What to Know About Kratom Use

Kratom pills

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You may have heard about kratom (Mitragyna speciosa), an herbal supplement used traditionally in Southeast Asia for energy and to help ease aches and pains. Derived from a type of evergreen tree, kratom contains alkaloid compounds called mitragynine and 7-hydroxymitragynine.

While kratom acts like a mild stimulant when taken in low doses, it can cause an opiate-like high when taken in high doses. Kratom is currently listed by the Drug Enforcement Agency (DEA) as a “drug of concern,” and has not been approved for any medical use by the Federal Drug Administration (FDA). 

Also Known As: Kratom products are also known as Biak, Ketum, Kakuam, Ithang, Thom, Herbal, and Ketum.

Drug Class: Kratom is classified as a stimulant.

Common Side Effects: Side effects of kratom use include pain relief, relaxation, improved mood, increased energy, sensitivity to sunburn, nausea, itching, sweating, dry mouth, constipation, increased urination, and loss of appetite.

How to Recognize Kratom

Kratom looks like fresh or dried leaves and can be made into a green powder, liquid extract, gum, or pill. Packets are often labeled “not for human consumption.” People chew kratom leaves, brew the dried or powdered leaves as a tea, eat them in food, or smoke them.

What Does Kratom Do?

According to FDA research, kratom is an agonist that binds to the mu-opioid receptors. This is the same part of the brain that is activated when you take opioids, like prescription painkillers or heroin.

Kratom is, essentially, a natural opioid. Like all opioids, it comes with a risk of tolerance, dependence, and withdrawal.

It’s thought that mitragynine and 7-hydroxymitragynine may help control pain by attaching to proteins called opioid receptors and, in turn, reducing pain perception.

The results of a recent online survey found that kratom users in the United States tend to be middle-aged, middle-income people living with pain.

Most of the over 8,000 survey respondents said that they were using kratom to treat pain or improve their mood. A smaller but significant number said they were using it to help them quit opioid drugs (a class of medication used for pain relief) or to treat opioid withdrawal.

What the Experts Say

Many proponents of kratom suggest that the herb could serve as a solution to the opioid crisis, both by offering another option for pain relief and by aiding those struggling to overcome opioid addiction.

Other experts say that it's not the magic solution some people claim it is.

Published research on kratom’s possible benefits as a pain reliever and opioid alternative is very scarce. The available research includes a report published in the International Journal on Drug Policy in 2010, for which scientists surveyed 136 active users of kratom and found that the herb was “described as affordable, easily available, and having no serious side effects despite prolonged use.” This report included no testing of kratom’s health effects or potential hazards.

In a more recent report published in Drug and Alcohol Dependence in 2014, researchers surveyed 293 regular kratom users and determined that more than half had developed severe dependence problems, including kratom withdrawal symptoms like muscle spasms, sleep disruption, anger, and tension.

A mouse-based study published in the Journal of Medicinal Chemistry in 2016 indicated that kratom may not slow breathing to the same extent as other pain-relieving drugs like morphine. Given that deaths due to opioid overdose are usually the result of respiratory depression, the study's finding suggests that further research on the compounds in kratom is warranted.

On August 30, 2016, the DEA announced their intent to place two of the herb’s active constituents on its Schedule I drug list as early as September 30, 2016. The DEA withdrew its notice of intent in October 2016 and opened an official public comment period lasting until December 1, 2016.

Schedule I drugs (which include heroin and MDMA) are considered to have “no currently accepted medical use and a high potential for abuse.” Mitragynine and 7-hydroxymitragynine are the kratom constituents set to be classified as Schedule I drugs, making possession or sale of the herb illegal. Kratom would remain on the Schedule I list for at least two years.

The DEA’s intent to place mitragynine and 7-hydroxymitragynine on its Schedule I drug list was met with a great deal of backlash. In mid-September 2016, for instance, protesters held a march and rally at Lafayette Park in Washington, D.C., and presented a petition signed by over 120,000 people opposing the ban.

At the rally, Botanical Education Alliance director Travis Lowin stated that the DEA “has failed Americans in its efforts to combat the opioid epidemic, and targeting kratom will make the situation worse.”

According to those opposing the ban, placing kratom's alkaloids on the Schedule I drug list would also stifle further research on the compounds.

On November 14, 2017, the FDA Commissioner Scott Gottlieb, MD, issued a public health advisory about risks associated with kratom.

Since then, the FDA has intensified warnings, citing strong evidence that the unregulated botanical substance has “opioid properties.” In an 18-month period, kratom was a contributing factor in more than 90 fatal overdoses; people had also taken fentanyl and heroin.

