Kratom: Panacea or Poison?

What is Kratom?

Kratom (scientific name: Mitragyna speciosa) is a tropical evergreen tree in the coffee family that is native to the jungles of Southeast Asia; specifically found in Thailand, Myanmar, and Malaysia. It is also found in Papua New Guinea. Other names for kratom include thang, kakuam, thom, ketum, and biak. Whatever it’s called and wherever it may be found, this tree, or at least the leaves on it, has been causing quite a commotion in recent years.

The Scientific Scoop

Mitragyna speciosa leaves contain multiple active components, referred to as alkaloids, with properties ranging from stimulant-like energizing and uplifting to opiate-like drowsiness and euphoria, so this makes it difficult to characterize kratom as one particular type of drug, i.e. as “stimulant” or “opiate.” Kratom’s two main alkaloids are mitragynine and its active metabolite, 7-hydroxymitragynine, which has strong activity at the µ-opioid receptors (where µ is pronounced like ‘you’ but with an m: mu). This is the main opioid receptor, the same one that is the primary binding target of opioids like heroin and oxycodone. Why is this so important? Why do we need to know exactly where kratom binds and what effect that has? Well, so we know how it may be used. Here in America, the government isn’t so good with just accepting that this ancient Asian secret does xyz just because they said so. Because kratom binds to µ-opioid receptors just like heroin etc, opponents say that it must be categorized as a narcotic and therefore, it must be addictive just like heroin etc. But Narcan/ naloxone is also categorized the same way, and obviously it’s not addictive; in fact, it’s used to save people in cases of opioid overdose. 

There is a great deal of supportive scientific evidence from many independent laboratory studies using mouse models and multiple human cell lines that confirms that kratom’s alkaloid metabolite 7-Hydroxymitragynine is in fact a key mediator of the analgesic effects of kratom, through its agonistic binding to the µ-opioid receptor. This has also been confirmed by the finding that in the presence of the opioid receptor antagonist naloxone, the pharmacological blockade of the analgesic effect will occur. In plain language: they’ve clearly shown that kratom binds specifically to the µ-opioid receptor in human cell lines, and demonstrated that this binding produces analgesic effects by giving it to a specific type of live mouse that essentially models the human system. So after the mice were given kratom, they exhibited analgesic effects from it– through previously established and accepted behaviors that I’m totally not going into here– just trust people. And then, as if that’s not enough, to further prove that this analgesic effect the mice were having was definitely the result of kratom’s binding to the µ-opioid receptor, they then gave the kratom-dosed mice Narcan, aka naloxone, which is a µ-opioid receptor antagonist. What does that mean? Think of it this way: the Narcan “antagonizes” the µ-opioid receptor; it basically bullies anything already bound to that µ-opioid receptor, pushes it off, and then it binds to it and blocks it so that as long as it’s parked there, nothing’s getting by it to bind to those µ-opioid receptors. That’s how and why Narcan saves people from overdose: it pushes all the opioids off all of the µ-opioid receptors and then sits on them, and hopefully that happens soon enough that the person survives the overdose. If they do, and if they then ingest more opioids for several hours after being given the Narcan, they won’t feel the effects of the drugs for as long as the Narcan is present there on those receptors, because the drug’s opioids won’t be able to bind to the µ-opioid receptors, as the Narcan will be sitting there. So there’s been a lot of work done in various labs all over the globe to elucidate kratom’s form and function. But despite all of this work, there’s much more to be done! I’ll talk more about that later.

None of kratom’s uses are clinically proven, as it has not been studied in the human clinical trials that the FDA requires to allow a drug compound to be legally available on the open market. Clinical studies are very important for the development of new drugs, as they help to identify consistently harmful effects, harmful interactions with other drugs, and dosages that are effective, yet not dangerous. That said, there have been many legitimate published laboratory studies with clear demonstrable findings in mouse models and human cell lines that do allow us to at least extrapolate the effects of kratom in humans with some accuracy and relative safety. Most findings have been positive, and there is a large vocal community of kratom supporters with numerous anecdotal testimonials of kratom’s effectiveness in treating various conditions. But despite this, because treatment practices using kratom have not been rigorously studied as either safe or effective, the DEA staunchly maintains that it has no valid medical uses or benefits. In fact, several years ago, the FDA threatened to make kratom a Schedule 1 narcotic, meaning it would be grouped with marijuana, LSD, and ecstasy, among others, and this elicited a huge backlash… tens of thousands of kratom proponents complained vociferously, signed endless petitions and all that yada yada, and the FDA caved, dropping the issue, at least for the time being. But that’s not going to be the end of that story people… not when the government’s involved. So for now, kratom’s status should be listed as “to be continued.”

What is Kratom Used For?

