Kratom (mitragyna speciosa) is a tropical tree native to Southeast Asia and, like coffee, is part of the Rubiaceae plant family. Ingesting the leaves produces a high. Taken in small amounts, it 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. It’s an opioid agonist, and 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 it 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 it 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; it lessened the discomfort of opioid withdrawal. Multiple studies have substantiated these findings, suggesting that it could be 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 it was associated with decreased alcohol use; this suggests that it may help those with alcohol use disorders (AUD) in addition to opioid addiction.
Compared to heroin, kratom is less addictive and has milder withdrawal symptoms. Furthermore, the risk of overdose is low. A 2018 literature review indicated that it may have harm-reduction potential for individuals who want to stop using opioids.
Dangerous & Addictive?
According to the CDC, there were 152 kratom-involved deaths between July 2016 and December 2018 (“kratom-involved,” meaning it 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, it 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 it for opioid withdrawal, it was likely the cause of acute lung injury. Use may also cause cardiac or respiratory arrest.
Kratom’s harmful effects are not limited to the body; a 2010 study linked chronic 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 it may affect learning. In 2019, researchers found that high doses 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 use leads to dependence, withdrawal symptoms, and cravings. Kratom cessation may also cause psychological withdrawal symptoms, such as anxiety and depression.
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 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 it to reduce/stop their opioid use, I’ll view it as harm-reduction. Until we have more answers, I will hold to the harm-reduction view… it has the potential to save lives.
- Apryani, E., Hidayat, M. T., Moklas, M. A. A., Fakurazi, S., & Idayu, N. F. (2010). Effects of mitragynine from mitragyna speciosa korth leaves on working memory. Journal of Ethnopharmacology, 129(3), 357-360.
- Burke, D., Shearer, A., & Van Cott, A. (2019). Two cases of provoked seizure associated with kratom ingestion. Neurology, 92(15), 4.5-030.
- Coe, M.A., Pillitteri,J.L, Sembower, M.A., Gerlach, K.K., & Henningfield, J.E. (2019). Kratom as a substitute for opioids: Results from an online survey. Drug and Alcohol Dependence, 202, 24-32. ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2019.05.005
- Eggleston, W., Stoppacher, R., Suen, K., Marraffa, J. M., & Nelson, L. S. (2019). Kratom use and toxicities in the United States. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.
- Gutridge, A.M., Robins, M.T., Cassell, R.J., Uprety, R., Mores, K.L., Ko, M.J., Pasternak, G.W., Majumdar, S., & van Rijn, R.M. (2019), Therapeutic potential of g-protein-biased kratom-derived and synthetic carfentanil-amide opioids for alcohol use disorder. The FASEB Journal, 33:1, 498.3-498.3.
- Halpenny, G.M. (2017). Mitragyna speciosa: Balancing potential medical benefits and abuse. ACS Medicinal Chemistry Letters, 8(9), 897-899. DOI: 10.1021/acsmedchemlett.7b00298
- Hassan, Z., Muzaimi, M., Navaratnam, V., Yusoff, N.H.M., Suhaimi, F.W., Vadivelu, R., Vicknasingam, B.K., Amato, D., von Hörsten, S., Ismail, N.I.W., Jayabalan, N., Hazim, A.I., Mansor, S.M., & Müller, C.P. (2013). From kratom to mitragynine and its derivatives: Physiological and behavioural effects related to use, abuse, and addiction. Neuroscience & Biobehavioral Reviews, 37:2,138-151, ISSN 0149-7634. https://doi.org/10.1016/j.neubiorev.2012.11.012
- Hassan, Z., Suhaimi, F., Dringenberg, H. C., & Muller, C. P. (2016). Impaired water maze learning and hippocampal long-term potentiation after mitragynine (kratom) treatment in rats. Front. Cell. Neurosci. Conference Abstract: 14th Meeting of the Asian-Pacific Society for Neurochemistry. doi: 10.3389/conf. fncel (Vol. 58).
- Hassan, Z., Suhaimi, F. W., Ramanathan, S., Ling, K. H., Effendy, M. A., Müller, C. P., & Dringenberg, H. C. (2019). Mitragynine (kratom) impairs spatial learning and hippocampal synaptic transmission in rats. Journal of Psychopharmacology, 0269881119844186.
- Hemby, S. E., McIntosh, S., Leon, F., Cutler, S. J., & McCurdy, C. R. (2018). Abuse liability and therapeutic potential of the mitragyna speciosa (kratom) alkaloids mitragynine and 7‐hydroxymitragynine. Addiction Biology, https://doi.org/10.1111/adb.12639
- Hughes, R. L. (2019). Fatal combination of mitragynine and quetiapine–a case report with discussion of a potential herb-drug interaction. Forensic Science, Medicine and Pathology, 15(1), 110-113.
