By Cassie Jewell, LPC, LSATP
Kratom (mitragyna speciosa)
is a tropical tree native to Southeast Asia and, like coffee, is part of the
Rubiaceae plant family. Ingesting kratom leaves produces a high. Taken in small
amounts, kratom leads to stimulant-like effects (i.e. increased energy and
focus – stronger than caffeine, less intense than cocaine). When taken in
larger doses, the high is similar to that of an opioid (euphoria, drowsiness,
“pinned” pupils, dry mouth, sweating, nausea, constipation, etc.) Kratom is
unique in that it produces both stimulant and opioid-like effects.
Note: “Opioid” is the term used for any drug that binds to the opioid receptors in the brain. An “opiate,” on the other hand, is a naturally occurring chemical found in the poppy plant, such as morphine or codeine. All opiates are opioids.
In the United States, kratom users cite pain relief as a primary motive
for use. Kratom, an opioid agonist, works by binding to opioid receptors in the
brain. It can be effective for both acute and chronic pain. Others report using
kratom for energy, increased focus, lower levels of anxiety, to reduce/stop the
use of opioids, to reduce symptoms of PTSD or depression, and to elevate mood.
Kratom is legal in Virginia; it’s sold at vape or “head” shops as
a loose powder or in capsules. (Alternatively, kratom can be purchased online.)
Packaging is typically labeled “botanical sample only; not for human
consumption.” The extremely bitter powder can be sprinkled over food or brewed
into a tea. It’s easily swallowed in capsule form.
What does kratom mean for the opioid epidemic in America? Will
kratom one day play a key role in the treatment of opioid use disorders? Or will
it fall into the “harm reduction” category? Is it a natural pain medication, a
safe alternative to highly addictive opioid pain killers?
Or, will we find that kratom, like heroin, is habit-forming and
deadly? Currently, the research is mixed.
An Alternative
to Opioid Drugs
The results of a 2019 survey published in Drug and Alcohol Dependence revealed that 90% of respondents found kratom
effective for relieving pain, reducing opioid use, and easing withdrawal
symptoms.
In 2011, researchers discovered that kratom alleviated morphine
withdrawal symptoms. A more recent study indicated that kratom may reduce
morphine use.
Earlier this year, researchers found that kratom use was
associated with significant decreases in the occurrence and severity of opioid
adverse effects; kratom lessened the discomfort of opioid withdrawal. Multiple
studies have substantiated these findings, suggesting that kratom is a useful
medication for opioid addiction and withdrawal.
Interestingly, in 2007, it was found that kratom reduced alcohol
withdrawal behaviors. More recently, researchers discovered that kratom
decreased alcohol use; this suggests that kratom may help those with alcohol
use disorders (AUD) in addition to opioid addiction.
Harm-Reduction
Compared to heroin, kratom is less addictive and has milder withdrawal
symptoms. Furthermore, the risk of deadly overdose is reduced with kratom use. A
2018 literature review indicated that kratom may have harm-reduction potential
for individuals who want to stop using opioids.
Dangerous
and Addictive?
According to the CDC, there were 152 kratom-involved deaths
between July 2016 and December 2018 (“kratom-involved,” meaning kratom was a
factor). In seven of those deaths, kratom was the only substance found in
toxicology tests (although it should be noted that the presence of other
substances was not fully ruled out). It’s possible to overdose on kratom, and
when combined with other drugs or medications, kratom can be fatal.
In rare cases, kratom has been linked to liver toxicity, kidney
damage, and seizures. In the case of a 32-year-old woman who was using kratom
for opioid withdrawal, kratom was likely the cause of acute lung injury. Kratom
use may also cause cardiac or respiratory arrest.
Kratom’s harmful effects are not limited to the body; a 2010 study
linked chronic kratom use to alterations in working memory. In 2016,
researchers found that kratom use was associated with cognitive impairment. An
additional 2016 study supported previous findings that kratom may affect
learning. In 2019, researchers found that high doses of kratom were linked to memory
deficits. In contrast, a 2018 study indicated that high kratom consumption was not related to long-term cognitive
impairment. That same year, researchers found that long-term kratom use did not
appear to cause altered brain structures. More research is needed in this area.
Regarding whether or not kratom is addictive, multiple studies have found that regular kratom use leads to dependence, withdrawal symptoms, and cravings. Kratom cessation may also cause psychological withdrawal symptoms, such as anxiety and depression.
Bottom
Line
Will kratom step up as the hero of today’s opioid epidemic?
Doubtful. And for kratom to be a viable treatment option, more conclusive research
is needed. Additionally, researchers must study the safety of long-term kratom
use.
While it’s unlikely, kratom use could lead to adverse health
effects or cognitive impairment; it could also fatally interact with other
substances or medications. Furthermore, long-term use may lead to addiction. In
sum, the majority of the literature suggests that kratom is, by no means, safe.
That being said, when compared to shooting heroin, kratom is safe (a safer alternative, at least). And if someone chooses to use kratom to reduce/stop their opioid use, I won’t lecture about the “dangers” of kratom. Until we have more answers, I will hold to the view that kratom is a harm-reduction measure… and it has the potential to save lives.
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