Perhaps you read about the attempt by the U.S. Drug Enforcement Administration (DEA) to add the psychoactive compounds found in the herbal agent kratom to the list of Schedule I drugs banned under the Controlled Substances Act. This was announced in August 2016, although after receiving public feedback, the DEA put this on hold pending further investigation by the U.S. Food and Drug Administration. If you have teenagers, kratom is something you should know about because it is still widely available on the Internet and legal in most states. Read the following kratom facts to find out if the drug is benign or dangerous and why it may have therapeutic benefits for drug addiction treatment:
How Does Kratom Work?
While the pharmacology and toxicology characteristics of kratom are still not fully understood, mitragynine and 7-hydroxymitragynine are the two key ingredients responsible for its mood- and pain-altering effects. Mitragynine binds to the same mu-opioid receptor as morphine. It also increases adrenergic activity, helping to boost alertness throughout the day. Kratom also has serotonergic activity, binding with serotonin receptors. Some opioid medicinal chemists suggest kratom pharmacology might reduce cravings for opioids while providing pain relief.1
Can Kratom Be Used to Treat Opioid Addictions?
More than 25 alkaloids have been identified in kratom extract, with analgesic, anti-inflammatory, antidepressant and muscle relaxant properties. These alkaloids are thought to activate supraspinal mu and delta opioid receptors, which explains the analgesic and euphoric effects derived from kratom. It also provides a scientific basis for why people abuse it to counteract the effects of opioid withdrawal and to self-medicate to treat their own opioid addictions. Some experts believe it has the potential to be used to treat opioid addictions. Pain specialists and drug treatment experts are continually seeking ways to help curb the opioid overdose epidemic through various interventions. Further studies on the clinical and long-term effects of kratom are necessitated. Time and research may demonstrate the active substances in kratom can be harnessed to treat pain or opioid addiction.2
Are Reports of Adulterated Kratom True?
Several commercially available kratom samples were purchased online for purposes of analyzing the content for possible adulterants. Researchers found evidence that multiple packaged commercial kratom products likely contained artificially elevated concentrations of 7-hydroxymitragynine, the alkaloid responsible for some of kratom’s side effects. These findings stress the importance of increased dietary supplement oversight of kratom-containing supplements.3 The inability of consumers and physicians to accurately identify the contents of substances sold as kratom fundamentally impairs the ability to analyze its true risks and benefits. Experts say any benefit or harm may be due to adulterants, rather than the kratom plant itself.4
Is Kratom Dangerous?
Used for medicinal purposes in its pure state, people in Thailand and Malaysia have reported effective and safe use of kratom as an adjuvant therapy for chronic musculoskeletal pain, enteritis, worm infections, cough, diabetes and hypertension. The misuse of kratom for recreational purposes has widely spread in Europe and in the U.S. because it is easy to purchase online and is legal in many places.5 This has led to an increased need for kratom addiction treatment.
The dangers of kratom derive primarily from abuse and its co-occurring use with other substances. “Krypton,” a mixture containing powdered kratom, caffeine and O-desmethyltramadol, caused the death of nine people in Sweden in a short period of time. In the southernmost provinces of Thailand, a kratom cocktail called “4 × 100” has caused several deaths among young Muslims. It contains kratom leaves, caffeine (from cola drinks), codeine (an antitussive) or diphenhydramine (an antihistamine), added to a fourth ingredient such as antidepressants, anxiolytics or analgesics (paracetamol or tramadol).5
- Larry Greenemeier. Should Kratom Use Be Legal? Scientific American. September 30, 2013. https://www.scientificamerican.com/article/should-kratom-be-legal/ Accessed February 13, 2017.
- Chang-Chien GC, Odonkor CA, Amorapanth P. Is Kratom the New ‘Legal High’ on the Block?: The Case of an Emerging Opioid Receptor Agonist with Substance Abuse Potential. Pain Physician. 2017 Jan-Feb;20(1):E195-E198.
- Lydecker AG, Sharma A, McCurdy C et al. Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine. J Med Toxicol. 2016 Dec;12(4):341-349.
- Kavita Babu and Edward Boyer. Regulate Quality, Dosage and Purity of Kratom. The New York Times. October 19, 2016. http://www.nytimes.com/roomfordebate/2016/10/19/is-kratom-the-plant-that-heals-or-kills/regulate-quality-dosage-and-purity-of-kratom Accessed February 13, 2017.
- Pantano F, Tittarelli R, Mannocchi G, et al. Hepatotoxicity Induced by “the 3Ks”: Kava, Kratom and Khat. Teschke R, ed. Int J Mol Sci. 2016;17(4):580. doi:10.3390/ijms17040580.