Kratom: Harmful Substance or Safe Drug Addiction Treatment?

What is kratom? This botanical substance is often used to get people off hard drugs like heroin and opioids, and it’s been labeled as a “drug and chemical of concern” by the U.S. Food and Drug Administration (FDA).

Why? Because despite its effectiveness at curbing addiction to certain drugs, there’s now evidence that users can become addicted to kratom itself. Plus, it may even be dangerous, with one 2018 review reporting that kratom exposure has been linked to side effects like agitation, irritability, tachycardia, withdrawal symptoms and even death. According to the CDC, 152 people who overdosed from July 2016-December 2017 tested positive for kratom, and kratom was determined to be the main cause of death in about 60 percent of these cases.

Due to its nature as a possible abusive drug, as well as its properties that are potentially harmful to humans, the DEA has debated categorizing kratom as a schedule 1 substance, just like hard drugs like cocaine and heroin. The Department of Health and Human Services also recommends such a ban on the chemicals in kratom, based on evidence that kratom is “an opioid” and has been “associated” with dozens of deaths.” On the other hand, people using kratom argue vehemently against the illegalization of this potentially life-saving plant.

Kratom is still legal by default in the U.S. It isn’t classified or listed as a controlled substance and is sold — usually crushed and dried in special “kratom bars” — in general stores scattered across the country. It produces a euphoric “high” and is said to mitigate the effects of opiate withdrawal. Reports show that kratom is extremely helpful for people struggling with debilitating pain, addiction to pain medications, and addiction to heroin.

With the opioid epidemic becoming the No. 1 cause of death for Americans under the age of 50, a natural substance like kratom seems like a potentially beneficial means of treatment. But this is an issue of much debate among the FDA, DEA, lawmakers and U.S. citizens. Despite calls for a ban, passionate arguments on both sides of the issue are being heard by legislators in state governments. You can still buy kratom online and in certain shops today, but many people are wondering: Does kratom do more to harm or help its users?

What Is Kratom?

So what exactly is kratom and what does kratom do? Kratom, scientifically named Mitragyna speciosa, is a tropical tree in the coffee family that is native to parts of Africa and Southeast Asia. The kratom herb has been valued in traditional medicine since the 19th century, and today it is used for natural pain relief, to self-treat drug addiction, and to ease drug withdrawal symptoms. People who have taken it in various forms have reported increased energy and mood, euphoria, as well as pain reduction in various forms.

Studies are still ongoing as to the long- and short-term effects in this arena. The tree extract is seen as a possible aid for abusers since it contains opiates itself and would bind the μ-opioid receptors in the brain, but they don’t intervene in physical dependence like other harsher opioids often do.

Traditionally, kratom leaves were crushed and made into tea, or they were chewed on or smoked for their euphoric effects. Today, the plant is used to make kratom capsules as well as kratom pills and powders. The American Kratom Association, a consumer advocacy group, estimates that 10 to 16 million people in the U.S. regularly use kratom by either eating its ground leaves in food or brewing them in tea.

The availability of kratom in the U.S. is a topic of much debate lately; the plant is receiving a lot of attention because of its confusing FDA status. Kratom contains over 40 compounds and more than 25 alkaloids. The main active alkaloids in kratom are mitragynine and 7-hydroxymitragynine, which can have a range of stimulating and depressant effects. Kratom constituents have shown to possess analgesic and anti-inflammatory activity.

The area in which the trees are grown is a large factor in the potency of its compounds. Naturally occurring trees found in Southeast Asia tend to have much higher potency (for better or worse) than farmed trees in other areas of the world or those grown in greenhouses.

Kratom types are generally divided into three different colors: red vein, white vein or green vein. This division is dependent on the color of the stem and vein of the leaf. This color determines the effect the kratom leaf will have on mind and body. There are variety of strains of kratom on the market today.

Legal Status

Except for some states that are considering a possible ban on all kratom products, kratom is legal in most parts of the U.S. This means anyone can buy, sell or possess it without fear of getting arrested. It also means that you don’t need a prescription to purchase it.

However, the FDA currently and clearly prohibits the sale of kratom products as a health product because of its alkaloid content. However, it can still be sold as a research compound. This restriction also implies that a supplier cannot market kratom supplement products as a health supplement.

