Kratom: A Potential Substitute for Addictive Opioids

Kratom (also known by its botanical name Mitragyna speciosa and as ketum) is an evergreen tropical tree native to Malaysia, Thailand, Myanmar, Indonesia, and Papua New Guinea. Although the plant has a great deal of potential as an herbal medicine, it has not been subjected to scientific scrutiny, and hundreds of users just in the USA have suffered side effects after taking it. The United Nations classifies kratom and other controversial drugs such as khat and Salvia divinorum, along with synthetic drugs like ketamine, as "new psychoactive substances," not yet illegal in the US, the Commonwealth, or Europe, but meriting government attention. The US Drug Enforcement Agency announced a plan to ban kratom as of September 30, 2016, but widespread protest prevented its being listed as a Schedule I drug.

Kratom is already illegal in Thailand, where 13,000 people have been jailed for kratom-related crimes. In the United States, the federal government has not made kratom illegal, although the states of Alabama, Arkansas, Florida, Indiana, Tennessee, and Wisconsin have. In the states where it is legal, teenagers often use the herb to experiment without the possibility of getting arrested. There are drug tests that can detect the breakdown products of kratom, although the home drug testing kits that cover kratom usually cost around $125.

How Do You Get Kratom?

Nearly all Americans who use kratom buy the herb online. It comes as powdered dry leaf. It is sold in bulk for making tea, or in capsules to be taken by mouth. Home growers outside of the tropics usually don't have much luck growing the herb. Kratom seeds go bad very quickly. It's impossible to grow kratom plants from old seed. 

What Is Kratom Used For?

Nineteenth century herbalists and doctors recommended kratom as a treatment for getting off opium, and an increasing number of people around the world are using it for treating chronic pain. British and Dutch plantation owners encouraged their workers to use kratom so they could bear more physical pain and do more work. In the twenty-first century,it is often used by people who got hooked on Oxycontin or other opioid pain relievers who are trying to cut back or save money without turning to heroin. It is also sometimes used by people who are trying to come off methamphetamines on their own.

Is Kratom Safe?

In low doses, one to five grams (up to about the equivalent of ten leaves or a heaping teaspoon of the powdered drug) kratom is a "euphoriant." Users feel good. They want to mix and mingle with people. They have more energy. In high doses, five to fifteen grams (up to about the equivalent of 30 leaves a heaping tablespoon of the powdered drug) kratom is sedative. Users become low-energy, although they are usually stoned. The effects of the herb come on quickly, in just a few minutes, and last six to eight hours, although the effects of very high doses may last longer than that.

In Asian countries where kratom is legal, there are no reports of side effects or fatalities. However, in these countries, very few users of kratom take prescription drugs, and the herb is available fresh as unadulterated leaf. Laborers who use the leaf for energy usually take only a small dose, the equivalent of two or three leaves or about a gram of the herb.

What Users Need to Know About Kratom Side Effects

Different doses cause different kratom side effects. At low doses, the predictable side effects are the same as using low doses of other stimulants:

• Overstimulation, anxiety, and agitation.
• Itchy skin.
• Nausea.
• Increased urination.
• If used regularly, constipation and abdominal pain.

The side-effects of a low dose of kratom can occur in the first five to ten minutes after it is taken.

At higher doses, there are side effects like those from opioid drugs:

• Constipation after just one or two doses.
• Tachycardia (accelerated heartbeat)
• Dry mouth.
• Hypotension (low blood pressure).
• Sweating.

Very high doses (over 15 grams in one session) may cause:

• Loss of appetite.
• Weight loss.
• Seizures.
• Psychosis.
• Hallucinations.
• Delusions.
• Chills.
• Liver problems.
• Torsade de points (a specific kind of heart rhythm that can lead to sudden death, although no deaths from torsade de points have been noted in the literature).

The side effect of high and very high doses of kratom take an hour or two. A side effect kratom doesn't have at high doses is fatal respiratory depression, which is the usual cause of death in Oxycontin and heroin overdoses. Very high doses of the kratom chemical mitragynine have caused respiratory depression in tests with lab animals, but they are not known to have this effect in people. There are multiple reports of fatal respiratory depression in users of the street drug krypton, which is a combination of kratom and the prescription opioid Tramadol. Don't combine kratom with Tramadol or other opioid pain relievers.

Kratom withdrawal often results in:

• Irritability.
• Insomnia.
• Diarrhea.
• Abdominal cramps.
• Blurred vision.
• Nausea.
• Insomnia.
• Runny nose.
• Hypertension (high blood pressure).
• Dilated pupils.
• Hot flashes.
• Fever.
• Rebound pain, especially of muscles and joints.

Addicted users of kratom will experience withdrawal 12 to 24 hours after their last dose.

In the last seven years, there has been exactly one death associated with kratom use in the USA. This was an individual who was also using the medications paroxetine (an antidepressant) and lamotrigine (an anticonvulsant and mood stabilizer). There were life-threatening symptoms in 49 users in the last seven years. Experts urge emergency room doctors to treat respiratory depression with naloxone, which is also used for treating heroin overdoses, although this use has not gone through a clinical trial.

If you are going to use kratom, use it safely:

• Always use kratom you obtained legally. Legal vendors take the time to test the herb both for potency and for purity.
• Start small. As little as 1 gram (about one-quarter of a teaspoon) of the herb will provide an energy boost.
• Avoid using more than 5 grams (a heaping teaspoon) in any 24-hour period.
• Don't use kratom more often than every other day.
• If you run into side effects, see your doctor, and be honest and straightforward about your drug use. Your doctor can relieve a bad drug experience much more quickly if you reveal what you have been using.