Off-Label or Recently Approved Uses

While kratom is traditionally used to boost energy and soothe stress, in recent years, kratom has gained popularity as an alternative to opioid pain medications like Vicodin (hydrocodone) and OxyContin (oxycodone). In many cases, kratom is used to manage chronic pain associated with conditions such as arthritis and fibromyalgia.

Kratom is also increasingly used as an herbal approach to alleviating symptoms associated with opioid withdrawal, such as muscle aches and mood disturbance.

Common Side Effects

Although case reports have reported drowsiness, irritability, palpitations, high blood pressure, poor concentration, insomnia, hypothyroidism, seizures, psychosis, hepatitis, and coma in people using kratom, it's unclear how much is directly attributable to kratom.

Risks appear to be higher when it's taken in concentrated extracts (which have a higher potency), mixed with other psychoactive substances, drugs, or adulterants, or when it's taken by people with alcohol use disorders, a history of heroin use, or certain health conditions.

Short-term side effects:

  • Calmness
  • Euphoria
  • Talkativeness
  • Increased social behavior
  • Sensitivity to sunburn
  • Nausea
  • Itching
  • Sweating
  • Dry mouth
  • Constipation
  • Increased urination
  • Loss of appetite

Long-term side effects:

  • Anorexia
  • Constipation
  • Frequent urination
  • Insomnia
  • Discoloration of the cheeks
  • Psychotic symptoms (hallucinations, delusion, confusion)

According to reports by U.S. poison control "hotlines," calls involving kratom overdoses rose 50-fold from 2011 to 2016. In most cases, the kratom was laced with other drugs. If you or someone you love are experiencing any signs of overdose, call 911 or Poison Control helpline (800-222-1222) immediately. 

Signs of Use

If someone you love is using kratom, it's important to be on the lookout for the common side effects (such as talkativeness, increased social behavior, itching, changes in appetite, sweating) as well as any unusual or extreme shifts in mood, behavior, appearance, and overall health.

Myths & Common Questions

Many people believe that since kratom is an herbal remedy, it's safe. But it's important to keep in mind that herbal products aren’t reviewed by the FDA before they hit the market. As a result, there’s no guarantee that a supplement will contain the ingredients listed on the label (or that those ingredients will appear in the indicated amounts). Adulteration and contamination with other drugs, herbs, and substances are possible.

Tolerance, Dependence, and Withdrawal

Kratom comes with a risk of tolerance, dependence, and withdrawal. Kratom users can build tolerance, or needing more to achieve the desired effect, and experience symptoms of withdrawal when they stop taking the drug.

How Long Does Kratom Stay in Your System?

More research is needed to determine the exact half-life of kratom. Like other substances, how long kratom stays in your system will depend on the following factors:

  • Type of kratom
  • Frequency of use
  • Age
  • Genetics
  • Body fat
  • Water and food intake
  • Metabolic rate

Its main active alkaloid, mitragynine, can be detected in a urine test.

Addiction

The DEA states that kratom abuse can lead to addiction and can result in psychotic symptoms, including hallucinations, delusion, and confusion.

Not everyone will experience addiction in the same way, but there are several hallmark signs and symptoms, including:

  • Tolerance, dependence, withdrawal
  • Secretiveness, stealing, and/or lying
  • Financially unpredictable
  • Changes in friends
  • Stashes of drugs or paraphernalia
  • Trouble scaling back or stopping drug
  • Loss of interests in hobbies, social activities, or job or school
  • Vast amounts of time spent getting, using, and recovering from the drug
  • Changes in mood, sleeping patterns, weight, and activity levels

Withdrawal

People who take large doses of kratom several times per day have an increased risk of moderate to severe withdrawal symptoms. In general, however, withdrawal symptoms are milder in comparison to opioid withdrawal and may include:

  • Increased muscle spasms and pain
  • Difficulty sleeping
  • Hot flashes
  • Fever
  • Watery eyes
  • Runny nose
  • Decreased appetite
  • Mood disturbances
  • Diarrhea

How to Get Help

Living with pain isn't easy. If you live with pain, you may already be all too familiar with the profound effect it can have on your quality of life.

If you are considering trying kratom, you should speak with your care provider first. Some pain clinics are exploring complementary approaches, in conjunction with pain treatment, to manage or cope with pain. For example, mindfulness (and other mind-body practices) may help some people remain pain-controlled despite the challenges of everyday life.

If you've been using kratom to self-medicate and have noticed that it has begun to take over your life, don't wait to get help. A trusted healthcare professional can help guide you toward the path of recovery and pain-free living.

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