Here are some noteworthy facts about how the FDA and other organizations have treated kratom over the past several years:

• Kratom has become increasingly popular in the natural health market and is used as an additive in natural pain medication and dietary aids. It’s also been utilized in drug addiction recovery — though it’s now cited as an addictive substance itself.
• Without reliable studies on the safety of the kratom drug combined with a booming import market, in 2014 the FDA issued an alert for the Drug Enforcement Administration (DEA) to confiscate any shipments that might contain the additive. The DEA reported that street names for kratom include thang, kakuam, thom, ketum and biak.
• In January 2016, the U.S. Marshals seized $400,000 worth of dietary supplements from Illinois-based Dordoniz Natural Products that contained the controversial kratom, at the request of the FDA. In the months following, more kratom shipments were intercepted because authorities are specifically concerned about the uncontrolled nature of the substance.
• In August 2016, the DEA announced its plans to move kratom and its alkaloid mitragynine to Schedule 1 status — a category that includes drugs like LSD and heroin. Drugs categorized as Schedule 1 are described as having no medical uses and a high potential for abuse.
• The DEA’s announcement sparked a lot of backlash and opposition from patients who have experienced the positive kratom benefits and its usefulness in managing opioid withdrawal and chronic pain. After a march and demonstration at the White House, a petition sent to then President Barack Obama and several congressmen, congresswomen and senators asking the DEA to reconsider the new kratom status, the DEA announced that the ban would be placed on hold.
• In October 2016, the DEA announced its decision to withdraw its intent to ban kratom and its main alkaloid because of the numerous comments from the public that offered opinions on the pharmacological effects of the plant.
• In November 2017, the FDA made another announcement about kratom. In this latest news, the FDA strongly warns consumers not to use Mitragyna speciosa, or kratom. The FDA is greatly concerned about the risk of addiction, abuse and dependence because the plant appears to target the same opioid brain receptors as morphine. In addition, the FDA urges consumers to be on the lookout for kratom’s psychoactive compounds mitragynine and 7-hydroxymitragynine and to steer clear of any products containing these derivatives as well. There are no FDA-approved uses for kratom or its compounds, and the administration remains worried about the plant’s safety.

Will It Be Illegal In the Future?

Although there is currently no ban on kratom and products containing the plant are available to U.S. residents, it’s important to know that these products are completely unregulated and consumers can’t be absolutely sure of the strain or doses used. Reports show that kratom has been laced and contaminated with potentially toxic drugs in order to intensity the effects. The lack of regulations and standardization of kratom products is proving to be more dangerous for people who rely on them to fight their chronic pain or drug withdrawal symptoms.

• The FDA released a statement in February 2018 that revealed the compounds in kratom are indeed opioids. FDA scientists analyzed the chemical structure of kratom compounds using computer analysis. The analysis showed that kratom activates receptors in the brain that also respond to opioids. This data, along with previous other experimental data, confirmed that two of the top five most prevalent compounds are known to activate opioid receptors.
• The FDA cautions that “kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids. There is no evidence to indicate that kratom is safe or effective for any medical use. And claiming that kratom is benign because ‘it’s just a plant’ is shortsighted and dangerous.”

As of November 2018, the Department of Health and Human Services (HHS) has recommended a ban on the chemicals found in kratom that would make kratom illegal, just like heroin or LSD. The HHS recommended that the DEA make kratom a Schedule I drug. Their recommendation was based on the fact that chemicals found in kratom have “a high potential for abuse” and that there is “no currently accepted medical use” for them.

The DEA still needs to make an official ruling about how kratom will be classified. This process is ongoing. Depending on their decision, anyone who buys, sells or uses kratom in the future might face punishment including jail time. Anyone who wants to do research with the chemicals found in kratom, such as scientists who are looking to uncover ways to help those addicted to opiods, would also need to obtain special permission from the the DEA.

Possible Health Benefits

According to a 2020 user survey analyzed by Johns Hopkins Medicine researchers, “psychoactive compound [in kratom] somewhat similar to opioids likely has a lower rate of harm than prescription opioids for treating pain, anxiety, depression and addiction.”

While kratom does have some addictive qualities, the majority of the plant’s elements are not addictive, so in reality the abuse potential of the plant is very low. Kratom also doesn’t appear to cause respiratory depression, or slowed breathing, which is a very dangerous factor of opioids because they have the ability to shut down the respiratory system during an overdose.

According to Albert Garcia-Romeu, PhD, instructor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, “There has been a bit of fearmongering because kratom is opioidlike, and because of the toll of our current opioid epidemic.”

Although the outlook by the FDA and DEA is grim, there have been documented benefits for taking the kratom drug in certain forms. Some of the top kratom uses include:

1. Helps Treat Opiate Addiction

Increasingly popular among people trying to get off of hard drugs, kratom is used for those suffering from opiate addiction. The compounds in the leaf help aid in lessening the side effects of withdrawal, while mimicking some of the feelings that opioids have on users.

