Kratom leaves have traditionally been used for medicinal purposes for centuries in many parts of Asia. Kratom is known for its ability to relieve chronic pain, ease anxiety, and help with opioid withdrawal.
Kratom, which is readily available for purchase on the internet as pills, dried leaves, or extract, has come under the international spotlight in recent years for its medicinal use, possible addiction, as well its abuse as a recreational drug. It has been banned in countries including Australia, Malaysia, and Myanmar. In the US and European countries, kratom is increasingly being used by individuals for the self-management of chronic pain or withdrawal from opioid drugs and prescription pain relievers. [1] [2]
What are Kratom Leaves?
Kratom (Mitragyna speciosa) is a tropical tree native to Thailand, Malaysia, Indonesia, and Papua New Guinea. The leaves from this tropical tree have been used for medicinal purposes due to its morphine-like effects. Mitragynine, the primary active alkaloid in kratom leaves, is associated with being responsible for its opioid-like effects. It is sold as dried leaves, kratom powder, extract, capsule, pellet, or gum, and it can be smoked, chewed or consumed as a tea. The European Monitoring Center for Drugs and Drug Addiction (EMCDDA) states that a few grams of dried leaves can cause an invigorating effect, including euphoria, within 10 minutes. This effect can last for one to one and a half hours. [3]
Different types of kratoms are called strains. They are mainly divided into three types based on the color of the stem or the vein of the kratom leaf. These three types are called red vein, green vein, or white vein. These leaves have different alkaloid compositions, which are known to produce different effects such as calming effects or as an energy booster. You may also find that kratom is sold for retail purposes according to the country of origin such as Indo (Indonesia), Malay (Malaysia), Thai (Thailand), Borneo, and Bali. Kratom also goes by the names of biak, ketum, kakuam, ithang, and thom. [4]
Kratom’s active ingredient, mitragynine, is found in its leaves. Photo Credit: Shutterstock
What is Kratom Used For?
Let us look at the ways kratom is increasingly being used medicinally.
Chronic Pain Reliever
An increasing number of kratom users, especially in the US and Europe, use the leaf and its formulations for chronic pain relief, especially from conditions like arthritis and fibromyalgia. When consumed in large amounts, kratom produces feelings of pleasure, pain relief, and can also have a sedative effect. According to an NIH report, kratom has a similar effect such as opioids and stimulants due to the presence of two compounds – mitragynine and 7-α-hydroxy mitragynine. These compounds interact with opioid receptors in the brain to help decrease overall pain in the body. This morphine or opium-like quality of kratom leaves is widely regarded as its most important application. [5] [6]
Treatment For Opioid Withdrawal
In the last few years, some people have used kratom as a herbal alternative to deal with the withdrawal symptoms and side effects caused due to opioid addiction. This is could be prescription pain killers or other drugs, and sometimes even alcohol addiction. However, there is no scientific evidence that shows that kratom use is safe to use for opioid withdrawal. [7]
May Ease Anxiety & Depression
A 2017 study on “Kratom use and mental health” in the Drug and Alcohol Dependence journal suggested that it can help enhance mood and relieve anxiety in some individuals. It also concluded that kratom use has important medical mental health benefits and risks that require study. Additionally, there is anecdotal data that some strains of kratom enhance energy levels and others that help individuals sleep better. However, this has not been scientifically proven. [8]
Traditional Use As A Home Remedy
According to the European Monitoring Center for Drugs and Drug Addiction, kratom is traditionally used in parts of southeast Asia to treat diarrhea and to wean off heroin addiction. It is also used as a cough suppressant, an antidiabetic, an intestinal deworming agent, and wound poultice. However, there are limited studies on these positive effects of kratom. [9] [10]
For instance, a 2004 animal model showed that the antinociceptive and cough-suppressant effects of mitragynine in kratom were comparable to those of codeine. Also, a study published in the Molecule journal revealed that the extract showed antimicrobial activity against Salmonella typhi and Bacillus subtilis. More studies with humans are required to understand the therapeutic potential of kratom. [11] [12]
Risks of Using Kratom Regularly
Researchers and drug abuse centers are increasingly gathering evidence that the risks of using kratom may be more than its positive benefits. The side effects of kratom seem to occur with repeated usage of high doses, but not enough studies have been done to understand the amount of kratom that can cause dependency.
Kratom Dependency & Abuse
A 2019 study conducted by the Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children’s Hospital found that there were more than 1,800 calls to U.S. Poison Control Centers regarding exposures to kratom from January 2011 through December 2017. Almost 65 percent of these exposures occurred from 2016 through 2017. [13]
The possible side effects noted in this study, published in Clinical Toxicology, include: [14]
- Tachycardia (rapid heartbeat)
- Agitation/irritability
- Hypertension (high blood pressure)
- Seizures [15]
- Coma (loss of consciousness)
- Increased bilirubin
- Renal (kidney) failure
- In certain cases, death [16]
Regular kratom users have reportedly also suffered from mental confusion, delusion, and hallucination. Others claim a “kratom hangover,” which includes headaches or nausea in the morning after use. [17]
Withdrawal Symptoms of Kratom
According to the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), studies show that regular kratom use is associated with drug dependency, the development of withdrawal symptoms, and craving. [18]
Physical withdrawal symptoms include anorexia, weight loss, decreased sexual drive, insomnia, muscle spasms, and pain, aching in the muscles and bones, jerky movement of the limbs, watery eyes/nose, hot flushes, fever, decreased appetite, and diarrhea. Psychological withdrawal symptoms commonly reported are nervousness, restlessness, tension, anger, hostility, aggression, and sadness. [19] [20]
Drug Interactions
The EMCDDA lists reports of adverse drug interactions involving kratom tea taken with carisoprodol, modafinil, propylhexedrine, or Datura stramonium. A fatal case in the US involved a blend of kratom, fentanyl, diphenhydramine, caffeine, and morphine sold as a herbal drug. [21]
Salmonella Infections Linked To Kratom Products
The Centers for Disease Control & Prevention (CDC) in the US investigated a multistate outbreak of Salmonella-infected kratom products in 2018. 50 people were hospitalized and most of them had consumed kratom powder. The CDC states that contaminated products may still be available for purchase because the investigation was not able to identify a single, common source of contaminated kratom. [22]
Is Kratom Legal?
The Drug Enforcement Administration (DEA) in the US has listed kratom as a “drug of concern”. Also, the US FDA issued a public health advisory in November 2017 about kratom, saying it appears to have properties that expose users to the risks of addiction, abuse, and dependence. Because kratom is a supplement, it is not regulated in the US. Furthermore, the USFDA has not approved kratom for medical use and has issued warnings to companies for selling kratom with false health claims. Researchers are asking for FDA regulation as this could help regulate the product quality, purity, and concentration of kratom being sold. Globally, it is banned or controlled in 16 countries, including Thailand and Malaysia, where it grows naturally. [23] [24] [25]