In its native regions of Southeast Asia, kratom has been known to be used as a traditional medicine for more than a century, but has likely been used for multiple centuries. There in Southeast Asia, the leaves of the kratom tree are typically chewed directly from the tree or consumed as a tea, and they induce stimulant and opioid-like analgesic effects, depending on the amount used. This is because the effects felt from ingesting kratom have been found to be dose-dependent: at low doses, which is generally considered 1 to 5 grams, kratom has been reported to work like a stimulant, imparting feelings of being more energetic, more alert, and more sociable. At higher doses, considered to be 10 to 15 grams, kratom has been reported as being more sedating, dulling emotions and sensations while producing euphoric effects. Anything over 15 grams is considered risky.

The stimulant type effects have traditionally made kratom popular among Southeast Asian agricultural workers especially, who use it to aid them in their long hours of hard labor. But for generations there, kratom has also been used successfully in its native regions for several other purposes: as an aphrodisiac to increase sexual desire, as an energy booster, to ameliorate withdrawal symptoms following cessation of opioid use, and for treating cough, diarrhea, and chronic pain. More recently, here in the US, there has been an uptick in the use of kratom by people who are self-treating chronic pain and managing acute withdrawal from opiates, while seeking alternatives to prescription medications. While some people claim to have success using kratom to treat depression and anxiety, and others say that kratom can also be used to treat muscle aches, fatigue, high blood pressure, diarrhea, and post-traumatic stress disorder (PTSD). Some studies report that kratom possesses anti-inflammatory, immunity-enhancing, and appetite-suppressing properties, but obviously more research is needed to confirm these benefits.

Kratom: Processing and Forms

The psychoactive compound referred to as kratom is found in the leaves of Mitragyna speciosa, and the processing seems pretty straightforward: after the plant’s large dark green leaves are harvested, they can be prepared in several ways: fresh leaf, dried leaf that is pulverized and powdered, dried leaf that is simply crushed, and concentrated liquid leaf extract. Kratom can typically be purchased in multiple forms, including paste, capsule, tablet, gum, tincture, and extract. In certain forms it is often combined with added sweetener to overcome its harsh bitterness. Kratom can be brewed into a tea as well, a form that is offered in kratom tea houses present in a few US states. Kratom can also be smoked or vaporized, though this is not very common.

While the use of Mitragyna speciosa is certainly not new, the alkaloid extraction and refinement methods to turn the alkaloids from the plant into kratom has certainly evolved, and now purity is said to be higher. I’ve read that now there are also fortified kratom powders available, and these contain extracts from other plants in a nod to the nutraceutical angle. In the United States, kratom is usually marketed as an alternative medicine, and often found in stores that sell supplements. Kratom can also be found in gas stations and paraphernalia shops in most parts of the US, except in the handful of states and cities that have banned it. Many people purchase kratom over the Internet, where it may be sold for “soap-making and aromatherapy,” a lot like what happened with synthetic marijuana or spice; that’s in an effort to circumvent the FDA’s 2014 ruling that made it illegal to import or manufacture kratom as a dietary supplement in the US.

Is Kratom Legal?

Although kratom is technically legal at the federal level, some US states and municipalities have chosen to ban it, making it illegal to sell, possess, grow, or use it. Other states have imposed age restrictions. In the states of Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin, kratom is illegal to buy, sell, possess or use. There are special cases in some states: while kratom is legal in California, it is banned in San Diego. While it’s legal in Colorado, in Denver it’s considered illegal for human consumption. Kratom is legal in Florida, except for Sarasota Country, where it’s banned. Kratom is legal in Illinois for those over the age of 18, except in the city of Jerseyville, where it is banned. Kratom is legal to use in Mississippi, except in Union County, where it’s banned. In New Hampshire, kratom is only legal for those over the age of 18. Please don’t quote me on these people- make sure to double check if you’re wanting to purchase- not that I’m encouraging that or even saying it’s acceptable btw. 

As far as countries around the globe go, kratom is illegal in: Australia, Denmark, Finland, Israel, Japan, Latvia, Lithuania, Myanmar, Malaysia, New Zealand (unless prescribed by a doctor), Poland, Romania, Russia, Singapore, South Korea, Sweden, Thailand, and Vietnam. Note that most places where native Mitragyna speciosa grows, it’s illegal… funny! Speaking of that, the country of Thailand has recently reconsidered the status of some illegal substances, so kratom might not remain illegal there.

In countries like Ireland, Italy, and the United Kingdom, the rules may vary from one city to the next. It’s also important to note that the status of kratom legality isn’t widely known for some countries. For example, it isn’t clear whether it is legal in China, or in many of the African nations. However, as the drug kratom becomes more widely known, countries, counties, and cities that don’t currently ban kratom may choose to do so at any point.

Is Kratom Safe?

