In recent months, you might have been hearing the word Kratom all over the place. You might have been wondering what that Kratom is all about. Well, you have come to the right place. In this article, we give you all that you need to know about Kratom and what has caused it to be the talk of the town in recent months.
What Is Kratom?
Kratom, also known as Mitragyna Speciosa, is a tropical evergreen tree. It is a native of Southeast Asian forests. It has been used in the regions of Malaysia, Thailand, Papua New Guinea and Indonesia.
Kratom leaves have been used for centuries as a remedy for pain. Its leaves can be eaten raw or crushed into powder for consumption. Its medicinal properties make it an ideal analgesic.
Belonging to the family Rubiaceae, Kratom has become a must-have ingredient during festivals and greeting guests. It has been mixed with tea and honey for recreational consumption. Medicinal uses have seen it in the form of tablets, extracts, and capsules.
Its unique properties in reducing the depression and pain have made it famous in western countries too. It acts as an opioid-like depressant and stimulant at lower doses.
For recreational uses, it produces euphoric sensation at high doses. It also helps treat the withdrawal symptoms of opiates such as heroin and other prescription drugs.
A Brief History of Kratom
Kratom has been an essential part of the local culture in Southeast Asia. There are extensive documents that show the effects of Kratom on the human body and the various ways it can be used to alleviate pain.
Historically its leaves have been chewed, much similar to khat and cocoa to increase energy as well as appetite. It has been used in Thailand for boosting sexual desire and relieving muscular pain from the body.
Local medicinal people have used this as an anesthetic for healing wounds effectively. Traditional medicine has documented the use of Kratom in the treatment of coughs, diarrhea, and intestinal infections.
People engaged in laborious professions have used Kratom as a painkiller and mood enhancer. Kratom has enjoyed prominence in the local tradition of Thailand as a gift in the ritual worship of ancestors and gods. Kratom is also given to guests to welcome them.
Since Kratom fruits are bitter in taste, they are usually mixed with sweeteners while giving to guests.
Benefits of Kratom
Kratom has gained its popularity in the United States for its therapeutic properties and psychoactive effects. It has been imported to the USA since 1900, to use in medical treatment.
It contains psychoactive compounds such as mitragynine and 7-hydroxymitragynine (7-HMG). The drug acts as a sedative when given in low doses. Because of these visible benefits, it has been prescribed by physicians for people suffering from cancer pain and drug withdrawal symptoms.
Kratom works by acting on the pain receptors of the brain. This reduces the sensation in the body and thereby pain. One of the major advantages of Kratom is that it does not have the harmful effects of respiration suppression that is associated with classic opioids.
Kratom is used as an analgesic in American hospitals. It has the ability to suppress diarrhea, cough, etc. It can also reverse the opioid-induced disorders such as overdose, constipation, etc.
Kratom has been used extensively in the USA for the treatment of opium addiction relapse and to prevent deaths due to opium overdose. Kratom has become a life-saving agent for millions of Americans suffering from addiction.
It does not have any side effects similar to opioids such as oxycodone, heroin, and morphine. It acts as a partial opioid agonist mitigating the body’s sensitivity to pain.
Therefore, Kratom has been preferred for medicinal use. Harmful effects such as addictive euphoria and respiration depression do not happen with Kratom use. All these properties have made Kratom a preferred drug in the treatment of pain and opium addiction.
Nearly 5 million patients have been benefiting from Kratom use in the US alone. It is also explored in the treatment of multiple sclerosis, arthritis, neck soreness, chest pain, etc.
Pharmacology of Kratom
There have been increased efforts by the scientific community to identify and characterize the active pharmacologic agents that mediate the effects of Kratom in the body.
As far as 20 active compounds have been isolated from Kratom that has potential pharmacological effects. The medicinal chemistry and pharmacognosy have been reviewed by scientists.
These Kratom derived compounds relate to the primary pharmacologic effects such as analgesia and the ability to suppress symptoms of opioid withdrawal.
