Mitragyna speciosa, commonly referred to as kratom, is a tropical evergreen tree that is native to Southeast Asia, specifically to Indonesia, Malaysia, Myanmar, Thailand, and Papua New Guinea, and elsewhere in the Pacific Rim. The word ‘Kratom’ originated in Thailand, and is synonymous to Biak-biak, Ketum, Kakuam, Krypton, Ithang, and Thom.

The structural and molecular formula of Kratom:

Mitragynine and 7-Hydroxymitragynine

C23H30N2O4 and C23H30N2O5

About The Kratom Plant

M. Speciosa can grow to a height of 82 feet or 25 meters. Its trunk can grow to a diameter of three feet or 0.9 meter. The trunk is straight and the outer bark is grey and smooth. The leaves are glossy and can grow 7 to 12 cm (2.8 to 4.7 inches) wide and 14 to 20 cm (5.5 to 7.9 inches) long when fully open. The dark green leaves are opposite in growth pattern and ovate-acuminate in shape, with 12 to 17 pairs of veins. The deep yellow flowers generally grow in clusters of three. The calyx-tube has five lobes and is 2 mm (0.08 inches) long; the corolla-tube is 2.5 to 3 mm (0.098 to 0.12 inch) long.

Kratom was first formally described in 1839 by Pieter Korthals, the Dutch colonial botanist who named the tree as such. It was renamed and reclassified a number of times before British surgeon and naturalist Dr. George Darby Haviland gave the final name and classification in 1859. Since the start of the 21st century, kratom has significantly increased in visibility throughout the world. Regular users consider it as an indispensable aid for physical and mental health. Others enjoy its recreational value, both as a stimulant and sedative-narcotic.

Traditional Use

Kratom is a member of the Rubiaceae family, along with coffee and gardenia. It is very bitter so it is usually combined with a sweetener. It has been used in traditional medicines since the 1800s and is now considered as an emerging herbal drug. It has some stimulant-like effects and exhibits opioid properties. Hence, there is potential for abuse. The leaves in particular contain substances with psychotropic or mind-altering effects. They are chewed to ease musculoskeletal pain, increase appetite, energy, and libido in ways similar to coca and khat. Extracts and leaves are used as local anesthetic and also to treat wounds. They have also been used to treat cough, loose bowel movement as well as intestinal infections. Kratom is even used by workers in monotonous or arduous professions to withstand exhaustion, enhance mood and as a painkiller. Peasant workers in Thailand have been known to munch on the leaves up to ten times a day while working under the sun.

The leaves are plucked by hand and consumed by chewing, boiling into a tea, drying and smoking, or by placing into capsules and tablets. The effects are unique because stimulation takes places at low doses, while euphoric and opioid-like depressant effects occur at higher doses. More recently, it is being taken for recreational purposes. The effects normally start to kick in within five to ten minutes and typically last for two to five hours.

Kratom for Opioid Withdrawal

Aside from the aforementioned uses, kratom is reportedly effective in preventing withdrawal from opiates like heroin or prescription narcotics. In 1836, it was first reported that kratom is being used as an opium substitute in Malaysia. It was also being taken as an opium substitute in Thailand since the 19th century. 

Data on how frequently kratom is used globally are lacking, since it is not detected by drug-screening tests. However it appears that the rate of use is increasing, particularly among people who have been treating chronic pain with opioids bought without prescription and are merely cycling their use. As of the time of this writing, there have been no official tests to determine the safety and/or efficacy of kratom when it comes to managing opioid addiction.

Recreational Use

Starting in 2010, a tea-based cocktail called 4×100 became extremely popular among teenagers across Southeast Asia, particularly in Thailand. It is a mixture of kratom leaves, Coca-Cola, cough syrup, and ice. The following year, those who consumed the cocktail were often perceived more negatively than users of the classic kratom. In 2012, the use of 4×100 became a serious issue among young people in three provinces situated along the border with Malaysia. In the United States, as of 2015, kratom can be purchased in head shops and online. However, the prevalence of its use was unknown at that time.

History and Statistics

It is not certain when the actual use of kratom started, but the practice is believed to be ancient. Amid the growing interest about kratom’s medicinal potential, the bioactive component mitragynine was isolated by scientists in 1921 and tested more than a decade later on humans (1932). It was compared to cocaine because of its stimulant effects on the brain.

In the early 1940s, the Thai government saw a huge drop in opium tax revenue. It was quite evident that drug addicts have turned to kratom to deal with their withdrawal symptoms. Consequently, The Kratom Act was passed in August 1943. It made the planting of kratom illegal across Thailand, while existing trees in the plantations and marsh jungles can be cut down. However, many of the impoverished classes in the southern section of the country continued to pick and use the leaves. These were also sold illegally to other regions but most of the workers kept them for their personal use. 