Proponents say kratom is an amazing compound, a game-changer and lifesaver. Opponents, like the FDA, say it has no viable medicinal properties. How the US DEA, medical professionals, and millions of regular kratom users can have such divergent views of the same plant is hard to fathom. The overarching “company line” seems to answer this question “No!!” They state that kratom is considered addictive, that people can develop a physical dependence on it, and that in and of itself indicates that it’s not safe. There are some anecdotal reports of people becoming dependent on kratom, but there are more reports of people successfully using it to recover from opioid addiction; not to mention successfully treating chronic pain, fibromyalgia, anxiety, depression, on and on. So in my book, the jury’s out people. 

The question of kratom’s safety comes down to two factors: the lack of regulation and the interactions with other drugs or substances, whether endogenous or exogenous. 

Lack of Regulation

Any time a substance, including herbal supplements, isn’t regulated by the FDA, there are potential safety hazards. This is because there is no standardization when a substance isn’t regulated. That means that companies, particularly if they’re operating online, can market the product however they want. There are no official drug warning labels for kratom, and people may take it without knowing what other substances it contains. A buyer never knows what level of potency a kratom product could have or whether it’s pure. In addition, the active ingredient in kratom varies widely by plant species. As with marijuana strains, different kratom strains have slightly different effects; there are multiple species of the tree, so this makes kratom’s effects unpredictable. This unpredictable nature leads to a risk of overdose and other serious side-effects, including seizures, hallucinations, chills, vomiting, liver damage, or even death.

Kratom Interactions

Because there is little research currently available on how kratom interacts with other substances, the breadth and severity of effects are yet unknown. This unpredictability adds to the dangers of using kratom in combination with something else, because you’ll have little idea what it could do to you. Potentially negative effects can be even more severe when kratom is combined with other drugs and prescription medicines. Some of the kratom chemicals have been shown to interact with how the liver metabolizes other drugs, which can lead to dangerous interactions. Another risk is presented when people buy commercial versions of kratom that have been combined with other drugs or substances, especially if they too work on the same opioid receptors. The potential consequences of many drug interactions can range from seizures to liver damage.

Various Points on the Kratom Controversy

Depending on what you read and who you believe, kratom is a dangerous, addictive drug with no medical utility and severely deleterious side effects that include overdose and death, or it is an accessible pathway out of undertreated chronic pain and opiate withdrawal, as well as being useful in treating many other health issues. There are great physicians and impressive institutions with interesting facts on both sides of this issue.

Recent increased kratom use in the United States, combined with concerns that kratom represents an uncontrolled drug with abuse potential, has highlighted the need for more careful study of its pharmacological activity. The major active alkaloid found in kratom, mitragynine, has been reported to have opioid agonist and analgesic activity in vitro and in animal models that are consistent with the purported effects of kratom leaf in humans. However, preliminary research has provided some evidence that mitragynine and related compounds may act as atypical opioid agonists, meaning they induce their therapeutic effects like analgesia, while also limiting the negative side effects that often accompany classical opioids. One such side effect that is absent in kratom is constipation. A chronic pain medication like kratom that doesn’t cause constipation like current opioids all do sounds like a good thing, but as I said before, it’s a long way from here to there, especially considering the FDA’s current opinion. And something tells me they won’t be changing their collective mind any time soon. 

As it stands now, there is little to no control or reliable information on growth, processing, packaging, and/ or labeling of the kratom currently sold in the US; and all of this adds to the already considerable uncertainty of its health risks. In 2018, the FDA instituted a mandatory recall of all kratom containing compounds over concerns about Salmonella contamination in these products. More recently, the DEA placed kratom on its “Drugs and Chemicals of Concern” list, but as I mentioned before, it has not yet labeled it as a controlled substance, though not for lack of trying. Time will tell how long that lasts.

Kratom can be addictive due to its opiate-like qualities, and a small minority of users may end up requiring addiction treatment. The CDC claims that between 2016 and 2017, there were 91 deaths due to kratom; but this claim should be met with healthy skepticism, as all but seven of these casualties had other drugs in their system at the time of their deaths, and that makes it totally impossible to uniquely implicate kratom.

A patient wishing to use kratom to treat chronic pain or to mitigate opioid withdrawal symptoms could expect to encounter several problems with doing so, not all of which even have anything to do with the intrinsic properties of the kratom itself.

A patient that wants to use kratom to treat a legitimate illness or condition will likely face four problems for the foreseeable future:

-The first problem is that the DEA still occasionally threatens to make it a Schedule 1 controlled substance, along with drugs like heroin and ecstasy. This would make kratom very difficult to access, and would likely make the supply as a whole even more dangerous than it is now. Generally, it’s not a good idea to use something to treat chronic pain or addiction that may soon become less available and less safe: you want to know it’s going to be readily available, and that as a cure, it won’t cause more problems than the illness it’s being used to treat!

