Kratom – myths vs. facts

You may have heard of kratom. It's a very unusual drug that is in a weird legal limbo in the U.S. and Canada. It's being billed as a safe and non-addictive alternative to opioids. But... beware. We are finally getting some detailed facts about kratom from the research community, and it turns out there is a lot of misinformation out there (note: scholarly sources appear at the end of the article).

Something just didn't add up for me. As an addict and alcoholic in recovery, and as a doc the idea of a psychoactive drug that gets you high being non-addictive made me suspicious, to say the least.

The research community in the U.S. has been very slow to look at kratom, but some quality research evidence is starting to emerge about this nebulous drug. So, now that reliable, hard facts about this novel drug are available, I'll go through those with you now to set apart myth from reality.

What is kratom?

Kratom is the common name for Mitragyna speciosa, which is a type of evergreen tree related to coffee. Kratom is native to Southeast Asia (specifically Thailand, Indonesia, Malaysia, Myanmar and Papua New Guinea), where its leaves have been used for over a century as a sort of opium substitute. The kratom drug is made by grinding up the tree leaves or brewing them in a tea.

Although the kratom plant (M. speciosa) is an evergreen tree, it is not coniferous (like pine or spruce trees). Rather, it produces broad aspen-shaped dark green glossy leaves that contain the psychoactive ingredients. The tree can grow up to 80 feet high with a trunk up to three feet thick.

Once dried and shredded, the leaves have a light olive-green color. Capsules are produced by filling drug capsules with dried and shredded or powdered leaves. Likewise, the tablets and tea are olive-green in color. Some subspecies of kratom have white-veined or red-veined leaves, so that the color of the drug preparations will have a white or reddish hue.

Kratom can be smoked but the amount of leaf that would be required is too large to be easily smoked. Some people dehydrate the tea to produce a resin that can be smoked.

Kratom is usually used orally. Locals in Southeast Asia sometimes chew the leaves off the trees or put them in their food. Kratom has a bitter taste, so it is usually consumed with a sweetener. In the U.S. and Canada kratom is available in several formats, all based on M. speciosa leaves, either whole or ground up:

• Powder: made by grinding the dried leaves, and is usually sold in packets labelled “not for human consumption”
• Capsules or tablets: the powder is packaged into capsules, or pressed into tablets
• Tea: made by brewing the dried or powdered leaves
• Gum: sometimes the tree gum (resin) is chewed

A popular drink in Southeast Asia – known as 4X100 – is a nasty mixture of kratom tea, Coca-Cola, ice and codeine cough syrup. This 4X100 has become a significant addiction issue among young people, especially in Thailand.

Myth or Fact #1: What does kratom do?

Kratom is used for pain relief, energy, and for helping withdraw from opioids. Fact! Kratom is a really weird drug, because it has opioid-like properties and stimulant properties. It is NOT an opioid (like heroin or codeine or oxycodone), but it stimulates opioid receptors in the brain.

As such, kratom does have some pain relief properties, although weaker than that of opioids. As well, kratom appears to exert an anti-inflammatory effect, which may enhance its pain relief effects.

In addition to its opioid-like activity, kratom does have stimulant effects... sometimes. Kratom has an unusual property whereby it has different effects on the brain at different doses. this is not unheard of for psychotropic medications, as , for example, with the mood-stabilizer drug olanzapine (Zyprexa), which also has different effects on the brain at different dose levels.

Kratom is not regulated or standardized, and the product that you buy may be cut with other plant species additives. As such, it may be difficult to know what dose one is taking. The effects of kratom – particularly the stimulant and opioid-like effects – are dose-dependent:

• Low to moderate dosages (1-5g of raw leaves) usually produce a stimulant effect that is described as pleasant but not intense like other stimulants (such as cocaine or methamphetamines)
• Moderate to high dosages (5-15g) result in effects similar to opioids, such as analgesia and euphoria. The euphoric effects are described as less intense than those of opioids
• High dose (above 15g) are toxic and may involve serious side effects and overdose

At higher doses, kratom has the opposite of a stimulant effect, as it makes people sleepy.

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Myth of fact #2: Is kratom a legal high?

There is a bit of a back story here. The DEA n the U.S. tried to make kratom a Schedule I substance (no medical use, harmful, high addiction potential) in 2016. As a Schedule I drug kratom would be illegal to import, sell, possess or use in America.

The kratom users in the U.S. organized into kratom associations and lobbied against this measure, arguing that it is not addictive, not harmful, and is medically useful. They put together a 140,000 person petition and actually got support from some U.S. Senators and managed to get the DEA to back off. This was probably the only time the DEA ever ignored science and responded to public opinion.

