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Kratom

Blessing in Disguise or Extension of the Opioid Crisis

Introduction

Kratom has been somewhat of an enigma for both researchers and drug regulators. While proponents have been accusing the FDA of demonizing the age-old ‘miracle’ herb, the drug regulator is tightening the grip on its use.

So far, there are 3 to 5 million kratom users in the US.1 Many of them have found solace for their excruciating pain and disabling opioid withdrawal symptoms in the so-called ‘godsend remedy.’ At a time when opioid-related death rates have increased sixfold since 1999, the herb seems to be a possible solution.2

Since kratom has opioid-like effects, many people believe it can help them fight opioid addiction. Furthermore, one 2018 review revealed that it could help lift the mood and reduce anxiety in some users.3

Increase in Poison Control Calls

Surprisingly, US poison centers tell a different story. Between 2010 and 2015, poison centers received 660 calls about kratom use. Most notably, the number of calls increased from 26 in 2010 to 263 in 2015.4

Between 2011 and 2017, there were 1,807 calls related to kratom use.5 During the same period, there were 1,174 cases of kratom-only exposures.6 In 2017, there were at least 44 deaths associated with its use.7 However, pure kratom was determined as a cause of death in only one case.

What is Kratom?

Kratom is a tropical tree that originates in Southeast Asia, the Philippines, and New Guinea. The scientific name is Mitragyna speciosa. The leaves of Mitragyna speciosa contain two psychoactive chemicals: mitragynine (MG) and 7-hydroxy mitragynine (7-HMG). Depending on the dose, consuming these chemicals can provide stimulant or sedative effects.

Use in Southeast Asia

People in Southeast Asia have been using the drug for hundreds of years as a recreational drug and during religious ceremonies.

Traditionally, farmers in these regions used it to increase energy levels and enhance productivity at work. They either chewed chopped fresh leaves or prepared tea using the leaves. People in Thailand used it to treat morphine dependence. Likewise, people in Malay used it as a substitute for opium.

Use in the United States

Kratom began to appear in the United States in the 1980s and 1990s. During the last few decades, usage has significantly increased in the US, likely due to easy availability, low cost, and legality.

In the US, it has been increasingly popular as a component of herbal or legal high products. Unlike in the Southeast Asian regions, smoking it is a rare practice in the US. People in the US typically use these products as an alternative to opioid drugs or as a sleep aid.

Other Names

Is Kratom Legal?

It is legal in many US states. It is currently illegal in Arkansas, Alabama, Indiana, Rhode Island, Wisconsin, Vermont, and the District of Columbia.8

Thailand, Australia, Malaysia, and many European Union countries have banned it as well.

What Does It Do?

Mitragynine (MG) and 7-hydroxy mitragynine (7-HMG) act on certain sites in the brain (opioid receptors). Interactions with these sites regulate pain, addictive behavior, and reward systems. Opioid pain medicines such as OxyContin, Percocet, Palladone, and Vicodin also act on these areas. For this reason, this drug is said to have opioid-like effects but it is not an opioid.

Interestingly, it can produce dangerous effects as both a stimulant and sedative. The nature of the effects depends on the dose.

Low doses produce cocaine-like stimulant effects — for example, increased energy levels, sociability, and alertness.

High doses produce opioid-like effects, including decreased pain sensations and muscle relaxation.

Are There Benefits?

First, kratom is not approved by the FDA for any medical conditions.

Limited evidence suggests that taking it may help relieve pain, lift mood, and calm anxiety.9  Scientists, however, warn that the side effects may outweigh these potential benefits. Abusing kratom can cause psychosis, seizures, liver injury, coma, and even death.

Thus, it is best to avoid use until strong scientific evidence finds clear benefits that outweigh the risks.

Effects

The effects are dose-dependent. At low doses (1 to 5 g of raw leaves), it has stimulant effects. While at higher doses (5 to 15 g), it has opioid-like effects.

According to Mayo Clinic, it shows the effects within 5 to 10 minutes after use, and the effects last 2 to 5 hours. 10

Kratom Addiction Treatment

Types of Kratom

Based on the places of origin, the types are:

  • Maeng da
  • Indo
  • Bali/red vein
  • Green Malay
  • Thai
  • Borneo
  • Malaysian

Maeng da is native to Thailand. It is also cultivated in Indonesia and Malaysia. People believe that maeng da has stronger and longer-lasting effects compared to other types. Users have reported increased energy levels, enhanced focus, and reduced pain.