There is evidence from the studies that Kratom, Kratom extracts, and molecules isolated from Kratom can alleviate various forms of pain in animal models.
The compounds isolated from Kratom has opioid-like effects on smooth muscle systems. Several peripheral and central nervous system effects due to these Kratom-derived substances can be sensitive to inhibition by opioid antagonists.
It is found that most of the opioid-like activity of Kratom has been attributed to the presence of the indole alkaloids, mitragynine, and 7-hydroxymitragynine.
Both compounds have been shown to have analgesic and antinociceptive effects in animals, although 7-hydroxymitragynime is more potent.
Along with these various central nervous system effects, Kratom also appears to have anti-inflammatory activity. 7-hydroxymitragynine is a highly responsible for causing the analgesic effects of Kratom in the body.
The other compounds present in the Kratom is found to modulate intestinal smooth muscle function and behavioral response in animals.
Opioid Crisis in US
From the 1990s, the uptake of prescription opioids by patients have been increased. This is because of the assurance from pharmaceutical companies that these substances are not addictive and increased prescriptions by healthcare professionals too.
This has led to the widespread misuse of these drugs leading to opioid overdose.
In 2015 alone, 33,000 Americans have died of drug overdose. Nearly 2 million people suffered from withdrawal symptoms of drugs such as heroin, prescription drugs, fentanyl, etc.
This issue has become a public health crisis with devastating consequences such as increased in the opioid misuse or due to related overdoses; Even the rising incidence of neonatal abstinence syndrome caused by opioid use and misuse, during pregnancy had made it a public concern. The increase in injection drug use has also contributed to the spread of infectious diseases including HIV and hepatitis C.
Opioid overdoses accounted for more than 42,000 deaths in 2016, more than any previous year on record. An estimated 40% of opioid overdose deaths involved a prescription opioid.
This opioid crisis has changed the social, moral and cultural resistance to the street drug alternatives such as heroin. This crisis has led various states to declare a state of emergency in tackling this epidemic.
It is considered to be the largest epidemic that is being handled by FDA even president Trump has voiced his concerns over the drug epidemic as a public health crisis.
In response to the opioid crisis, U.S. Department of Health and Human Services has prioritized the following actions:
- Creating better access to the prevention, treatment and recovery support services thereby enabling individuals to recover from the opioid addiction.
- Prioritizing the availability and distribution of overdose-reversing drugs in local markets helping people get the much-needed medication for people in high-risk areas.
- Improving the quality of public health data reporting and collection thereby ensuring the timeliness of data and accuracy.
- Funding for cutting-edge research that helps in understanding pain and addiction. Enhancing government role in identifying potential new treatments, medicines, and effective public health interventions to reduce opioid-related harms.
- Encouraging advanced innovations in pain management to increase access to high-quality pain care that is supported by evidence thus aiming to reduce the burden of pain for patients, families, and society.
The Recent Controversies Around Kratom Use
Recently there have been reports in the media about deaths due to an overdose of Kratom. It has not been validated and the FDA has taken steps to curb the supply of Kratom citing hazard to public safety.
The drug has come under the radar of Drug Enforcement Administration too. These steps are due to the perceived increase in deaths related to Kratom overdose. This has lead to the widespread dissatisfaction and protests from the patient community that is dependent on the drug for dealing with chronic pain and those recovering from drug abuse.
They have formed an association supporting Kratom use. They have signed petitions supporting Kratom use and demanding government’s involvement in creating awareness about the correct use of Kratom.
Around 1,170 doctors, scientists and law enforcement officials have come together showing their support for Kratom.
The Kratom support group has indicated the various studies that have been conducted over the years about the therapeutic effects of Kratom or its pharmacological mechanism, the usage of Kratom for medicinal purposes.
