Recently, it seems that everyone from Dr. Oz to the Food and Drug Administration (FDA) have been talking about kratom. Even the DEA had jumped on the band wagon and briefly considering criminalizing it. What is kratom? Where does it come from? What is it used for and how has it come into the societal spotlight? Some say that it is the miracle cure, a gift, to the severe opiod crisis that we are in the midst of and some say that it is a merciless killer. Who's right?
What is Kratom?
Kratom (Mitragyna speciosa) is an evergreen tree found in Southeast Asia. It is indigenous to Thailand, Malaysia, Indonesia, and Papua New Guinea. It is a member of the Rubiaceae family which includes edibles like coffee and medicinals like ipecac. In Southeast Asia, kratom is usually consumed in the form of chewed fresh or dry leaves. It is also made into a tea. Traditionally it is used as a way to lessen fatigue and increase work productivity by manual laborers[1].
It is also used in religious ceremonies by shamans, to treat morphine dependence in Thailand, and as an opium substitute. There are a few phytochemicals present in kratom like speciogynine and speciociliatine but the main psychoactive substances in kratom are mitragynine and 7-hydroxymitragynine.
At low doses these alkaloids produce effects similar to stimulants like cocaine. At higher doses kratom acts like an opiate sedative.
Although this herb has been used in Southeast Asia as a stimulant and traditional medicine for millennia, the recent deaths associated with it has given many a cause for concern.
As of this writing, according to the FDA, there have been 44 deaths associated with kratom. The FDA had put kratom on an import alert in 2012 and 2014. Attesting to it's believed dangerous status, the FDA seized thousands of pounds of raw kratom and dietary substances containing it in 2014 and again in 2016. Does this mean that kratom is a dangerous substance that shouldn't be used for human consumption?
A Closer Look into the Kratom Deaths
44 reported deaths have been linked to the use of kratom. While any loss of life is a tragedy, it is helpful to look closer at these deaths to determine whether kratom is indeed the culprit it is made out to be.
The ages of the deceased encompasses a wide range. Some were as young as seventeen while others were middle aged at forty-five. While there is a female death mentioned, most of the deceased were Caucasian males.
Of the 44 cases listed as kratom related deaths, there are 2 that are related to kratom alone. The rest of the deaths involve multiple drugs combinations namely opioids and benzodiazepines.
1 of the "kratom related deaths" was actually ruled a suicide because the deceased was found hanged by deputies searching for him after a friend received a suicidal text message. This can hardly be attributed to kratom. The only reason why this was included as a kratom related death was because the substance mitragynine (a psychoactive chemical found in kratom) was found in the patient's blood in toxicology reports.
Another had pulmonary thromboemboli listed as his cause of death with polysubstance abuse as a contributing factor. Clearly this person had many factors contributing to his tragic death.
Some of the reports indicate the deceased had done internet searches on "natural ways to get high" before ingesting kratom with other prescribed and non prescribed pharmaceuticals.
Clearly, the majority if not all of the kratom related deaths involved very troubled individuals with histories of drug abuse, depression, mood disorders and/or suicidal thoughts and tendencies. Some of them suffered from chronic pain and had been prescribed multiple pain medications that they combined with kratom to a tragic end.
The 2 deaths attributed to kratom alone were significant since the amount of mitragynine found in toxicology reports was extremely high. The levels found in these individuals suggest that either more kratom than intended was accidentally ingested or a tolerance to kratom had occurred and higher doses were needed for the intended physiological effect.
Kratom Use And Withdrawal
While the documented kratom deaths may be due more to multiple drug toxicity and mental illness, there is still a question of kratom's ultimate use and safety.
A systematic review of kratom in scientific literature has found that kratom is not only useful as a powerful analgesic but it also helps to reduce anxiety and enhance mood in many people[2]. It also has the potential to reduce adverse events like debilitating withdrawal symptoms in those who want to quit opioids.
While it seems that many people are finding relief from pain and mood disorders with kratom, there is still reason for concern. Studies have shown that while withdrawal from kratom is much less severe than that of opioids, there is still a chance of dependency.
More than half of the long term kratom users, who used it more than 6 months, developed muscle pain and spams, sleeping difficulties, diarrhea, anger, sadness and nervousness when withdrawing from kratom[3].
There are also cases where an individual will switch from an opiod to kratom to avoid the symptoms of opiod withdrawal and experience the need to ingest ever increasing amounts of kratom just to prevent opioid withdrawal symptoms. Such as the case of a veteran who started brewing kratom tea to avoid opioid withdrawal symptoms and escalated his consumption to 20 grams day[4].
Research also shows that people using kratom for chronic pain or sleep issues experience mild to moderate pain and sleep disturbances when no longer using the herb.
Although there is a real concern for dependency and physiological tolerance, it is interesting to note that researchers also stated that "cessation from regular kratom tea/juice consumption is not associated with prolonged pain and sleep problems, as compared to those reported for opioid analgesics"[5].
What Are We To Make of All This?
So is kratom the miracle cure that many have been touting it as? Is it a monster that indiscriminately kills those seeking relief from chronic pain?
I'd say that both descriptions aren't quite accurate. Our human nature causes us to separate things into black and white, wrong and right, when this is hardly the case.
Is kratom helpful for people experiencing chronic pain? No doubt it is. Is kratom a safe and helpful alternative for reducing opioid withdrawal symptoms? I'd say definitely not because of the risks involved concerning addiction and withdrawal. Is kratom potentially highly addictive and can have dangerous, even lethal, consequences? Definitely.
Just like with any potentially addictive substance, herbal or not, precautions must be taken and care should be exercised.
With that caveat, if you are using kratom or going through kratom withdrawal to manage chronic pain or mood disorders, then you should know that you don't have to go through this alone. There are many different approaches to chronic pain, mood disorders, and even opioid withdrawal like acupuncture, diet, botanical medicines and so much more. Don't hesitate to discuss your health concerns with a naturopathic physician.
Kratom is a powerful herb used that some find helpful but it is highly addictive and there is a huge cause of concern with withdrawal symptoms. Don't hesitate to contact your naturopathic physician with any questions or health concerns you may have.
Have you used kratom? If so, what did you use it for? What else have you done to help your condition? Let me know in the comments or through email.
References
1.Cinosi E, Martinotti G, Simonato P, et al. Following “the Roots” of Kratom (Mitragyna speciosa): The Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries. BioMed Research International. 2015;2015:968786. doi:10.1155/2015/968786.
2. Swogger M, Walsh Z. Kratom use and mental health: A systematic review. Drug Alcohol Depend. 2018;183:134-140. doi:10.1016/j.drugalcdep.2017.10.012.
3.Singh D, Müller C, Vicknasingam B. Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug Alcohol Depend. 2014;139:132-137. doi:10.1016/j.drugalcdep.2014.03.017.
4. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2017.120305
5.Singh D, Narayanan S, Vicknasingam B et al. Severity of Pain and Sleep Problems during Kratom (Mitragyna speciosa Korth.) Cessation among Regular Kratom Users. J Psychoactive Drugs. 2018:1-9. doi:10.1080/02791072.2018.1443234
