Mitragnya speciosa, commonly known as kratom, is a tropical evergreen tree that grows across Southeast Asia that has been rapidly increasing in popularity for its therapeutic and recreational properties since 2011. Natives living where the tree grows indigenously have been known to chew the leaves for their analgesic side effects with limited to no negative consequences. These benefits have spiked interest in Western culture and medicine as a potential means to counter the increasing over prescription, overdose and addiction opioid crisis.
As of 2018, little is known regarding the validity of Kratom’s therapeutic effects, and the Drug Enforcement Administration (DEA) went as far to say that there are no medical uses for the plant in 2013. There are over 40 active compounds in Mitragnya speciosa, but mitragynine and 7-hydroxymitraginine are the most significant psychoactive compounds, both of which are selective full agonists of the u-opioid receptor. The relationship these compounds have with the brain’s opioid receptors suggest that it should behave similarly to common opiates when ingested. A unique aspect of Kratom is that effects produced vary greatly depending on dosage of the drug with higher doses resembling opiate properties and low doses, conversely, producing stimulant side effects.
How is Kratom Used?
Means of how kratom is administered has evolved drastically from the chewing of raw leaves in Asia. The drug is now largely exported in powders and pills to be dissolved and ingested, to to oil reductions that can be inhaled through vaporizing devices sold in smoke and paraphernalia retail locations.
Kratom is still legal at a federal level, however where there have been reports of addiction and overdose in certain communities, legislative action has been taken. From 2011-2017 there have been 44 related deaths in the United States. In all but one of the cases other opioids or narcotics were found in victim toxicology reports. This is not to mitigate the severity of the kratom drug because there was a case of kratom specific overdose. At exceedingly high doses, this drug resembles very closely the adverse effects produced by heroin and morphine with drastic reductions in respiration, heart palpitations, nausea, vomiting, and gastrointestinal discomfort.
Is it Addictive?
The first case of kratom specific addiction was reported in Betty Ford in 2015 with withdrawal symptoms identical to opiate withdrawal. Signs of abuse are irritability, lethargy, insomnia, and body aches. Chronic users have been found to have elevated heart rate, blood pressure, and in some cases liver toxicity and epilepsy. A large contributor to growing interest in use of kratom has arisen in opiate addicts attempting to reduce withdrawal discomfort. Where the drug succeeds in lessening some discomfort, a further disservice is afforded the user in fostering new neurological imbalances with the selective agonistic relationship mytraginine and 7-HMG have with the brain.
What types are there?
Kratom is marketed predominantly under three major strains: red vein, white vein, and yellow vein referring to the appearance of different species of the plant leaves. Red vein is most similar to opiates in terms of analgesia and euphoria, White vein is indicated in insomnia treatment, and yellow vein is alleged to have more anxiety calming properties. Kratom demands further investigation as it holds some promise as a relatively lower risk medication than mainstream opiates. The fact remains, however, that kratom is risky territory for those that struggle with addictive tendencies as it still stimulates the reward pathways in the brain related to eliciting the craving phenomenon in addicts.
Due to the fact that it is a weaker psychoactive chemical, users and abusers will often combine it with other drugs to produce more profound effects. As mentioned earlier, little is known or has been studied as to the pharmacology of the kratom plant, but the 44 related deaths suggest that there may be some significant interaction properties with other chemicals. Certain drugs can have potentiating or negating properties when combined in specific ways. A common example of this is the fear of overdose when combining sedative narcotics and alcohol, which has been well studied already.
The issue is its dose dependent effects make it unpredictable when combining with other drugs. Users taking this drug for its stimulating properties (typically under 5 grams) experience increased heart rate, sex drive, and energy with decreased appetite. Interactions at this dose have been reported with the newer attention deficit disorder chemicals like Modafinil and various cardiovascular regulatory chemicals. More significant issues are seen in users seeking the sedative effects by heavier users. Large doses (5 grams or more) can result in respiratory depression, itching, and liver toxicity. The risk of liver toxicity at high doses in combination with alcohol consumption compounds damage to the liver. This interaction contradicts the argument for kratom as a safer alternative because of the lack of thorough research on the drug and pervasive sense of blind faith in head shop advertisements.