Kratom is a herb that has received a lot of attention lately. Though there is a growing awareness of this drug, it remains a bit of a mystery for many. Some individuals swear by its beneficial effects. Unfortunately, though, several others have been victims of this substance.
Have you ever heard of kratom? Do you use it? Or do you know someone who uses it? What has your experience been?
There are many alleged medicinal reasons for kratom use. There are, however, no scientific evidence to support these uses. This herb can also be unsafe to use. More so, when mixed with other drugs. I do not doubt that some people have benefited from using this substance. Many patients have talked to me about the benefits they derive from using kratom. In the same vein, I have had several patients struggle with this herb.
Let us talk a little bit more about kratom!
Kratom is a tropical tree native to Southeast Asia. This area includes countries like Thailand, Malaysia, and Myanmar. The scientific name for this plant is Mitragyna speciosa. Interestingly, this herb is related to the coffee plant, and its leaves have medicinal properties.
The kratom tree can grow as high as 50 feet with a spread of over 15 feet. The leaves reduce fatigue and help with stamina. Locals chew the leaves to provide energy and make them work harder. Also, the leaves contain chemicals with mind-altering effects.
The local population of Southeast Asia believed this herb could cure many illnesses. As a result, they used this plant for many medicinal reasons, including pain treatment. Its use dates back centuries.
The use of kratom as a cough suppressant and antidiarrheal agent is common in locals. Also, wound treatments, diabetes, as a deworming agent and as an aphrodisiac are other uses. Furthermore, individuals engaged in high-intensity labor use it to help with stamina and reduce fatigue.
Treatment of opioid withdrawals with this plant is common. In addition, another common use for this plant is chronic pain. The recent spike in popularity of kratom is likely due to its alleged help with pain, mood, and opiate addiction.
Some other names are:
This substance is available in different forms. It is present as powders, dried leaves, tinctures, resin, capsules, liquids, tablets, and gum. Unfortunately, most of these forms are available on the internet. In the U.S., other sources are gas stations, tobacco shops, and some juice bars. Interestingly, seeds and whole trees are also available from some sellers over the internet.
Consumption of the leaves is by chewing, smoking and brewing as a tea. Lemon, honey, or sugar makes it tastes better. When chewed, users chew one to three fresh leaves each time. This herb can, however, cause constipation. For this reason, individuals add salt to the leaves.
Kratom is sometimes available as a powder in packets labeled “not for human consumption.” The use of this plant has increased quite a bit since 2016. This increase is probably related to the ease of getting it via the internet. In addition to this, there is also the widespread belief of its medicinal benefits. Again, most of this information is via the internet. It mostly sells in the United States as a dietary or herbal supplement.
Kratom contains many different chemicals. Mitragynine is one of such compounds. This substance works like opioid drugs such as codeine and morphine. Kratom also contains small doses of another chemical called 7-hydroxymitragynine. This chemical is the addictive part of this herb.
The status of Kratom as an illegal substance differs across the world. The United States Drug Enforcement Administration (DEA) sees kratom as a substance of concern. It is illegal in Ohio, Vermont, Indiana, Alabama, Arkansas, Rhode Island, and Wisconsin. There is a ban on this herb in countries like Malaysia, Sweden, Vietnam, Australia, and Poland.
In 2016, the DEA submitted a notice of intent for kratom. This notice was to schedule it as a Schedule I Substance temporarily. However, the American Kratom Association and other advocates campaigned against this. Due to this campaign, the DEA withdrew the scheduling request. Kratom is not a controlled substance in the United States.
The FDA, in a 2018 report, stated that it has no scientific data to support the use of kratom for medical purposes. The FDA also discourages using this plant as an alternative to prescription opioids or treatment of withdrawals. Ultimately, the recommended treatment for opioid use disorder remains buprenorphine, methadone, and naltrexone.
Between 2011 – 2017, the National Poison Center reported 1,807 calls for kratom. There are reports of overdose deaths involving this substance. However, many of these cases have been a combination of kratom with other drugs.
The use of this substance as a recreational drug is more in the younger population and middle-aged. 55% of individuals who use this herb regularly become dependent.
The most commonly abused forms of this substance are the liquid, capsules and powder. The self-prepared tea is also readily available. The three highest uses are for:
A study done in a group of long-term users of kratom showed interesting results. This group had used for half a year or longer. 50% of these users showed severe withdrawal symptoms. 45% showed milder withdrawals. On the other hand, there was no withdrawals in only 5% of this group. Furthermore, more than 80% of these users had tried and failed to stop using kratom.
The addictive nature of this herb is common. Locals of Southeast Asia have shown dependence on kratom for many years. Not consuming this herb leads to cravings. Also, people develop withdrawals a few hours after the last dose. As a result of the addictive potential of kratom, many countries have banned this herb.
According to the DSM-5, kratom use disorder occurs when there is a problematic use that causes significant impairment or distress. The DSM-5 requires at least two of such of impairments that occur within 12 months. These impairments or difficulty include:
The effects depend on the dose taken. In small doses (less than 5 gm), kratom acts as a stimulant. These low doses act like cocaine or amphetamines. As a result, it can cause increased alertness, talkativeness, boosted physical energy, and more social behavior.
In larger doses (above 5 gm), it has opioid-like effects. It can, therefore, reduce pain and cause sleepiness. Due to acting like opioids in high doses, some individuals use kratom to help with opioid withdrawals.
