What You Should Know About Kratom
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 Administration (DEA) as a “drug of concern,” and has not been approved for any medical use by the Food and Drug Administration (FDA).
Also Known As: Kratom products are also known as Biak, Ketum, Kakuam, Ithang, Thom, Herbal, and Ketum.
Common Effects: 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.
What Does Kratom Do?
What the Experts Say
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.
The available research includes a report published in the International Journal on Drug Policy in 2010, for which scientists surveyed 136 people who actively used 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.
However, in a 2014 report published in Drug and Alcohol Dependence, researchers surveyed 293 people who regularly used kratom 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 suggested 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.
A 2019 review concluded that kratom offers some potential benefits but has a high potential for abuse, interactions, and adverse side effects. The review also suggested that placing it behind the pharmacy counter could be a potential middle ground between banning the drug and allowing its sale unrestricted.
The future legal status of the drug remains unclear, although the DEA’s past statements on the subject give some indications of what might be expected. In 2016, the DEA announced their intent to place two of the herb’s active constituents on its Schedule I drug list. Two months later, the DEA withdrew its notice of intent and instead opened an official public comment period.
Mitragynine and 7-hydroxymitragynine are the kratom constituents that would 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.”
In addition to the DEA’s position, the FDA has also issued warnings about the potential dangers of the drug. In late 2017, FDA Commissioner Scott Gottlieb, MD, issued a public health advisory about risks associated with kratom.9 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. In these cases, people had also taken fentanyl and heroin.
In 2018, the website STAT reported that the Department of Health and Human Services had recommended a ban on the chemicals found in kratom.
As of 2020, federal regulation remains on hold as the debate over the substance continues. The FDA has issued warnings to companies that sell kratom in the U.S. and illegally market the drug as an herbal supplement to treat addiction, anxiety, pain, and other health issues. Only FDA-approved drugs can make such claims. The future legal status of the drug remains to be seen.
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.
Potential health effects include:
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.
Many people believe that because kratom is an herbal supplement, it’s safe to use. But it’s important to keep in mind that supplements aren’t regulated 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). Contamination and adulteration with other drugs, herbs, and substances are possible. For instance, in 2018 at least 199 Americans became sick after taking kratom tainted with salmonella.
Tolerance, Dependence, and Withdrawal
Kratom comes with a risk of tolerance, dependence, and withdrawal. People who use kratom can build a tolerance, or the need to use 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:
- Body fat
- Frequency of use
- Metabolic rate
- Type of kratom
- Water and food intake
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, and withdrawal. Other common signs of addiction include:
- Changes in friends
- Changes in mood, sleeping patterns, weight, and activity levels
- Financial trouble
- Loss of interest in hobbies, social activities, or job or school
- Secretiveness, stealing, and/or lying
- Keeping stashes of drugs or paraphernalia
- Trouble scaling back or stopping drug
- Spending vast amounts of time spent getting, using, and recovering from the drug
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:
- Decreased appetite
- Difficulty sleeping
- Hot flashes
- Increased muscle spasms and pain
- Mood disturbances
- Runny nose
- Watery eyes
- Discoloration of the cheeks
- Dry mouth
- Increased social behavior
- Increased urination
- Loss of appetite
- Psychotic symptoms (hallucinations, delusion, confusion)
- Sensitivity to sunburn
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 healthcare provider first. Some pain clinics utilize complementary and alternative therapies in conjunction with traditional medical approaches for pain treatment and management. 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.