It is native to Indonesia and considered to have milder effects than other types. People use it to relieve pain, calm anxiety, and enhance feelings of well-being.

It originated in Indonesia. Users believe the effects of Bali kratom are similar to those of opioids. It is thought to help relieve pain and ease depression.

Green Malay is native to Malaysia. It may help increase energy levels, relieve pain, and enhance focus.

It is native to Thailand. There are three types of Thai kratom. They are red vein Thai, green vein Thai, and white vein Thai. The effects reportedly vary according to color. Users say green and white veins have stimulant and euphoric properties. The red vein is thought to help relieve pain.

It is native to Borneo, the third-largest island in the world. People use it to calm anxiety and stress. Borneo is said to have more sedative effects relative to other types.

It originated in Malaysia. Green, red, and white vein kratom varieties are available. Malaysian kratom is said to have balanced stimulant-sedative effects. People use it to ease depression, manage pain, and improve focus.

Kratom Side Effects

Abusing this drug can cause several side effects, some of which may be fatal.1112 The side effects include:

  • Slowed breathing
  • Increased nervousness
  • Agitation
  • Aggression
  • Loss of sleep
  • Dry mouth
  • Shakiness
  • Reduced sex drive
  • Constipation
  • Darker skin especially in the face
  • Nausea and vomiting

Short-Term Side Effects

Short-term use side effects:

Nausea

Constipation

Sleep disturbances

Temporary impotence

Itching

Increased sweating

Long-Term Side Effects

Long-term use side effects:

Reduced appetite

Dry mouth

Increased urine production

Darker skin

Hair loss

In some cases, especially high doses of kratom can cause seizures. Seizures have also been known to occur when it’s mixed with other drugs. Drug misuse is a common finding in kratom-related deaths. 4 out of every 5 cases have a history of drug misuse.13

Other rare side effects include:

  • Psychotic symptoms, such as hallucinations (seeing or hearing things that are not there), delusions, and low moods
  • The obstructed flow of bile from the liver
  • Inflamed lungs that can cause shortness of breath and bluish skin

Fatal Outcomes

Using kratom with any of the following drugs can cause fatal outcomes:

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Is Kratom a Controlled Substance?

Kratom is an emerging drug of abuse, according to the National Institute on Drug Abuse (NIDA). Nonetheless, it is not a controlled substance.

DEA Concern

The US Drug Enforcement Administration (DEA) included it in the list of “Drug and Chemical of Concern” in 2011.14 This means the Controlled Substances Act does not currently regulate the drug. However, this does not mean it is safe. Abusing it can cause severe side effects, addiction, or even death.

FDA Uncertainty

There is a lot of uncertainty about its status as a dietary supplement in the US. Researchers say the FDA does not consider it a recognized supplement as of April 2019.15 Howwever, an FDA alert says it qualifies as a dietary ingredient under section 201(ff)(1) of the Federal Food, Drug, and Cosmetic Act. The alert was published on 06/11/2019.16

According to the FDA, the drug is a new dietary ingredient, and its sale as a dietary supplement in the US began after October 1994. Thus, it is not in a state to assure consumers about the safety of kratom products.

Most notably, the FDA has recently determined that both MG and 7-HMG are opioids. It has also recommended classifying these chemicals as Schedule I controlled substances.

Dosage and Abuse

Kratom Dosage

The dose depends on several factors, including type, intended use, as well as age, weight, and gender, of the person using it. Likewise, the method of use can also affect the amount of kratom that reaches the bloodstream. For example, ingesting the powder may be less potent than drinking kratom tea.

Manufacturers in the US recommend a dose of 2 to 6 grams. However, there are no clear guidelines on the daily recommended doses. Participants in a 2018 study reported that a daily intake of 15 grams in three divided doses provided beneficial effects.17

Scientists do not know how much kratom can cause death. Thus, the best way to reduce the risk of toxic effects is to start with a low dose and gradually increasing.

How is it Abused?

Most people abuse the drug by consuming tablets, capsules, or extracts. Some people may consume powdered leaves in the form of tea.