The chewing of the leaves, done by many recovering abusers in Asia, has a psychological and consistent effect, as well as a safe and immediate “boost” relatable to their addiction as opposed to using harsher drugs. Additionally, kratom does not seem to cause hypoventilation, which is respiratory depression and a leading cause of death due to opiates, as is typical in other opioids.

Because kratom is an unregulated product, the number of reliable studies on the plant is scarce, but anecdotal reports support the beneficial role of kratom in helping people to overcome opioid withdrawals.

2. Boosts Energy

The compounds found in the leaf have been shown to increase productivity levels due to heightened focus and buzz-like stimulation, without the increased heart rates often felt from too much caffeine consumption or caffeine overdose. This is due to the metabolic processes it affects — the extract can increase oxygen in the bloodstream and calm nerves for a more stable boost.

This particular energy boost is different than others and is often called out singularly as a “kratom high.”

3. Relieves Pain

Many people use kratom for pain, and it can be especially useful for those suffering from chronic, persistent symptoms such as back pain, headaches or joint problems.

A study published in Addiction evaluated self-treatment of opioid withdrawal using the substance. A patient who had abruptly ceased injection hydromorphone abuse self-managed opioid withdrawal and chronic pain using kratom. The alkaloids in the leaf attach to opioid receptors in the brain, which can help dull and relieve pain felt in the body and make opioid withdrawal less severe.

4. Improves Mood and Anxiety

The properties of the kratom plant lend itself to be used as an anxiolytic (an anti-panic or anti-anxiety agent). For the same reason it helps boost energy through metabolic activities, it can help people who suffer from severe mood swings, depression and anxiety. The leaf extracts aid in controlling the release of hormones throughout the body, thereby regulating mood swings in a more controlled manner, if not eliminating them completely.

Using kratom for anxiety can be tricky for those who don’t have experience with it. The reason for this is the large variety of kratom strains, all with different effects, which means that if the wrong strain is chosen, such as a highly energetic strain, it provides little benefit. Some of the most common strains used as natural remedies for anxiety include Borneo, Indo, Bali and some Red Veins.

5. Enhances Sexual Function

Traditionally, kratom has been seen as an aphrodisiac and used to increase fertility in men, as well as aiding in premature ejaculation. Though no scientific studies have been shown to prove the sexual effects, animal models have shown increased sperm production in mice, and there has been a growing market for the use of kratom for sexual enhancements.

Precautions and Side Effects

So is kratom safe? While kratom is readily available to buy online, there are many apparent side effects of kratom to consider as well. Although it only entered the U.S. market within the past few years, taking the extract has been occurring for centuries, and many have documented the negative effects it has on the body.

Many of the positive effects shown to occur using kratom ultimately can be reversed to opposite and negative effects on the body. There have also been documented “kratom hangovers,” where symptoms of a more traditional alcoholic hangover are present.

1. Addictive

As kratom use has expanded to Europe and the U.S., there are increasing reports of individuals becoming physically dependent on or addicted to it. There are documented studies recently noting how the nature of kratom’s properties can cause the user to become hooked. The opioid-like analgesic effects are the main reason for possible addiction. The euphoric effects of kratom generally tend to be less intense than those of opium and opioid drugs. Nevertheless, it is still being sought by drug users.

Chronic, high-dose usage has been associated with several unusual and/or serious kratom side effects, including hyperpigmentation of the cheeks, tremor, anorexia, weight loss and psychosis. Most published studies of kratom addiction are case reports of heavy, compulsive users.

In each case, the individual exhibited substantial tolerance to the effects of kratom and showed overt symptoms of withdrawal when kratom use was stopped. The symptoms of withdrawal were similar to those from traditional opioids and included irritability, dysphoria, nausea, hypertension, insomnia, yawning, rhinorrhea, myalgia, diarrhea and arthralgias.

There have  been a handful of cases of death due to overdose or addiction. Drug addicts often try to self-medicate with kratom, and this can be fatal.

2. Digestive and Liver Problems

Kratom use has been shown to lead to adverse side effects like upset stomach and vomiting. There also have been reported issues with seizures and liver problems, as well as severe nausea and dehydration.

A study published in the Journal of Medical Toxicology reported the case of a young man who had jaundice and pruritus (itching) after intake of kratom for just two weeks in the absence of any other causative agent.

3. Chronic or Prolonged Issues

Kratom taken in large, sedating doses corresponding to 10–25 grams of dried leaves may initially produce sweating, dizziness, nausea and dysphoria, but these effects are shortly superseded with calmness, euphoria and a dreamlike state that last for up to six hours. For regular kratom users, loss of weight, tiredness, constipation and hyperpigmentation of the cheek may be notable negative effects of kratom.

4. Psychological Effects

While some physical symptoms may be experienced and can pass within a week, psychological effects can be just as typical and sometimes more damaging. These can include delusions, hallucinations, loss of sexual desire, anxiety, severe mood swings, episodic panic, loss of appetite, crying, lethargy, psychotic episodes, aggressive behavior, addiction and paranoia.

5. Withdrawal Symptoms in Newborns

Research released in November 2018 showed that kratom’s opioid-like effects can cause significant withdrawal symptoms in newborns. This has been reported in the U.S. in two cases thus far, raising concerns about the use of kratom during pregnancy. Experts are now worried about a “broader trend among pregnant women toward seeking alternatives to opioid painkillers such as morphine, heroin and oxycodone (OxyContin).”

In one case study, 33 hours after birth, the baby began showing symptoms consistent with opioid withdrawal, including sneezing, jitteriness, excessive suck, scratching at the skin around his face, and irritability. The baby’s mother reportedly drank kratom tea daily during pregnancy, such as to help with sleep.

Traditional Uses

Wondering how to use kratom and how it’s produced? The leaves, harvested from trees that can be either deciduous or evergreen depending on the climate, are often dried and ground before being used. Indigenous use means chewing the leaves straight up.

Once the leaf has been processed, it’s typically dried and ground to be made into a powder or tea. Most of the powder is sold in the form of kratom capsules. These powdered forms tend to be green to brownish in color and are also available in formulated batches with other botanical extracts and readily available to buy online. The powder is also sometimes boiled down in water to form pastes so it can be applied on wounds or used orally. Typically, lemon is added to the tincture or tea before in order to aid in the extraction of the alkaloids. The dried leaves can also be smoked.

The effects of the leaf are dependent on the kratom dosage. Small doses up to 10 grams can tend to give more of an uplifting, opioid effect. Meanwhile, taking a large kratom dose of the botanical extract, ranging from 10 grams and up, can have a sedative effect.

Traditional methods of chewing leaves often lead to stimulating effects. In Thailand, most males chew between 10–60 leaves a day. In some studies, it was found that roughly 70 percent of Thai males chew kratom, or ketum as it’s known locally in Malaysia. They often remove the stems and sprinkle salt on the leaves to decrease the possibilities of constipation.

For those using kratom for anxiety relief, it’s typically good to dose at moderate levels. The reason is some strains tend to be much more energetic at low doses, while at high doses tolerance can build, diminishing the effect.

History

This tropical, deciduous tree, native to Southeast Asia, is in the same family as coffee. Similar to coca leaves in South America, kratom has commonly been chewed by laborers in Malaysia and Thailand to help boost physical production. However, the Thai government banned its growth and sale in 1943 (Kratom Act 2486) when it conflicted with its opium trade and was found to be harmful to the nervous system. Since it’s naturally occurring in the region and the chewing is endemic among natives, it was too hard to stop, and the practice continues to this day.

In the 2000s, Thai officials recommended that the plant be decriminalized and taken off the narcotics drug list but still regulated because of its possible adverse effects. These were only recommendations, however, and Thai police still to this day arrest traffickers of the substance, which is sold at high potency in a black market setting. That regulating trend is only now starting to trickle across the Pacific to America.

Despite the laws, kratom cocktails have become increasingly popular among Thai youth. The drink, made with a mixture of kratom leaves and any assortment of cough syrups, sodas and other additives, such as fluorescent powders used to make road signs or even mosquito spray, is called “4×100.”

In 2012, researchers at the Thailand’s Office of the Narcotics Control Board conducted a survey of 1,000 teens in Pattani, Thailand and found that 94 percent used kratom. Out of those who used, 99 percent were Muslim. In other surveys conducted by the office, it was found that the villages in this area considered kratom use to be the worst problem for the community, ahead of the insurgent jihadist terrorists.

Final Thoughts

• What is kratom and what are the benefits? Also known as Mitragyna speciosa, it is a type of plant that is used to boost energy levels, reduce pain and treat addiction.
• While the subject of regulating or completely banning it has been heating up, legislators are determining new laws while reviewing the side effects and precautions of taking this botanical substance. A recent suicide linked to abuse of the plant has intensified the debate, as well as a rise in impure batches due to increased demands and mixing the kratom powder with other drugs.
• Regulators and researchers will continue to research the negative side effects, and for good reason. However, the positive effects on many users’ health and lives are also something to consider. For drug abusers who use it in a short-term, controlled and positive way to end their lethal drug addictions, it can truly be life-saving.
• It remains to be seen how it will be treated legally across the U.S., but the studies and news will certainly continue on whether or not it should be considered a safe stimulant, pain reliever and effective drug addiction treatment, or if it should be banned just like any other dangerous, illegal and addictive drug.