What Is Kratom?
If you travel West across the globe, it’s unlikely you’ll hear much of anything positive about kratom. In the United States in 2016, the CDC reported that poison control centers were receiving 10 times as many calls as they had in 2010 for kratom exposures. In the same year, the FDA banned kratom, and public controversy ensued when the DEA proposed classifying kratom as a schedule I substance in the same category as heroin, LSD, and ecstasy. Though the DEA eventually withdrew its classification of kratom in late 2016, controversy continues to rage over kratom as evidenced by articles such as “Should Kratom Use be Legal?” in Scientific American and “FDA Warns of Risks Associated With Kratom” on NPR.
Meanwhile, on the opposite side of the globe, kratom has been used for centuries as part of traditional medicine in Southeast Asia. Inhabitants of Malaysia and Thailand have used kratom to provide an energy boost as they labor outdoors under the hot sun while others who dwell in Southeast Asia have used the substance to treat relatively minor ailments including fever, diarrhea, and pain.
What is kratom? What are its effects? Is it a dangerous and addictive substance no different than heroin or ecstasy or is it something else?
What is Kratom?
Kratom refers to a leafy green tree with yellow flowers that grows in Thailand, Malaysia, Indonesia, Papua New Guinea, and some areas of Africa. The leaves from the tree can be chewed, boiled into a tea, or smoked to yield their therapeutic effects.
The two psychoactive components in kratom are mitragynine and 7-hydroxymitragynine. The bulk of the chemical makeup of kratom is mitragynine. Mitragynine’s chemical structure differs from that of opioids (e.g. heroin, morphine), but it is able to bind opioid receptors in the body just as drugs like heroin and morphine do. When a substance binds to opioid receptors in the body, characteristic effects can be observed, depending on the dose of the substance administered. These effects may include euphoria, drowsiness, pain relief, nausea, and constipation.
What Effects Does Kratom Have on the Body?
As with other substances that bind opioid receptors in the body, kratom’s effects are largely dose-dependent. At low doses (i.e. 1-5 g), kratom appears to work like a stimulant; it can provide the user with a boost of energy and improve mood. At doses ranging from 5-15 g, kratom appears to have the same effects as opiates, including euphoria, pain relief, and, in individuals who are suffering from diarrhea, constipation. Doses higher than 15 g appear to have a significant sedating effect on individuals.
Is Kratom Safe or Unsafe to Use?
The easy answer to this question is, we don’t yet know. Most studies on kratom point out that very little research has been done on the substance, making it hard for anyone to know what effects kratom has on the body, what effects the body has on kratom, and how kratom interacts with other substances.
To get the answer to this question, it may be necessary to explore further the dichotomy presented above. Let us contrast how kratom is used and viewed in the West to how kratom is used and viewed in the East.
Kratom has been used in the West as a dietary aid, energy supplement, pain reliever, and even to achieve a “legal high.” Kratom was introduced to the West largely in the form of dietary supplements about 15 years ago. In 2012, the FDA identified kratom “on an import alert for unapproved drugs,” and, since then, multiple seizures of kratom and kratom-containing products have been conducted, reports have been filed regarding the deaths of individuals apparently due to kratom exposure, and kratom has even been linked to multiple, multistate cases of Salmonella infection. Nevertheless, kratom continues to be sold online by various vendors in powder, pill, and extract form. Whether or not raw kratom leaves can be purchased via the Internet is questionable, though this author was not able to locate any vendors after a cursory online search.
As discussed above, kratom has been used in the East as part of traditional medicine, and the kratom is often sourced from trees grown by the users themselves. Kratom is used to treat fevers, to heal wounds, alleviate constipation, and provide pain relief. Kratom has even been used to alleviate the symptoms of opiate withdrawal in individuals who are trying to overcome opiate addiction. While there are undoubtedly individuals in Southeast Asia who use kratom for illicit purposes, it is crucial to recognize that the substance in this area of the world has been viewed largely as a therapeutic agent and not as a means to get high.
Why is it important that we explore this dichotomy in greater detail? Because the differences in how kratom is used and viewed on opposite ends of the globe may explain why kratom is safe in some contexts while dangerous in others. Researchers have pointed out that, whereas consumers of kratom in the West do not know how the product has been manufactured, consumers of kratom in countries like Thailand and Malaysia, for the most part, know exactly what they buying. Also, whereas there have been questionable reports of serious side effects associated with the use of kratom in the West–including liver toxicity and fatal seizures–there have been scant to no reports of such side effects in Southeast Asian populations. It should also be noted that many death reports associated with kratom exposure concern individuals who were not using kratom alone. As can be seen in the table in Dr. Galbis-Reig’s case study, multiple individuals died from consuming kratom mixed with a metabolite of the opiate tramadol or kratom mixed with drugs known for their ability to cause profound sedation and respiratory depression at high doses (e.g. zopiclone and benzodiazepines).
It is unclear whether the scientific community will ever reach a consensus on kratom. What is known is that much more research must be done to understand kratom and the potential benefits and dangers that it poses. If you or someone you know needs help breaking the cycle of drug addiction, please give us a call today.