-The second problem is that the complete lack of oversight and quality control in the production and sale of kratom makes its use potentially dangerous.

-The third problem is that kratom has not been well studied for any of the uses its proponents claim it has an affinity in treating! Maybe the FDA hasn’t heard the saying that goes, “Absence of evidence of benefit isn’t evidence of absence of benefit.”

-The fourth and final problem is that kratom doesn’t show up on drug screens. I like kratom’s potential, but I can argue that adding another potentially addictive opiate-like substance while an opiate epidemic is already going on may not be the best course of action. 

Is there a sensible path forward with kratom?

I’m not sure that anyone has the answer to that question, but at a bare minimum, the safety of kratom could be improved through:

-Regulation: it would be safer if people knew the exact dosage of kratom they were truly consuming, and that it was totally free of contamination.

-Education: educated consumers who know all of the potential benefits and dangers of the compound they are consuming are far less vulnerable to misleading claims.

-Research: if kratom does in fact have the benefits that have been demonstrated in the laboratory for treating either addiction or chronic pain, we should absolutely know it and make it known: accurately defining the risks of using kratom is critical, as is making all medical personnel and laypersons informed.

If all four of these points could somehow be accomplished by scientists and public health specialists, without: overdue distortion from corporate interests, anti-drug ideology, and romanticism by kratom enthusiasts, then we should have enough clarity to answer the basic questions about kratom, including the most important question of all…is it harmful or helpful?

Effects of Kratom: Good, Bad, Ugly

The Good

Recall that the expected effects from kratom are dose-dependent: that smaller doses will produce a stimulant-like effect, while larger doses will produce sedative or opioid-like effects. 

A small dose of kratom to produce stimulant effects would be up to just a few grams, and these effects would be felt within 10 minutes after ingestion and can last up to 90 minutes. These expected stimulant effects include increased energy, alertness, and sociability, increased sex drive, decreased appetite, and giddiness.

A larger dose of kratom, between 10 and 25 grams, can have a sedative effect, imparting feelings of sedation, calmness, euphoria, pain reduction, and cough suppression, which last for much longer periods of time, potentially up to six hours.

The Bad

Potential unsafe and negative effects of regular kratom use, even at low doses, can include: agitation, tachycardia, drowsiness, vomiting, confusion, anxiety, tremors, itching, sweating, insomnia, lack of appetite, tremor, coordination problems, and withdrawal symptoms.

There can also be negative effects of high dose kratom, including: addiction, nausea, itching, constipation, and withdrawal symptoms of tremor and sweating.

There can be negative side effects of taking any dose of kratom at irregular times or random intervals as well. Many users of kratom have reported something called “The Kratom Hangover” the day after taking it, the symptoms of which can include irritability, anxiety, nausea, and headaches.

Because kratom can cause problems with coordination and sleepiness, it’s dangerous to drive or operate machinery while using it. For this same reason, pregnant women are also advised never to use kratom. 

The Ugly

There can be grave side effects from taking kratom, which can include seizures and respiratory and/ or cardiac arrest.

If a person takes a high dose of kratom and falls asleep, they may vomit and choke while asleep.

Kratom Overdose

There are numerous calls into the CDC poison centers for kratom overdose every year.

The risk of overdose increases when kratom is taken with another substance, especially opioids.

Recent studies have found evidence of fatal kratom-only overdoses involving severe and negative side effects that can occur when someone takes too much. Some of the symptoms of taking too much kratom can include: impaired motor skills, lethargy, slurred speech, either shallow or very heavy breathing, tremors, listlessness, aggression, delusions, and hallucinations.

Long-term and heavy use of kratom can lead to liver problems, as kratom tends to make it more difficult for the liver and kidneys to process and filter toxins out, contributing to the potential for this type of organ damage.

Signs of liver damage include dark-colored urine and yellow skin and eyes.

Kratom: Necessary Evil or Just Plain Evil?

Kratom is currently considered a dietary supplement, as it is not approved nor regulated by the US FDA. That said, there are anecdotal reports of beneficial effects of kratom use, though there is no clinical evidence yet to support them. In the future, with the proper supporting research, kratom may indeed have proven potential. 

But without this research, there are a lot of unknowns with kratom, such as effective and safe dosage, possible interactions, and possible harmful effects, including death. These are all things that you should weigh before taking any drug, but for kratom, they’re all question marks. In the final analysis, going by laboratory findings, kratom holds great potential. But if you’re thinking about using kratom to treat chronic pain or opioid addiction, or anything else… exercise extreme caution people.

I hope you enjoyed this blog and found it to be interesting and educational. Sharing means caring, so please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA