Kratom Controversy: Miracle Medicine or a Dangerous Drug?

Kratom's role in fighting opioid addiction

Kratom

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Many people suffering from anxiety or opioid addiction call the herbal supplement, kratom, a godsend. They describe it as a safe, natural pain killer and mood booster, but there is little scientific research to back its use. The opioid-like drug has been implicated in 91 fatal overdoses in a one-year period, leaving many to question its safety.

So is kratom a life-saving herbal supplement or a dangerous drug? We have spoken to leading experts in kratom research to find out whether this controversial supplement is safe and effective for use.

Kratom's Use

Kratom—also referred to as biak-biak, ketum, or Maeng Da—comes from the leaves of the Mitragyna speciose tree, a cousin of the coffee plant.

The plant, which is commonly found in Southeast Asia, has been used for nearly 200 years for a wide range of recreational and medicinal purposes. Historically, farmers in Malaysia and Thailand have chewed dry kratom leaves or drank kratom teas seeking additional energy while working.

Kratom has been on the U.S. market since the 1980s or 1990s but its popularity has only begun to increase in the past decade. Currently, estimates of kratom users are elusive, but researchers say the number might be in the hundreds of thousands, with most users in the 31 to 50 age range.

More recently, products made from the plant have started appearing in gas stations, drug paraphernalia stores, and holistic health food shops throughout the U.S. It’s sold in a variety of forms ranging from capsules and gums to teas and different beverages, mainly to individuals seeking alternatives to prescription pain relievers, assistance going through opioid withdrawal, or as an anti-anxiety supplement.

Christopher McCurdy, professor of medicinal chemistry at the University of Florida, hypothesizes that the rise in popularity may be due to the banning of synthetic cannabinoids in the early 2000s.

“What made kratom burst onto the scene was the banning of bath salts and ice, which left caffeine products sitting next to kratom. Kratom really became the next best thing,” said McCurdy.

McCurdy, who has been researching kratom since 2004, says the initial products were highly concentrated and heavily adulterated with other drugs, such as heroin and fentanyl. Several near overdose deaths with laced kratom products spurred research to determine how kratom affects the brain and the body.

“A few emergency room cases popped up where people who claimed only to be using kratom tested positive for hydrocodone or morphine. We thought this was very odd. We later found that their kratom was laced with prescription opiates. This spurred us to do research on the herb itself and how it interacts with other drugs,” McCurdy says.

How Does Kratom Affect the Brain?

The herbal product, sold mostly online in the U.S. in the form of capsules or green powder packets, contains many chemically active metabolites which may explain why the drug may help with anxiety, acute pain, and opioid withdrawal symptoms.

Kratom has a dose-dependent effect on the brain, which means that different doses of the drug may produce different effects. Small doses can lead to a feeling of alertness, while larger doses of 10 grams or more can have a sedative effect.

Anecdotally, healthcare professionals hear that kratom helps with everything from diarrhea and anxiety to acute pain to mitigating opioid withdrawal symptoms. Mitragynine and 7-hydroxymitragynine are the main psycho-active compounds in Kratom, with 7-hydroxymitragynine being the more psycho-active of the two.

The two act as partial-opioid agonists on the same parts of the brain responsible for controlling pain and reward, but also addictive behaviors. This means that regular kratom use can lead to dependence, abuse, and addiction.

In fact, kratom dependence is not uncommon. In Malaysia, where kratom tea is used daily, some people develop a mild dependence on the stimulant, similar to caffeine dependence in the U.S., which often involves withdrawal symptoms of headache and irritability. At higher doses, one can develop an opioid-like dependence, albeit less severe.

"An opioid-like Kratom dependence can occur if someone ingests more than 5 grams per dose more than three times a day for a week to a month. The dependence looks like other opioid dependence, but the withdrawal symptoms differ. The withdrawal symptoms seem to be far less severe than what's associated with classic opioid addiction," says McCurdy.

Still, kratom research, including studies on the drug’s addiction potential, are preliminary at best.

The Kratom Controversy

Currently, the U.S. Drug Enforcement Agency (DEA) lists the popular opioid-like drug as a drug of concern, but it has not been deemed illegal or taken off the market despite the Department of Human Health and Services' (HHS) recommendation to the DEA that the drug be classified as a Schedule 1 drug—the same category of drug as heroin and LSD.

In 2018, in a letter to the DEA, HHS asserted that two chemicals, mitragynine and 7-hydroxymitragynine—the psychoactive components in kratom—should be classified as Schedule I substances, because the substances have “a high potential for abuse” and there is “no currently accepted medical use” for them.

The DEA responded that it would take months to years for this designation to be put in place. In fact, they tried to ban kratom in 2016 but public outcries from kratom users and members of Congress thwarted their efforts.

The Food and Drug Administration (FDA) does not monitor or regulate kratom supplements for its dosage or purity and has no approved use of the drug for any medical purpose.

The FDA warns that kratom may cause adverse reactions, especially at high doses including seizures, tremors, psychosis, and other serious toxic effects. They strongly suggest against the use of kratom in those with medical conditions or who take medications as the risk of adverse reactions is higher in these populations.

The agency has raised serious concerns regarding kratom’s supplement or other use, including its safety, effectiveness, lack of clinical testing, and failure to submit to FDA’s process for evaluating botanical drug products.

Top kratom researchers say surveying people and seeing how they use kratom is important to understanding its social impact and why people are using kratom to begin with; and many agree that anecdotal evidence of kratom's effectiveness, even in light of little research, cannot be ignored.

A Word From Verywell

Currently, the medical community does not endorse kratom’s use to treat opioid addiction citing a lack of research. Without knowing information such as kratom’s safest and most effective dosage, its possible interactions, and its harmful effects healthcare professionals caution against taking this mysterious drug.

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