed as incense.

Elsewhere, kratom is classed as illegal in Israel, Japan, Thailand, Myanmar, Malaysia, Singapore, South Korea, Australia, New Zealand, Vietnam, and most European countries. This list by no means complete and every country might change how they control the use and distribution of the herbal supplement.

Kratom is easily orderable on the internet and is often sold as a green powder labeled “not for human consumption”.

Bottom line: Many users stand by the therapeutic effects of kratom with almost zealous fever. However, there are many safety concerns surrounding kratom, among them its potential for addiction and the risk of contamination with other potentially toxic substances. Kratom may have medical properties but the evidence so far is still limited, warranting further research. The FDA is rather clear about it: there is no scientific evidence that supports the use of kratom for medical purposes, nor should it be used as an alternative to prescription opioids. What’s more, kratom is not regulated so you have no guarantee that what you buy online doesn’t contain potentially toxic substances.

Although kratom is derived from a plant, consumers should not be fooled by the myth that anything natural is 100% safe. Many drugs with dangerous side effects are botanical in nature, including heroin, cocaine, and nicotine.




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