However, FDA has considered Kratom to be unsafe because of its opioid properties. This is primarily because of the opioid crisis in which several deaths have been attributed to drug overdose. There have been anecdotal indications that the dead patients have consumed Kratom.
The FDA investigation has come in the wake of chronic Kratom abuse cases encountered in various hospitals all over the USA. According to FDA, Kratom abuse can result in seizures, liver toxicity and extremely high dose with other drugs might even result in death because of its respiration suppression effects.
Other common side effects include nausea, itching, and anxiety. Heavy users also have symptoms of withdrawal including hypertension, distress, and insomnia. However, it is not proven beyond doubt that Kratom is the root cause of these deaths.
Recent Studies on Kratom
According to an academic study published in The Journal of the American Osteopathic Association, Kratom is a natural herbal remedy with substantial therapeutic effects. There have been rigorous studies related to the pharmacological effects of Kratom on a human body.
Around 65 research articles have been published in various journals about the drug reactions. It is found that Kratom can be used for the management of pain, diarrhea, as well as opioid withdrawal symptoms, and can be used as a euphoriant.
Low to moderate doses of Kratom helps stave off fatigue. Very high doses (>15 g) of Kratom tend to be quite sedating and can induce stupor, mimicking opioid effects.
There are also vast sources of information in general information websites and online vendors indicating that Kratom has been quite popular in the United States.
These Web sites contain a variety of information including the drug’s uses and effects, discussions of individuals’ personal experiences, and various reactions when using Kratom. It has been found in these studies that Kratom is preferred for most chronic pains.
These studies concentrate on the role played by Kratom on pain management. In addition, recent publications have highlighted the use of Kratom products for the self-management of opioid withdrawal symptoms.
Studies on Psychoactive Properties of Kratom
Although Kratom has been considered as a legal opioid, there have been very few studies related to the psychoactive properties of Kratom. Most of the available information is based on patient experiences and anecdotal evidence.
Websites such as Erowid, Sage wisdom, and WebMD host blogs about patient experiences and also allows users to comment on the Kratom use.
It is found that there is an unusual combination of stimulant and opioid-like effects in Kratom. These psychoactive effects are dependent on the dosage levels of the substance.
Low to moderate doses (1-5 g of raw leaves) usually produce a mild stimulant effect that most individuals perceive as pleasant but not as intense as those of amphetamine-like drugs.
Those who have used Kratom products for pain management tend to view the stimulant effects of Kratom as being more desirable than the sedative effects of traditional opioids.
Moderate-high doses of Kratom produce Opioid-like effects, including euphoria, constipation, analgesia, sedation, etc.
Depending on the user, high doses of Kratom can produce both euphoric or dysphoric effects. However, it is found that the psychoactive effects of Kratom are less intense than that of opium and opioids.
Toxic Effects of Kratom Abuse
During the past 3 years, there has been an increasing number of case reports describing unusual adverse reactions in patients who had been using Kratom or Kratom-based products.
Many users who have experienced the side effects of Kratom is acute in nature and due to the direct result of Kratom’s stimulant and other opioid activities.
Some individuals might see these stimulant effects as irritability, anxiety, increased aggression, etc. Whereas the effects due to opioid activities include itching, constipation, sedation, and nausea. But, all these effects dependents on the dose and might differ from individual to individual.
Chronic, high-dose usage has been linked with several unusual effects. Hyper-pigmentation of the cheeks, sudden weight loss, anorexia, tremor, and psychosis might be seen in individuals with long-term addiction.
Nine reports of serious toxic effects are rare and can happen due to relatively high doses of Kratom, i.e., more than 15g in a day.
Of particular concern, there have been various recent reports of seizures occurring in individuals who are consuming high doses of Kratom, either alone or along with other drugs, like modafinil. Scientists have recently described a case of intrahepatic cholestasis in a chronic user of Kratom.
However, it is important to note that the patients may have been using other drugs along with Kratom. Therefore, it has not been proved that Kratom is the reason for the drug overdose.
