Kratom, formally called Mitragyna speciosa, is a type of tree native to Southeast Asia related to the coffee plant. For centuries, those native to Southeast Asia have chewed on kratom leaves or made a tea from kratom as a stimulant for pain relief. It’s also used in that part of the world to cope with heroin withdrawals.
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As an herbal supplement, kratom is available in the U.S., typically found in smoke shops or online. Instead of the fresh leaf form, it’s usually made with powdered dry leaves sold as tablets or capsules, although sometimes used as a tea. When it goes from fresh leaves to the powdered form, its chemistry and effects may change, says Christopher McCurdy, a medicinal chemist and behavioral pharmacologist who has done extensive kratom research at the University of Florida in Gainesville. McCurdy is a professor and The Frank A. Duckworth Eminent Scholar Chair at UF.
There are a few reasons why people in the U.S. use kratom:
— As a stimulant, even though it doesn’t have caffeine. It serves as a stimulant in low doses but has sedative type effects at higher doses.
— To cope with pain.
— To serve as an opioid substitute. For instance, someone who uses an opioid drug like heroin or oxycodone may decide to try kratom instead. Although kratom is not an opioid, it works on the body’s mu-opioid receptors. However, the U.S. Food and Drug Administration doesn’t support using kratom as a substitute for opioid drugs.
Estimates on the number of people using kratom vary. One 2021 study reported that 0.7% of the U.S. population have tried it over the previous year, but there are much higher estimates in popular media that claim as many as 10 million to 16 million U.S. kratom users.
Is Kratom Safe?
There’s a lot of unknown information about kratom’s effects as it hasn’t been widely studied.
It’s not uncommon for people to buy and try kratom without a clear understanding of its effects, says Dr. Sidarth Wakhlu, a psychiatrist and addiction expert at UT Southwestern O’Donnell Brain Institute in Dallas.
Because it’s available in most states, it’s easy for people to assume kratom is safe. Although not everyone who uses the form of kratom manufactured in the U.S. will get sick from it or addicted to it, there are enough reports of problems that the FDA warns consumers against using it. The warnings against kratom are there because of its potentially serious side effects and the risk for addiction when used at a high level.
“People who use high doses more frequently are more likely to experience adverse effects than those who use low doses infrequently,” says Dr. David A. Gorelick, professor of psychiatry at the University of Maryland School of Medicine in Baltimore and editor-in-chief of the Journal of Cannabis Research. Gorelick’s comments in this story do not represent his university or the journal.
Here are some of kratom’s potential side effects:
— Confusion.
— Constipation.
— Heart effects, such as a faster or slower heart rate. The difference may depend on each individual and the dose used.
— Itching.
— Loss of appetite.
— Nausea.
— Respiratory arrest, which is when you stop breathing.
— Vomiting.
Kratom is also associated with some deaths, according to a 2019 report in the New England Journal of Medicine and another report from 2019 in the Morbidity and Mortality Weekly Report. In Sweden, the combination of kratom with O-desmethyltramadol, a breakdown of the pain reliever tramadol, was associated with nine deaths in 2010.
The majority of deaths reported with kratom are associated with the concurrent use of other substances, such as opioid drugs or benzodiazepines. It’s not always clear which substance caused the deaths or if it was the combination.
Gorelick cautions against using kratom if you have opioid use disorder or are at risk for it, due to the substance’s opioid-like properties.
There also are people who use kratom for years and seem to have developed some tolerance for it, McCurdy says. Still, the lack of knowledge about its interaction with other substances is a red flag, he adds.
Pregnant women should avoid using kratom due to literature reports of neonatal abstinence syndrome, a condition in which newborns experience withdrawal symptoms after they are exposed to drugs in the womb.
Kratom can cause opioid-like withdrawal symptoms, such as:
— Diarrhea.
— Feeling agitated.
— Muscle aches.
— Nausea.
— Vomiting.
Many health providers don’t think to ask about kratom use among patients, and patients often don’t mention it because it’s considered a supplement, Wakhlu says. If you’re seeing a health care provider for medical treatment and are using kratom, let your health care team know, Wakhlu recommends. It’s important that they are aware of it to help you avoid any adverse drug interactions. You can also ask them for help to stop using kratom.
A person who needs help to stop using a substance has several available treatments, Wakhlu says. These include:
— Medications.
— Talk therapy.
— Going to support group meetings, such as Narcotics Anonymous.
These same treatments are available for opioid use disorder, including medications approved by the FDA to treat it.
[READ: 10 Signs of Addiction.]
Is Kratom Legal?
Kratom is legal on a federal level, but the Drug Enforcement Agency considers kratom a drug and chemical of concern. However, kratom is illegal in the following states:
— Alabama.
— Arkansas.
— Indiana.
— Rhode Island.
— Vermont.
— Wisconsin.
Other states specify age restrictions for kratom. In those states, only those over age 18 or 21 can purchase it. There also are some cities and counties throughout the U.S. that have banned kratom.
The FDA hasn’t approved kratom for any specific medical use. Kratom, just like other herbal supplements, doesn’t have to go through strict clinical trials to prove how or why it’s effective. