Kratom (Mitragyna speciosa)

What is Kratom?

Kratom is a tropical tree native to Southeast Asia, particularly Indonesia, Thailand, Malaysia, and Papua New Guinea. Its scientific name is Mitragyna speciosa. The active compounds found in the tree’s leaves are known as alkaloids, including mitragynine and 7-hydroxymitragynine. These active compounds are responsible for the plant’s psychoactive opioid and stimulant-like effects which can lead to psychological and physiological dependence, addiction, and kratom withdrawal.

Kratom has been used for centuries to relieve pain, increase energy, and enhance mood. Over the last couple of decades, it has gained popularity in the Western world as a recreational drug for its euphoric effects. Additionally, many companies make claims and market it for treating physical, mental, and substance use conditions, so people have been using kratom to self-manage anxiety, depression, pain, and opioid withdrawal symptoms. However, its safety and effectiveness are still subject to ongoing research.

How is Kratom Consumed?

For centuries, people from Southeast Asia have commonly consumed kratom by chewing on the leaves or by ingesting it in tea form. In the Western world, people consume kratom by oral ingestion in the form of tea, capsule, powder, liquid, resins, and tinctures.

Kratom powder is commonly mixed with sweet foods, smoothies, or citric juices such as grapefruit, orange, lemon, or lime juice. Mixing the powder with citric juices enhances the potency and activates the compounds for faster effect. The toss-and-wash method involves taking a spoon full of kratom powder then washing it down with water or juice.

Capsules are popular because they are convenient and easy to take on the go. Kratom liquid has been marketed to treat muscle pain, weight gain, gastrointestinal dysfunction, and mood disorders. Resins and tinctures are more concentrated and therefore more potent in smaller amounts.

Is Kratom Legal in the United States?

Although kratom has been banned in several countries and states within the United States, it remains available online and in numerous states across the country. As of November 28, 2023, Alabama, Arkansas, Indiana, Rhode Island, Vermont, Wisconsin, and Tennessee have banned the sale or possession of kratom.

Additionally, certain local governments, such as San Diego, California, and Sarasota County, Florida, have enacted their own bans on kratom. Colorado, has also banned kratom, despite Colorado’s state-level regulations that permit its sale under specific conditions.

State-Level Regulations

Arizona, Colorado, Florida, Georgia, Kentucky, Maryland, Nevada, Oklahoma, Oregon, Texas, Utah, Virginia, and West Virginia have all passed the Kratom Consumer Protection Act (KCPA), a legislative framework developed by the American Kratom Association (AKA) to regulate the sale and use of kratom while discouraging states from implementing outright bans. The KCPA sets forth specific guidelines, including:

• Prohibition of Adulteration: Vendors are prohibited from preparing, distributing, or selling adulterated or contaminated kratom products.
• Labeling Requirements: Kratom products must be labeled with the amounts of mitragynine and 7-hydroxymitragynine they contain.
• Age Restrictions: The sale of kratom products is restricted to individuals aged 18 and older in most states, with some states setting the age limit at 21.

Regulated States

States such as Illinois, Louisiana, Minnesota, Oregon, and South Dakota regulate the possession, manufacture, distribution, and sale of kratom products with age restrictions. In Illinois and Minnesota, the age limit is set at 18, while in Oregon, South Dakota, and Louisiana, the limit is 21. These states have implemented varying degrees of oversight, but not all of them require specific product labeling that details alkaloid content or safety warnings.

Additional State-Specific Regulations

Tennessee permits the regulated sale of natural kratom but continues to ban synthetic forms of its active compounds. West Virginia has imposed comprehensive regulations, including mandatory product testing and labeling requirements, along with a tax on kratom sales.

Colorado allows for local governments to impose stricter regulations or bans on kratom within the state. As of the latest updates, thirty-two states do not impose specific controls or regulations on kratom, allowing its sale and possession with minimal oversight. However, the legal landscape for kratom remains fluid, with ongoing discussions in various states regarding potential regulatory changes.

How Does Kratom Affect the Brain?

The scientific evidence on kratom effects is limited, and much of what is known about the drug comes from anecdotal reports and case studies.

The specific effects on the brain depend on the dosage and the individual’s unique physiology. At lower doses, Kratom can stimulate the release of neurotransmitters such as serotonin and norepinephrine, leading to increased focus, energy, and mood enhancement. At higher doses, it can produce opioid like sedative effects, leading to relaxation, pain relief, and a sense of well-being.

What Are Negative Health Effects of Kratom?

Nausea and vomiting

The exact mechanism is not fully understood, but it is thought to be related to Kratom effects on the digestive system. In addition, some people may be more sensitive to the psychoactive compounds in kratom, and these compounds can cause an imbalance in the body’s chemistry, leading to nausea and vomiting.

Loss of appetite and weight loss

The alkaloids in kratom interact with the opioid receptors in the brain and gastrointestinal tract. This interaction can lead to a decrease in appetite and a feeling of fullness, which can contribute to weight loss. Additionally, some users report feeling nauseous or experiencing vomiting, which can also contribute to a loss of appetite and weight loss.

Constipation

Kratom can slow down digestion, leading to constipation and other digestive problems.

Dehydration

Kratom can cause dehydration, which can lead to electrolyte imbalances and seizures.