- Jaliawala, H. A., Abdo, T., & Carlile, P. V. (2018). Kratom: A potential cause of acute respiratory distress syndrome. DRUG INDUCED LUNG DISEASE: CASE REPORTS, A6604-A6604, American Thoracic Society.
- Khor, B.S., Amar Jamil, M.F., Adenan, M.I., & Chong Shu-Chien, A. (2011). Mitragynine attenuates withdrawal syndrome in morphine-withdrawn zebrafish. PLOS ONE 6(12):e28340, https://doi.org/10.1371/journal.pone.0028340
- Kumarnsit, E., Keawpradub, N., & Nuankaew, W. (2007). Effect of mitragyna speciosa aqueous extract on ethanol withdrawal symptoms in mice. Fitoterapia, 78:3, 182-185. ISSN 0367-326X, https://doi.org/10.1016/j.fitote.2006.11.012
- Meepong, R., & Sooksawate, T. (2019). Mitragynine reduced morphine-induced conditioned place preference and withdrawal in rodents. Thai Journal of Pharmecutical Sciences, 43:1, 21-29.
- NIDA. (2019, April 8). Kratom. Retrieved from https://www.drugabuse.gov/publications/drugfacts/kratom on 2019, July 19
- Olsen, E.O., O’Donnell, J., Mattson, C.L., Schier, J.G., & Wilson, N. (2019). Notes from the field: Unintentional drug overdose deaths with kratom detected – 27 states. MMWR Morb Mortal Wkl Rep, 68:326-327.
- Palasamudram Shekar, S., Rojas, E.E., D’Angelo, C.C., Gillenwater, S.R., & Martinez Galvis, N.P. (2019). Legally lethal kratom: A herbal supplement with overdose potential. Journal of Psychoactive Drugs, 51(1), 28-30.
- Raffa, R.B., Pergolizzi, J.V., Taylor, R., & Ossipov, M.H (2018). Nature’s first “atypical opioids”: Kratom and mitragynines. J Clin Pharm Ther, 43: 437-441. https://doi.org/10.1111/jcpt.12676
- Sakaran, R., Othman, F., Jantan, I., Thent, Z. C., & Das, S. (2014). An insight into the effect of mitragyna speciosa korth extract on various systems of the body. Global J Pharmacol, 8, 340-346.
- Saref, A., Suraya, S., Singh, D., Grundmann, O., Narayanan, S., Swogger, M.T., Prozialeck, W.C., Boyer, E., Chear, N.J.Y., & Balasingam, V. (2019). Self-reported prevalence and severity of opioid and kratom (mitragyna speciosa korth) side effects. Journal of Ethnopharmacology, 238, 111876. ISSN 0378-8741, https://doi.org/10.1016/j.jep.2019.111876
- Singh, D., Chye, Y., Suo, C., Yücel, M., Grundmann, O., Ahmad, M. Z., … & Mϋller, C. Brain magnetic resonance imaging of regular kratom (mitragyna speciosa korth) users: A preliminary study.
- Singh, D., Müller, C.P., & Vicknasingam, B.K. (2014). Kratom (mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug and Alcohol Dependence, 139, 132-137. ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2014.03.017
- Singh, D., Narayanan, S., Müller, C.P., Swogger, M.T., Rahim, A.A., Abdullah, M.F.I.L.B., & Vicknasingam, B.K. (2018). Severity of kratom (mitragyna speciosa korth) psychological withdrawal symptoms. Journal of Psychoactive Drugs, 50:5, 445-450. DOI: 10.1080/02791072.2018.1511879
- Singh, D., Narayanan, S., Müller, C. P., Vicknasingam, B., Yücel, M., Ho, E. T. W., … & Mansor, S. M. (2019). Long-term cognitive effects of kratom (mitragyna speciosa korth) use. Journal of Psychoactive Drugs, 51(1), 19-27.
- Swogger, M.T., & Walsh, Z. (2018). Kratom use and mental health: A systematic review. Drug and Alcohol Dependence, 183, 134-140. ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2017.10.012
- Tayabali, K., Bolzon, C., Foster, P., Patel, J., & Kalim, M.O. (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
- Veltri, C., & Grundmann, O. (2019). Current perspectives on the impact of kratom use. Substance Abuse and Rehabilitation, 10, 23–31. doi:10.2147/SAR.S164261
- Yusoff, N. H. M., Suhaimi, F. W., Vadivelu, R. K., Hassan, Z., Rümler, A., Rotter, A., Amato, D., Dringenberg, H. C., Mansor, S. M., Navaratnam, V., & Müller, C. P. ( 2016). Abuse potential and adverse cognitive effects of mitragynine (kratom). Addiction Biology, 21:98– 110. doi: 10.1111/adb.12185