What’s the Buzz

Kratom (mitragyna speciosa korth) is a tropical and subtropical tree from the same family as the coffee plant. It is native to Southeast Asia and some parts of Africa. The leaves of the kratom tree contain a substance called mitragynine, which has opioid-like effects.

Historical Usage of Kratom Products

Kratom is among the herbal medicines used by natives in Southeast Asia to overcome the burdens of manual labor. In these parts of the world, people chew Kratom leaves or brew it to make tea to increase energy and relieve muscle pain. Kratom has also been used as a substitute for opium and to manage opioid withdrawal symptoms in chronic opioid drug users.

In the United States, kratom powder is sold on the Internet and in stores to self-treat a wide range of medical conditions, including pain, cough, diarrhea, anxiety, and depression. It is also used by people with an addiction to opioid drugs to self-treat opioid withdrawal symptoms. 

The National Survey on Drug Use and Health (NSDUH) conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) showed that about 1.7 million Americans reported using kratom in 2021.

Current Legal Status

Food and Drug Administration (FDA)

The U.S. FDA has not approved any over-the-counter or prescription drugs containing kratom or its two main chemical components, mitragynine and 7-hydroxymitragynine.

Further, based on available information, the FDA does not consider kratom to be safe in dietary supplements. The FDA has also determined that kratom is an unsafe food additive. 

Therefore, kratom is not legally marketed in the U.S. as a drug, dietary supplement, or food additive.

Drug Enforcement Administration (DEA)

Kratom is not a controlled substance under the Controlled Substances Act. The DEA lists kratom as a Drug and Chemical of Concern. There may be regulations or prohibitions in some states against the possession and use of kratom. 

Potential Risks and Safety Concerns of Kratom

Common Side Effects of Kratom Compounds

Known side effects of kratom include:

• Dry mouth

• Weight loss

• Nausea 

• Vomiting

• Constipation

• Muscle pain

• Dizziness

• Drowsiness

• Hallucinations

• Delusions

Serious Risks Associated With Kratom Use

Over 25 alkaloids found in psychoactive drugs, including mitragynine and 7-hydroxymitragynine, have been isolated from kratom.

The FDA has warned consumers that kratom use is associated with a risk of serious adverse events, including high blood pressure, confusion, liver toxicity, seizures, and respiratory depression (trouble breathing). 

There are rare reports of deaths related to kratom use, confirmed by toxicology reports. However, kratom was used with other drugs in these cases, and its contribution to the deaths remains unclear. 

Is Kratom Addictive?

Kratom research shows it may have addictive potential. People using this herbal extract have met some of the criteria for a substance use disorder (SUD) or drug alcohol addiction. Signs of a kratom use disorder include:

• Using higher doses of kratom than intended

• Using it for longer than intended

• Continuing to use kratom despite negative physical and psychological effects

• Experiencing cravings for kratom

• Tolerance (needing more kratom to get the same effects)

• Physical dependence (experiencing withdrawal symptoms after stopping kratom use)

Risk of Adulteration

In the past, kratom products were found to be contaminated with high levels of heavy metals, including toxic metals like lead. Kratom products purchased illegally were also found to contain other substances, such as harmful bacteria (Salmonella), putting kratom users at serious risk of negative health effects.

Kratom Use During Pregnancy

There are reports of neonatal abstinence syndrome in newborns who had prolonged exposure to kratom before birth. Withdrawal symptoms have included irritability, jitteriness, and muscle stiffness in the newborns.

Kratom Dosage Considerations

Kratom powder is made by grinding up dry leaves obtained from the kratom tree. 

People who consume kratom believe it is natural and safe because it comes from a plant. Most users believe you can safely use about 3.5 grams of kratom powder per day. This is a “guestimate” at best and assumes that low doses of this herb are safe.

However, kratom is not regulated by the FDA and is not sold in standardized doses. As a result, it can be hard to know the amount of active chemicals in kratom products. The dose can vary greatly in different products from different suppliers who make red kratom, green kratom, etc. High doses of psychoactive chemicals in kratom can be harmful, and an overdose can be fatal. In addition, kratom can interact negatively with other drugs and cause serious adverse effects.

Some manufacturers provide a kratom report or certificate of analysis. But these are self-reported, and there are no third-party certifications done on kratom products. 

Uses and Benefits of Kratom

The use of Kratom has primarily been used as an herbal remedy. However, it is important to note that its use has not been approved by the US Food and Drug Administration. 

Those who choose to self-medicate with Kratom have reported a wide range of benefits, including the following:

Pain Management

Research suggests the two main chemical compounds in kratom, mitragynine, and 7-OH-mitragynine, bind to mu opioid receptors in the brain. These are the same receptors to which morphine, codeine, fentanyl, and other opioids bind. Therefore, taking kratom may provide pain relief to people with chronic pain, similar to opioid drugs. 

Mood and Energy Enhancement 

The chemical components of kratom also affect the levels of other chemicals in the brain, including dopamine, serotonin, and norepinephrine. These natural chemicals play an important role in mood regulation and energy levels. By binding to kappa opioid receptors, kratom may, therefore, have therapeutic potential to enhance mood and energy. This may help people with chronic fatigue and mental disorders like depression and anxiety.

Stimulant and Sedative Properties

Kratom contains psychoactive chemical compounds, and kratom users report that low doses have a stimulant effect, making them feel more alert and energetic. Higher doses of kratom products reportedly have sedative properties, reducing pain and anxiety.

Opioid Withdrawal Symptoms

Given that kratom compounds bind to the same receptors as opioids and have opioid-like effects, there may be a potential therapeutic use for kratom in people with opioid addiction. 

In fact, some people use kratom to manage opioid withdrawal symptoms because it is more easily available than prescription medications such as methadone and buprenorphine. 

However, kratom is not currently an approved treatment for opioid use disorder. More research is needed to assess its efficacy and potential safety issues. 

Scientific Research and Medical Perspectives

Current Research on Kratom and Future Research Directions

The FDA recognizes there is a lot that we don’t know about kratom compounds. While there are some published reports on the use of kratom extracts in animals, there are very few well-designed and scientifically robust published studies on the health effects of kratom leaves in humans. Future research by academic institutes, drug companies, and government agencies may provide important health information about kratom products and their potential therapeutic uses.

Expert Opinions

Kratom is commonly marketed as a dietary supplement that is sold as a mood lifter, energy booster, pain reliever, and remedy for opioid addiction. However, healthcare professionals and experts from the US Food and Drug Administration, Centers for Disease Control and Prevention, and National Institutes of Health do not recommend using kratom because there are many safety issues linked to its use. It is also important to note that the FDA does not legally recognize it as a dietary supplement. 

Final Thoughts on Kratom

Kratom is a herbal extract made from the leaves of a tropical tree called Mitragyna speciosa that grows in Southeast Asia. Kratom users chew the leaves or brew them to make a herbal tea. 

Kratom compounds have stimulant and sedative properties. People use this herb to increase alertness and energy, reduce pain and anxiety, and help manage withdrawal symptoms related to an opioid use disorder.

However, experts warn that taking kratom can have dangerous health effects, including liver damage, seizures, respiratory depression, and a substance use disorder similar to alcohol or drug abuse. Poison centers have reported deaths related to kratom use.

More research is needed, but the information currently available does not support the claims about the health benefits of kratom.

The US FDA has not approved kratom to treat any medical conditions and considers it unsafe as a dietary supplement or food additive. The DEA considers kratom a drug of concern.

Given these serious safety issues linked to kratom exposures, it is best not to take it for any health conditions or pain-relieving and mood-boosting effects. Talk to your healthcare provider for safer alternatives.