Seizures

Kratom may lower the seizure threshold in certain individuals, making them more susceptible to seizures. It may interact with other drugs including prescription medications and illicit substances. These interactions can increase the risk of seizures, especially if the person is taking high doses or combining it with other substances.

Liver damage

Kratom use can cause liver damage by triggering oxidative stress, which can damage liver cells and lead to inflammation, scarring, and liver failure.

Kidney damage

Kratom use can cause kidney injury by affecting the way kidneys filter waste from the blood. It may also cause damage to the kidneys by increasing blood pressure and reducing blood flow to the kidneys.

Respiratory depression

Kratom can slow down breathing and cause respiratory depression at high doses, which can be dangerous and potentially fatal.

Agitation and irritability

Kratom use can affect the levels of certain neurotransmitters in the brain, including dopamine and serotonin, which play a role in mood regulation. At higher doses, it may also cause symptoms such as tremors, rapid heartbeat, and sweating, which can contribute to feelings of agitation and irritability.

Psychosis

Kratom use can cause psychotic symptoms, including hallucinations and delusions. Some studies suggest that its psychoactive effects may be due to its interaction with various neurotransmitters including the dopaminergic, serotonergic, and adrenergic systems.

Furthermore, it is thought that the risk of psychosis may be increased in individuals who have a history of mental illness, such as schizophrenia or bipolar disorder, or in those who use high doses or use it frequently.

Is Kratom Addictive?

Yes, like opioids, kratom can be addictive. Its alkaloids, particularly mitragynine, interact with the brain’s dopamine receptors, which are associated with pleasure and reward. This can lead to a cycle of increasing use to achieve the desired effects resulting in changes to the brain’s structure and function.

A strong physical and psychological dependence occurs and addiction, also known as substance use disorder develops. This creates a compulsion to use, meaning the individual is unable to cut back or quit, even when it negatively impacts their life. When a person stops using it, Kratom withdrawal may occur including:

• depression
• anxiety
• sweating
• muscle aches
• problems sleeping

Not everyone who uses kratom will become addicted, and the risk of addiction may be influenced by individual factors such as genetics, mental health, and environmental factors.

What is the Treatment for Kratom Addiction?

Kratom addiction can be challenging to overcome, but there are various treatment options available to help individuals struggling with addiction. Here are some steps people can take to get treatment:

Consult a healthcare professional

The first step towards treatment is to consult with a healthcare professional, who can provide a proper assessment and diagnosis of the addiction. They can recommend an appropriate treatment plan based on individual needs.

Inpatient or Outpatient Treatment

Treatment can be done on an inpatient or outpatient basis. Inpatient treatment involves staying in a rehabilitation center for a certain period, while outpatient treatment involves visiting the center for therapy and/or medication management.

Behavioral therapy

Behavioral therapy is a vital part of addiction treatment. It helps individuals to identify triggers and develop coping mechanisms to manage cravings and triggers. Cognitive-behavioral therapy (CBT) and contingency management are two types of behavioral therapy that are effective for treating kratom addiction.

Medication treatment

• There is currently no medication that has been approved by the FDA specifically for the treatment of Kratom addiction. However, there are several medications that have been used to manage kratom withdrawal and reduce cravings. These medications include:
• Buprenorphine-naloxone: A medication that is commonly used to treat opioid addiction, buprenorphine-naloxone, also known as Suboxone, has been shown to be effective in managing Kratom withdrawal and reducing cravings.
• Clonidine: This medication is used to treat high blood pressure, but it can also help manage Kratom withdrawal including anxiety, agitation, and sweating.
• Gabapentin: This medication is used to treat nerve pain, but it can also help manage symptoms of withdrawal such as anxiety, insomnia, and restlessness.
• Naltrexone: This medication is used to block the effects of opioids, and it may be helpful in reducing cravings for kratom.

Support groups

Support groups such as Narcotics Anonymous (NA) and SMART Recovery can be helpful for people in recovery from kratom addiction. These groups provide a sense of community, encouragement, and accountability.

Points to Remember

• Kratom is a tropical tree native to Southeast Asia, whose leaves have been used for centuries to alleviate pain, boost energy, and improve mood.
• The legal status of kratom varies by country and states in the United States.
  Kratom can cause a range of effects depending on the dose, strain, and individual. At low doses, it acts as a stimulant, while at higher doses, it can have opioid like sedative effects.
• Kratom can cause nausea, vomiting, constipation, loss of appetite, weight loss, dehydration, seizures, liver damage, kidney damage, respiratory depression, and psychosis.
• Kratom can be dangerous if it is contaminated with other substances, such as opioids or synthetic drugs, or if it is consumed in excessive amounts. Additionally, it should not be used in combination with other substances, such as alcohol or prescription drugs, as this can increase the risk of adverse effects.
• Kratom can be addictive, especially for those who use it frequently or in large doses. Kratom contains compounds that bind to the same receptors in the brain as opioids, which can lead to physical dependence and withdrawal symptoms if use is stopped abruptly.
• Treatment for Kratom addiction typically involves a combination of behavioral therapy and medication treatment. Behavioral therapy helps individuals identify and change the behaviors that led to addiction, while medications may help reduce cravings and manage Kratom withdrawal.

REFERENCES

• National Institute on Drug Abuse
• Mayo Clinic
• Legislative Analysis and Public Policy Association
• The U.S. Food and Drug Administration
• American Kratom Association
• Congressional Research Service