Since then, kratom has been in legal limbo. It is illegal in seven U.S. states and in D.C., as well as in some municipalities (such as Sarasota County in Florida). In Canada it is illegal to sell, but legal to possess, although Health Canada strongly advises against its use.

The DEA has announced that it still intends to make it a Schedule I drug at some point, and in the meantime has classified it as a "chemical of concern." The U.S. FDA has issued repeated consumer warnings against using kratom due to safety concerns.

Myth or Fact #3: Is kratom addictive?

One of the chief cheesy behaviors of the kratom advocacy groups is that they spread misinformation to support their cause. And they've done well at it. On the Internet and even in the media they have managed to maintain a campaign of denial about the addictive potential of kratom. However, at this point the denials have been overtaken by fact: kratom is definitely, absolutely and positively an addictive substance.

Kratom possesses the properties that make a substance addictive:

Tolerance: over time, people require more and more of the drug to get the same effect.

Withdrawal: people experience withdrawal symptoms when they try to reduce or stop the drug.

Cycle of addiction: the drug creates a cycle of addiction: 1) drug use, 2) withdrawal, 3) obsessive thoughts about using and a need to stop the withdrawal, and back to 1).

Neuro-psycho effects that allow users to chase the high, or self-medicate mental health symptoms, or escape from the reality of life's problems.

Myth or Fact # 4: Kratom can be used to withdraw from opioids.

This one is true. Because of its opioid-like action on the brain, kratom does appear to reduce withdrawal symptoms for people who are detoxing from opioids.

The problem is that kratom itself produces a withdrawal syndrome nearly identical to opioids when it is stopped or reduced. Because kratom is touted as non-addictive and safe by the people who sell it on-line and by the kratom advocacy groups, there have been many cases reported of people go to the ER in withdrawal from kratom unsure of why they are so sick. They were led to believe that the drug was harmless, so they were unaware of the withdrawal syndrome.

We have data from some really good medical studies about kratom withdrawal, so we know a lot about it.

About 65% of kratom users experience mild withdrawal effects, while the other 35% report moderate to severe symptoms. The severity was related to the amount of kratom used, with those consuming the equivalent of 3 glasses of tea or more daily being more likely to experience severe symptoms. The duration of kratom use has less of an effect on the severity of withdrawal symptoms than does the daily amount taken.

Most kratom users also use other substances of abuse. As such, kratom withdrawal symptoms may be accompanied by symptoms from those substances.

Myth or Fact #5: Kratom is safe

The medical literature has identified short-term and long-term side effects of kratom, and there have been a number of deaths attributed to the drug.

As well, kratom is not regulated by the FDA or Health Canada, so the production, distribution, and sale of the drug is completely unregulated and not subject to the inspections or safety standards that normally ensure the safety of our drugs. So, it's buyer-beware. No matter how awesome and safe a website claims that its kratom is, you really don't know for sure what's in it and where it came from.

Case in point: there have been numerous instances of Salmonella poisoning in kratom products, and in one such episode there were 130 reported Salmonella poisonings in 38 states; 35 people died in that case (in 2018).

As well, there have been a number of cases of heavy metal toxicity in kratom products, causing the FDA to issue warnings to the public and seize kratom shipments.

So what?

Well, if you decide that you want to use kratom, at least be aware of the facts. Please feel free to contact us if you have any questions about this unusual drug.

Sources:

Anwar, M., Law, R., & Schier, J. (2016). Notes from the Field. Kratom (Mitragyna speciosa) exposures reported to poison centers — United States, 2010–2015. CDC Morbidity and Mortality Weekly Reports, 65(29), 748–749. Retrieved from https://www.cdc.gov/mmwr/volumes/65/wr/mm6529a4.htm#suggestedcitation

Buresh, M. (2018). Treatment of kratom dependence with buprenorphine-naloxone maintenance. Journal of Addiction Medicine, 12(6), 481-483. doi: 10.1097/ADM.0000000000000428

Clopton, Jennifer. (2019, February 11). Regulations are on hold as kratom debate rages. WebMD Health News. Retrieved from https://www.webmd.com/mental-health/addiction/news/20190211/regulations-are-on-hold-as-kratom-debate-rages

Drug Enforcement Administration (DEA). (2016). DEA announces intent to schedule kratom. Retrieved from https://www.dea.gov/divisions/hq/2016/hq083016.shtml

Drug Enforcement Administration (DEA). (2013). Kratom. Retrieved from https://www.deadiversion.usdoj.gov/drug_chem_info/kratom.pdf

Food and Drug Administration (FDA). (2019). FDA and kratom. Retrieved from https://www.fda.gov/news-events/public-health-focus/fda-and-kratom