Also, the research on the interaction of Kratom with other prescription drugs has been negligible. This lack of understanding is compounded by relative lack of regulations and standardization related to the production and sale of Kratom. Still, there is no evidence which can prove the same.
Studies of Kratom abuse, addiction are incomplete with only anecdotal evidence. There is a strong need to research in this area to understand fully the pharmacological effects of Kratom.
And its effect if taken with other drugs or medicines, so that one can use it accordingly without facing even the acute side effects.
Legality of Kratom in US
From a legal viewpoint, Kratom is regulated as an herbal product under the laws of US Food and Drug Administration and US Drug Enforcement Administration (DEA) policies. It is not prohibited by the controlled substances act.
Kratom is considered a legal substance in the United States. However, DEA has released a Drugs and Chemicals of Concern list in 2010 stating that Kratom does not have a legitimate medical use in the U.S. This means that it cannot be legally advertised as a remedy for any medical condition.
Also, the lack of clarity in regulations has enabled various vendors to produce low-quality Kratom products that have harmful effects. This has tarnished the reputation of Kratom further.
There is a clear need for strong regulations that dictate the right quality for Kratom products so that consumer interest is protected at all costs. The varying quality of the substance and the improper production methods have more side effects than the original benefits associated with Kratom.
But in the recent scenario, legalization of Kratom is taking place in various states of US, even it’s not legal in various countries.
Support From Kratom Community
Because of the misconception from news and other unreliable sources, the reputation of Kratom as a medicinal supplement has been eroded.
Recently FDA has moved to restrict the supply of Kratom in the local market. This has created concerns for millions of patients who depend on Kratom for pain relief.
To showcase their support, scientists, Kratom producers, distributors, and users have conducted Kratom Leadership summit. The participants have discussed the various challenges that are present in the current scenario. They have shown solidarity in supporting Kratom use and putting efforts in spreading information about the benefits of Kratom to the people.
The summit showcased speeches from eminent scientists such as Dr. Jack Henningfield, a leading addiction researcher and molecular biologist Dr. Jane Babin and Georgia state representative Vernon Jones. They have highlighted the existing research that is available in Kratom’s pharmacological effects.
They also pointed to the lack of evidence in FDA’s reports in concluding Kratom as a precursor for the recent overdose deaths. The summit has ensured that Kratom advocates and producers will advance the cause of millions of Americans who are in desperate need of Kratom to carry on their daily lives normally.
They have collectively agreed on a law for Kratom distribution without affecting its supply to patients. The scientific community has urged the government to invest in researching the potential benefits of Kratom in pain relief instead of going for an outright ban.
There is a need for right policy prescription and industry standards that address the concern of the public related to the availability of high-quality medicinal Kratom.
Kratom has been in medicinal use for centuries. Due to misconception and wrong information spread by media without validation of facts have attracted a bad reputation for Kratom.
Fortunately, Kratom supporters have rallied together to build awareness about the benefits of the plant. They have urged the government to invest in studying the medicinal benefits of the plant so that the society as a whole can benefit from it.
Academics, scientists, medical practitioners have gathered in the first ever Kratom summit to discuss the current challenges and way forward for the substance. They have insisted that a collaboration between different agencies is paramount if all the benefits of Kratom have to be realized.
As Kratom is essential for millions of drug recovery patients in America, a well thought out approach is required in controlling the distribution of Kratom so that it does not get abused.
A combination of education and awareness programs can give a good idea about how to use Kratom in the right way. With active participation from various stakeholders such as government, public health professionals, patients, scientists, Kratom can redeem its reputation as an effective pain reliever and addiction antidote.See References:
- “Following “the Roots” of Kratom (Mitragyna Speciosa): The Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries”. BioMed Research International. 2015: 968786.
- “Biochemical Benefits, Diagnosis, and Clinical Risks Evaluation of Kratom”. Frontiers in Psychiatry. 8: 62.
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