Kratom Withdrawal Symptoms

Withdrawal symptoms typically occur when the usage of an addictive substance suddenly stops. They may occur due to physical or psychological dependence, or both. Long-term abuse can also cause withdrawal symptoms.19 Typically, the symptoms of kratom withdrawal are similar to those of opioid withdrawal and include:

One animal study suggests that physical symptoms usually begin 12 hours after the last dose. Likewise, the psychological symptoms, such as anxiety, peak after 24 hours of withdrawal.20

Treatment for Addiction and Withdrawal

Currently, there is no specific treatment for kratom addiction. A doctor may prescribe drugs, dihydrocodeine, and lofexidine (Lucemyra) to treat withdrawal symptoms.

Other medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, and anti-anxiety drugs, may also be used to treat withdrawal symptoms.

Intensive behavioral therapy can help a person cope with behavioral problems associated with addiction. These behavioral issues can include cravings, relapse, and abuse. Behavioral therapy helps a person identify and change negative attitudes and behaviors that cause addiction.

If you are struggling with any type of substance use, Safe Harbor can help you find a new way to live without the use of substances.

Overdose: Things to Know

An overdose occurs when a person consumes too much of a substance within a short period. It can be intentional or accidental.

Kratom overdose is increasingly common in the US. Among 27,338 overdose deaths in 38 states from July 2016 to December 2017, toxicology testing detected this drug in 152 cases. Out of the 152 positive cases, this drug was determined as the cause of death in 91 cases.21

Testing also revealed the presence of other substances including fentanyl, heroin, benzodiazepines, prescription opioids, cocaine, and alcohol. Surprisingly, only 7 of the 152 cases involved kratom alone and no other substances.

The lethal dose in humans has not been well-defined. Animal studies report that 200 mg/kg of the extract can produce lethal effects.22 This finding, however, cannot be accurately translated for humans.

What is certain is that any amount more than the recommended dose can cause potentially life-threatening effects. 

  • Agitation
  • Hostility
  • Seizures
  • Racing heartbeats
  • Elevated blood pressure
  • Kidney failure
  • Slowed breathing
  • Coma

If you think an overdose has occurred, call 911.

Poison emergencies can also be reported at 1-800-222-1222.

Treatment of Overdose

There are no standard guidelines for the treatment of kratom overdose. In most cases, slowed breathing is the cause of death. Thus, maintaining airflow and circulation, and continuous monitoring of the vital signs is the primary mode of treatment. A doctor may also order tests to determine the levels of glucose, salts, and other substances in the bloodstream.

Several studies suggest that naloxone (Narcan) can offset the breathing issues caused by the overdose. However, there is a lack of large-scale human studies about the use of naloxone. Naloxone is commonly used to reverse the effects of an opioid overdose.

Moreover, treatments may also be necessary for liver injury, kidney problems, and high blood pressure resulting from the overdose.

  • Agitation
  • Hostility
  • Seizures
  • Racing heartbeats
  • Elevated blood pressure
  • Kidney failure
  • Slowed breathing
  • Coma

Top Misconceptions About Kratom Use and Abuse

Fact: It may not be safe even when taken as recommended. This is because there is a lack of studies about this drug’s safety and possible negative health effects. In some cases, the potential risks may outweigh the benefits.

The FDA does not regulate dietary supplements. It means you cannot be assured of their purity, potency, and effectiveness. On April 03, 2018, the FDA issued a mandatory recall order for several products that were contaminated with salmonella.23

Fact: Many people believe that these supplements are a safer alternative to opioids. Because the supplements are available without a prescription, some people tend to self-treat their conditions without consulting a doctor.

Such practices can greatly increase the risk of abuse, addiction, and overdose. Always  consult a doctor before using any supplement.

The FDA has warned consumers not to use this drug due to the risk of addiction, abuse, and dependence.

Fact: While a few studies suggest that it can ease the symptoms of anxiety and depression, you should NEVER use it as a replacement for your prescription medicines. Doing so not only worsens your condition but can also increase the risk of suicide.

Also, you should avoid taking this drug if you take medications for anxiety, depression, or mental health conditions.

Key Takeaways

There are no FDA-approved uses for kratom. Limited evidence suggests it may be useful in certain conditions. However, the risks outweigh these benefits. As of now, it is not safe for use in any amount or condition.

Though it is legal in many US states, the FDA has warned consumers not to use this drug due to the risk of addiction, abuse, and dependence.

Overdose has been linked to several deaths in recent years.

The FDA has determined that two chemicals in kratom – mitragynine (MG) and 7-hydroxy mitragynine (7-HMG) – are opioids.

Abuse can cause psychosis, kidney failure, liver injury, coma, and death.