Food and Drug Administration (FDA). (2019). Laboratory analysis of kratom products for heavy metals. Retrieved from https://www.fda.gov/news-events/public-health-focus/laboratory-analysis-kratom-products-heavy-metals

Fluyau, D., & Revadigar, N. “Biochemical benefits, diagnosis, and clinical risks evaluation of kratom.” Frontiers in Psychiatry, 8(62). doi: 10.3389/fpsyt.2017.00062

Galbis-Reig, D. (2016). A case report of kratom addiction and withdrawal. Wisconsin Medical Journal, 115(1), 49-52. Retrieved from https://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/115/1/49.pdf

LaBryer, L., Sharma, R., Chaudhari, K., Talsania, M., & Scolfield, R. (2018). Kratom, an emerging drug of abuse, raises prolactin and causes secondary hypogonadism: Case report. Journal of Investigative Medicine, High Impact Case Reports. doi: 10.1177/2324709618765022

Leow, C. (2019). Kratom. Texas Tech University Infant Risk Center. Retrieved from https://www.infantrisk.com/content/kratom

Lu, J., Wei, H., Wu, J., Jamil, M., Tan, M., Adenan, M., et al. (2014). Evaluation of the cardiotoxicity of mitragynine and its analogues using human induced pluripotent stem cell-derived cardiomyocytes. PloS One, 9(12), e115648. doi:10.1371/journal.pone.0115648

Meireles, V., Rosado, T., Barroso, M., Soares, S., Gonçalves, J., Luís, Â., et al. (2019). Mitragyna speciosa: Clinical, Toxicological Aspects and Analysis in Biological and Non-Biological Samples. Medicines (Basel, Switzerland), 6(1), 35. doi:10.3390/medicines6010035

National Institute on Drug Abuse. (2019). Kratom. Drug Facts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/kratom

National Institutes of Health, National Center for Complementary and Integrative Health. (2018). In the news: Kratom (Mitragyna speciosa). Retrieved from https://nccih.nih.gov/news/kratom

Olsen, E., O’Donnell, J., Mattson, C., Schier, J., & Wilson, N. (2019). Notes from the field: Unintentional drug overdose deaths with kratom detected — 27 States, July 2016–December 2017. CDC Morbidity and Mortality Weekly Reports, 68, 326–327. doi: http://dx.doi.org/10.15585/mmwr.mm6814a2

Prozialeck, W., Avery, B., Boyer, E., Grundman, O., Henningfield, J., Kruegel, W., et al. (2019). Kratom policy: The challenge of balancing therapeutic potential with public safety. International Journal of Drug Policy, 70, 70-77. https://doi.org/10.1016/j.drugpo.2019.05.003

Prozialeck, W., Jivan, J., Andurkar, S. (2012). Pharmacology of kratom: An emerging botanical agent with stimulant, analgesic and opioid-like effects. Journal of the American Osteopathic Association, 112, 792-799. Retrieved from https://jaoa.org/article.aspx?articleid=2094342

Singh, D., Narayanan, S., Muller, C., Swogger, M., Rahim, A., Abdullah, M, et al. (2018). Severity of kratom (Mitragyna speciosa korth.) psychological withdrawal symptoms. Journal of Psychoactive Drugs, 50(5), 445-450. https://doi.org/10.1080/02791072.2018.1511879

Smith, K., & Lawson, T. (2017). Prevalence and motivations for kratom use in a sample of substance users enrolled in a residential treatment program. Drug and Alcohol Dependence, 180, 340-348. http://dx.doi.org/10.1016/j.drugalcdep.2017.08.034

Stanciu, C., Gnanasegaram, S., Ahmed, S., & Penders, T. (2019). Kratom withdrawal: A systematic review. Journal of Psychoactive Drugs, 51(1), 12-18. https://doi.org/10.1080/02791072.2018.1562133

Substance Abuse and Mental Health Services Administration (SAMHSA). (2019). Urgent and emerging issues in prevention: Marijuana, kratom, e-cigarettes [Ppt presentation]. Retrieved from https://www.samhsa.gov/sites/default/files/samhsas_15th_annual_prevention_day_afternoon_plenary_recording.pdf

Tayabali, K., Bolzon, C., Foster, P., Patel, J., & Kalim, M. (2018). Kratom: A dangerous player in the opioid crisis. Journal of Community Hospital Internal Medicine Perspectives, 8(3), 107–110. doi:10.1080/20009666.2018.1468693

White, Michael. (2018). Pharmacologic and clinical assessment of kratom. American Journal of Health-System Pharmacy, 75(5), 261-267. https://doi.org/10.2146/ajhp161035