Kratom has taken the alternative wellness world by storm, but like so many before it, this new-to-market plant medicine comes to the table hot, with a side of controversy.
Kratom, scientific name Mitragyna speciosa, comes from a tropical evergreen tree native to Southeast Asia. Kratom’s veiny leaves have been used as a natural remedy for centuries to alleviate chronic pain, increase energy, ease coughs, and much more. It’s a longstanding remedy of traditional medicine in the area.
Kratom’s use
Kratom is commonly used in countries like Indonesia and Thailand by field workers as a stimulant, either in the form of kratom powder, tea or simply by chewing the leaves. Kratom’s leaves contain powerful alkaloids that bind to receptors in the human system and produce therapeutic benefits. The two primary active kratom compounds are called mitragynine and 7-hydroxymitragynine. These occur naturally in the plant but are also often isolated and extracted, and then put into kratom products like capsules. The kratom compounds found in kratom leaves have been used for centuries in herbal medicines.
The Science Behind Kratom
Kratom alkaloids target both opioid and non-opioid receptors in the central nervous system. These specific receptors also happen to be common pharmaceutical targets for drugs to treat chronic pain, anxiety, and mood. The process is similar to the mechanisms by which cannabinoids interact with the endocannabinoid system.
Kratom compounds, mitragynine and 7-hydroxymitragynine, interact with opioid receptors in the brain, producing various effects such as less anxiety and pain relief. However, the affinity of alkaloids for opioid receptors makes taking kratom a different ballgame. Herein lies the root of most of the controversy surrounding kratom exposures.
The Controversy Surrounding Kratom
Although kratom is sold as a natural remedy for anxiety, pain, and energy, the reality is that its surge in popularity runs parallel to the worsening opioid epidemic in the United States and beyond. Its potential for drug abuse and opioid addiction, particularly at high doses, goes to show the need for caution.
Coming off of this herbal substance can be horrendously difficult and frightening, but those who are looking to cut down or cut out pain meds from their life often land on kratom to ease withdrawal symptoms.
The major concern here is that addictive personalities will simply switch out one substance for another, a substance that’s not approved by the FDA, mind you. In addition, the drug enforcement administration’s kratom report has issued warnings about kratom’s potential dangers and has proposed scheduling it as a controlled substance.
The Lack of Regulation and Standardization
As far as what we know scientifically about how to use kratom products safely and effectively, the current literature is relatively scant. The data revolves mostly around reporting on what people are doing through self-directed administration.
However, well-known pharmacological data reveals kratom alkaloids' potent effects on the central nervous system, including a handful of animal studies that positively demonstrate their ability to relieve pain and opioid withdrawal. The severity of kratom withdrawal symptoms can vary. Of course, this depends on factors such as the duration and intensity of use.
If you really want to know everything about what we currently know about kratom exposures, look no further than this review article published a few months ago in the Journal of Experimental Pharmacology and Drug Discovery. It features a comprehensive analysis of the past five years worth of kratom studies, trials, and surveys. Here’s the gist:
The combined findings suggest number one, that “kratom use is no longer a niche”, and number two, that kratom is most often used to “feel good generally”, not to get high from recreational use.
Because kratom has been categorized as one of the psychoactive drugs, It’s no surprise that the evidence shows that the majority of US kratom consumers take it for pain relief, energy, improved cognition, and to improve their mood. Globally, kratom users overwhelmingly report improved well being and quality of life.
The Dark Side of Kratom
But there’s a dark side, too, where the controversy primarily surrounds two subjects: KUD, aka Kratom Use Disorder, and kratom deaths.
Kratom products can be habit-forming, which has led to the emergence of opioid use disorder. However, the analysis of the current research points out that KUD is not listed in the DSM-5 or ICD-11. Instead, kratom use disorder is now being used to identify kratom consumers that fit within wider criteria of substance abuse disorders in general.
The research supports that although a small number of users say they try to avoid kratom withdrawal, the opioid withdrawal is actually fairly moderate, with many reporting no opioid withdrawal symptoms at all. According to the authors, the other lynchpoint of kratom products controversy, the kratom deaths, is buried deep in murky data, with many deaths never getting backed up by toxicology reports, for example. Using kratom products for a long time can lead to physical and psychological dependence. Trying to stop can lead to severe withdrawal symptoms.
It also looks like a lot of the deaths associated with taking kratom products were found to be caused by dangerous contaminants in the products, not the kratom itself. In addition, the drug enforcement administration has expressed concerns about the potential dangers of opioid addiction, citing its potential for overdose.
Understanding The Legal Status of Kratom
The FDA, who by the way does not approve kratom as an ingredient, recently stated that kratom deaths usually occurred when used in combination with other drugs and that “the contribution of kratom in the deaths is unclear.” Also, the drug enforcement administration listed kratom as a drug of concern.
All in all, the published research over the past five years indicates that kratom’s abuse potential may be exaggerated, and it infers that safe kratom use starts with a safe kratom product.
But controversy continues to linger in spite of these insights. Just this year the family of an Oregon man sued a local smoke shop for a staggering $10 million in wrongful death from their kratom products.
And it’s not comforting that we don’t yet know exactly how kratom interacts with other drugs.
For lay persons, the best piece of advice if you’re curious about kratom is this:
- Buy from a legit vendor, someone who has been in the business a while, has a good relationship with local producers, and provides third-party contaminants tests if you ask for them.
- Don’t take kratom if you’re on prescription medication without talking to your doctor. As mentioned, it can interact with other drugs.
The Future of Kratom
As we find out more about how kratom can safely be used to help with chronic pain, energy, and anxiety, we can hopefully apply it to wellness at a more macro-level for plant-based relief. Until then, kratom users will have to continue to rely on self-directed administration.
