Kratom is a plant getting attention in the health community for its psychoactive effects. Different doses can deliver different effects, including stimulating and relaxing, sedative-like effects.
Kratom acts as a stimulant, similar to caffeine, and in larger doses, it becomes more like a sedative, helping with sleep and relaxation. It has also been reported to help with pain associated with chronic illness.
Kratom is usually ingested as a tea, decoction, or ground into a fine powder that can be taken in capsules.
Due to its potentially addictive nature, more studies need to be conducted to explore potential long-term issues between kratom and human health.
Kratom is a plant indigenous to Southeast Asia that has been used there for hundreds of years. It has recently become popular in Western countries for its biological effects.
However, because of the opioid-like alkaloids in the plant, there is concern about potential addiction or dependency, and more studies need to be conducted to understand its long-term effects fully.
In the United States and other Western countries, kratom use is on the rise as smoke, and herbal shops are marketing its sale as an alternative to coffee. However, what exactly is kratom, and is it safe to consume?
How is kratom used?
Kratom (Mitragyna speciosa) is a tropical evergreen plant indigenous to Southeast Asia. It has been used for centuries for its unique biological properties. Kratom has also been called biak-biak, thom, ithang, and ketum, depending on what country the plant is being used.
Traditionally, the raw leaves are chewed or smoked for psychoactive effects. However, the most common preparations are to make a tea or decoction. In recent years, it has been common in Western countries to have kratom leaves dried and processed into powders, extracts, and capsules for easier and tasteless consumption.
A recent research review published in Pain and Therapy has shown kratom to have similar effects to opioids, including euphoria, pain relief, mood enhancement, and stimulant properties. Because the alkaloids in kratom, or compounds in the plant responsible for its effects, are similar to opioids, there is a concern about its potential for dependence and addiction by some researchers. On the other hand, other researchers are exploring its use in supporting opioid addiction withdrawal and recovery.
Researchers have isolated over 40 different alkaloids in kratom, with mitragynine (MG) being its most abundant, accounting for about 66% of the plant’s alkaloid content.
Mitragynine is considered to be what’s called “a partial opioid receptor agonist,” meaning it binds to receptors in the brain and nervous system, blocking pain sensations. You might be familiar with full opioid receptor agonists like heroin, oxycodone, methadone, morphine, and opium. These are all very powerful pain relievers associated with high levels of abuse and addiction. However, Dr. Chris McCurdy with the University of Florida, a trained medicinal chemist, pharmacologist, and professor whose research focuses on the design and development of drugs to treat pain and drug abuse, says we can’t lump kratom in with these other opioid agonists.
He has "collected data to show [kratom] has much less abuse and dependence liability than other opioid analgesics." He attributes this to it being only partially active on opioid receptors. Mitragynine's chemical composition prevents some opioid-related adverse side effects like respiratory depression and constipation. He adds, "if you look at poison control center data, kratom overdoses resemble stimulants, not opioids."
For these reasons, Dr. McCurdy and his research team are determined to continue studying the effects of each of kratom’s alkaloids to see exactly which pose potential threats and which could potentially help treat disease, pain conditions, and even help with opioid withdrawals.
Is kratom legal in the US?
In the U.S., six state legislatures — Alabama, Arkansas, Indiana, Wisconsin, Rhode Island, and Vermont — have successfully passed statutes criminalizing kratom possession. However, it remains legal and easily obtained online and at local retailers in the rest of the United States. In Europe, the sale is permitted with the exceptions of Poland, Ireland, Romania, and most of the Nordic and Baltic states.
Kratom benefits and use
There are three main colors or strains of kratom — red, green, and white — each having slightly different ratios of the active alkaloids. Because of these different combinations, each variation has slightly different effects, some being more euphoric and others better at pain management. Generally speaking, all types of kratom have similar benefits, with the most promising effects including:
- Stimulant activity similar to coffee (adrenergic effects);
- Mood-enhancing (serotonergic effects);
- Pain-relieving (analgesic effects);
- Anti-anxiety (anxiolytic effects);
- Restore insulin function (potentially helping diabetes);
- Increased libido;
- It’s also being studied in helping to support opioid withdrawal and opioid addiction recovery.
Kratom is used both therapeutically and as a recreational drug. In either case, there is still uncertainty regarding its long-term safety and addictive potential. However, legitimate therapeutic users report kratom as life-changing and revolutionary in their health journey.
Risks and side effects of kratom
A review published in Pharmacotherapy looked at a total of 2,312 kratom exposures in humans as reported by the National Poison Data System to determine the toxicities associated with kratom use and found the following side effects and their corresponding prevalence. It’s important to keep in mind that over 1,300 of these exposures included products where kratom was not the only active ingredient, so it is not completely clear if kratom was the leading cause by itself. The most commonly reported effects included:
- Agitation (18.6%);
- High heart rate (tachycardia) (16.9%);
- Drowsiness (13.6%);
- Vomiting (11.2%);
- Confusion (8.1%).
However, more serious side effects included:
- Seizure (6.1%);
- Withdrawal (6.1%);
- Hallucinations (4.8%);
- Respiratory depression (2.8%);
- Coma (2.3%);
- Cardiac or Respiratory arrest (0.6%);
Cardiac or Respiratory arrest (0.6%).
Kratom was listed as a contributing factor in the death of four people per the county medical examiner's office.
Dr. McCurdy of the University of Florida speaks on these findings by sharing that “we know very few deaths are attributable to a kratom product alone, and for those that are, there could be extreme circumstances, in terms of overdosing, or it could be adulterated with synthetic compounds such as fentanyl derivatives or other novel psychoactive substances that are unknown or undetected”.
An extensive study published in Frontier Pharmacology found that "kratom consumption does not implicate the plant's role in toxicity, especially given the large variability of MG serum levels ranging from 5.6 to 29,000 ng/ml". In addition, because kratom is a partial agonist, the study found that kratom alone does "not contribute to significant respiratory depression in preclinical animal studies, making 'poisoning,' when kratom alone is used, a highly questionable cause of death".
Once again, these mixed findings reflect a need for continued research to see exactly what dosage of kratom can be safely consumed to achieve its maximum benefits with the lowest potential for negative side effects. Additional research will also help us better understand what other substances kratom may negatively interact with and what specific groups may have the highest risk factors for negative side effects and addiction. For your safety, please consult your doctor before trying kratom.
- Pharmacotherapy. Kratom Use and Toxicities in the United States.
- Pain and Therapy. Kratom—Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review.
- NIH News in Health. Is Kratom Safe?
- NIH Record. McCurdy Studies Whether Kratom Can Reduce Opioid Withdrawal, Ease Pain.
- Frontiers in Pharmacology. Understanding Kratom Use: A Guide for Healthcare Providers.
- Bulletin on Narcotics. The alkaloids of Mitragyna with special reference to those of Mitragyna speciosa, Korth.
- Natural Product Research. Study on glucose transport in muscle cells by extracts from Mitragyna speciosa (Korth) and mitragynine.