The effects of this herb tend to occur quickly. Following a dose, its effects start within 10 minutes in some cases. In as much as it works quickly, its effects also go away fast. Kratom can last between one to five hours.
Some side effects noticed with using this plant are:
The number of deaths involving kratom has steadily increased since 2016. This increase is related to the sudden spike in internet searches for this herb. As you would expect, an increase in search translates to an increase in use. Hence, more problems with using this substance. Unfortunately, side effects and death can occur.
Most deaths from this substance appear to be due to taking adulterated products. Also, taking it with other illegal drugs contributes to fatality. “Krypton kratom” is a street drug that contains kratom, tramadol, and in some cases, caffeine. There are several other unsafe products on the market. Interestingly, the FDA investigated a salmonella outbreak from kratom in 2018.
People who use this substance tend to dose every 6-12 hours. Withdrawals can begin about 12 hours after the last use. These, however, tend to last about four days or less. Also, the severity of the symptoms is related to the daily dose, frequency, and duration of use. Symptoms include:
Mixing kratom with other drugs such as tramadol, cough syrup, alcohol, or benzodiazepines can be fatal. Also, combinations with caffeine, fentanyl, cocaine, and diphenhydramine are dangerous. Smoking and injecting it into the body can be hazardous. Unfortunately, there are several reports of deaths following consumption of this herb. Many of these deaths have, however, involved other drugs.
The National Poison Data System analyzed some data in 2019. This data found that between 2011 and 2017, there were 11 deaths related to kratom. The FDA, in 2017, identified at least 44 kratom related deaths. Many of these deaths have been as a result of taking adulterated products. Also, taking kratom with other drugs has contributed to these fatalities.
Standard drug screens do not detect this substance. Detecting this drug in the body requires special tests. The reason for this is because of the difference in chemical structure between kratom and other drugs. Some studies have shown that kratom can stay in your body for up to 9 days.
Over the last few years, there has been an increase in media coverage for kratom. This coverage is likely due to the increased use and associated side effects and complications. As an illustration, let us look at the following news items:
As you can see, some of the articles are in support of this herb, while some are against it. This disparity has always been the case, and both sides give their arguments pretty strongly. There are many confirmed side effects and deaths from using this substance. In the same vein, individuals who believe in the benefits of kratom give accounts of the positives.
There are many side effects and risks to using kratom. Nevertheless, support for this substance continues to grow. The American Kratom Association (AKA) is a non-profit organization that supports the use of this substance.
The mission of the AKA is: ” On behalf of the growing numbers of Kratom users, including doctors, lawyers, teachers, and law enforcement officers, The American Kratom Association, as a Virginia registered non-profit works to help protect their ability to use Kratom for the purposes of improved health and well being.”
According to the website of the AKA, they have five main goals:
This association encourages donations on their website. They aim to ensure that kratom continues improving lives. The AKA talks about ways to keep kratom safe and legal, good manufacturing processes, and also encourages people to tell their stories.
There is currently no specific medication for treating withdrawals from this substance. Management is similar to treating opioid withdrawals. The medications and duration of treatment for opioids are helpful for kratom. Some treatment centers use suboxone and clonidine for detox. Also helpful is methadone. Other “comfort medications” help to make the detox process more manageable.
Kratom has opioid-like effects, especially in high doses. The withdrawals are similar to the withdrawals of other opioids. As of 2018, the FDA has confirmed that kratom has opioid properties. However, despite these similarities with opioids, there are no clear cut management guidelines.
For now, we do not have enough evidence on the best way to manage sobriety from this substance long-term. Medication-assisted treatment involving behavioral therapy is an option to consider. Even with treatment, relapses seem to be very common. These relapses are probably due to the distressing withdrawals and strong cravings.
In conclusion, kratom is a tropical plant native to Southeast Asia. Locals have been using it for medicinal purposes for centuries. Lately, this herb has been more available on the internet and in local shops. As a result, there has been an increase in its use. Many individuals use kratom for anxiety, depression, chronic pain, and also opioid withdrawals.
There remains a lot of division in opinion on the harmful effects of kratom. Many individuals highlight the benefits of using this herb. However, there are also numerous cases of side effects and even death. These effects are even more so when mixed with other drugs.
Although kratom use is common in Thailand, Malaysia, and Myanmar, it is illegal in all three countries. There is also a ban in several other countries and many states in the U.S. Currently, the DEA regards this substance as a drug of concern. Advocacy groups like the American Kratom Association continue to advocate for the benefits of this herb.
Kratom has an unusual action. In low doses, it acts as a stimulant. In higher doses, however, it causes depressant and opioid-like effects. There are many withdrawal symptoms including sweating, body pains, diarrhea, runny nose, anxiety, irritability and mood swings.
There are two sides to every story. Similarly, there are strong arguments for and against this substance. So, what do we do with this herb? Do we put a complete ban on it due to its potential risks? Or do we give room for more research to explore its alleged benefits further?
I treat a lot of patients with substance use disorders. I have had many patients talk about the benefits they have experienced from using kratom. Similarly, I have had several other patients who have struggled with addiction to this herb. I sometimes wonder if kratom might be beneficial from a harm reduction standpoint. For example, using methadone for opioid addiction. However, the statistics from the FDA regarding side effects and deaths infer that we also need to tread carefully. In my opinion, we need to have more research on this plant.
Have you had negative effects from using kratom? Has this herb helped you in any way? How so? Please leave your comments below on this polarizing substance.
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Kratom is not currently a scheduled substance. It remains to be seen if the FDA changes this in the near future.
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