Elsewhere, the interest from the scientific community prevailed. At least 20 alkaloids were successfully isolated during the 1960s. In 1994, scientists identified kratom’s second primary active compound: 7-hydroxymitragynine. The following year saw yet another breakthrough: the first synthesis of mitragynine.

Public awareness about kratom grew throughout the early 2000s, mostly via online forums and message boards. However, in 2005 Australian authorities banned the sale of both M. speciosa and mitragynine. Possession without a license was likewise prohibited. At about the same time, the government of Thailand ramped up the enforcement of the Kratom Act, with records showing that police arrests quintupled from 2005 to 2009. Three years later, Thai officials ordered the destruction of kratom trees in Satun Province, but the locals defied their attempts.

In the United States, a number of advocacy groups, including the American Kratom Association, the United Kratom Association, and the Botanical Education Alliance have stood their grounds and fought to ensure kratom’s legality. This forced the Drug Enforcement Administration (DEA) to withdraw a “notice of intent” to put kratom into Schedule I of the Controlled Substances Act.

As of 2013, kratom has been studied both in animals and human cells. However, no substantial clinical tests have been performed in the United States. A 2007 survey in Thailand found that the lifetime, past year, and past month usage prevalence of kratom were 2.32 percent, 0.81 percent, and 0.57 percent respectively. The survey was conducted among respondents aged 12 to 65 years. These findings made kratom the most widely used drug in Thailand.

To date, Kratom is not listed as an illegal substance and is relatively easy to order online. It is sometimes marketed as a green powder in packets although with labels clearly indicating “not for human consumption.” Kratom is also occasionally sold as a gum or extract.

Little remains known about the real value of kratom or its safety as a herbal drug, since studies into its use are generally of sub par quality. The United States’ Food and Drug Administration (FDA) stated in February 2018 that there is no definitive evidence suggesting that kratom is safe or effective as a therapeutic agent for any condition. 

Kratom Side Effects

The common documented side effects include constipation, nausea, and vomiting. More serious side effects include addiction, psychosis, seizure, and respiratory depression in the form of decreased breathing. Other side effects include high heart rate (tachycardia), high blood pressure (hypertension), insomnia, and rarely, liver toxicity. Withdrawal symptoms can occur once use is stopped.

At low doses – approximately 1 to 5 grams of raw leaves – at which stimulant effects have been reported, the side effects include blushing and contracted pupils. Adverse effects associated with stimulation include agitation and anxiety, as well as opioid-related effects like nausea, skin irritation, polyuria (frequent urination), and loss of appetite.

At moderate doses (5 to 15 grams of raw leaves) and higher, at which opioid effects usually appear, additional adverse effects include constipation, dizziness, dry mouth, hypotension, tachycardia, and sweating.

Frequent use of high doses can cause anorexia, weight loss, tremors, psychosis, and seizures. If frequent users stop using kratom, they may suffer from withdrawal symptoms like diarrhea, feelings of distress, hypertension, irritability, insomnia, nausea, muscle and joint pain. 

Severe toxicity is quite rare and typically appears at high doses or when users mix kratom with other substances.

Fatalities have been reported with kratom, both by itself and when it is mixed with other substances. In the United States the FDA reported 44 kratom-related fatalities between 2011 and 2017. One of the deaths involved kratom alone. In Sweden, nine kratom-related fatalities were documented in 2011 and 2012. All of the cases involved a mixture of kratom and other opioids.

There is currently a global concern regarding a potential risk to public health from the use of kratom. In some jurisdictions, its importation and sale have been restricted, and a number of public health officials have already raised alerts. In 2014, the United States FDA prohibited the importation and production of kratom as a dietary supplement. The finished product is sometimes mixed with other psychoactive substances like codeine and caffeine. A total of 16 countries have now listed Kratom as a controlled substance.

The Centers for Disease Control (CDC) issued a report in July 20166 stating that during the period between 2010 and 2015, poison control centers across the U.S. received 660 reports of kratom exposure. The medical outcomes related to such exposures were reported as minor for 162 or 24.5% of the cases. These involved minimal signs or symptoms that resolved quickly with no residual disability. Moderate exposures accounted for 275 or 41.7% of the cases, which are non-life-threatening but required some form of treatment. Major exposures accounted for 49 or 7.4% of the cases, which are life-threatening and had some residual disability. 

Kratom overdoses are managed in the same way as opioid overdoses. Naloxone is the drug of choice when treating an overdose, in spite of mixed results for its efficacy based on animal studies.

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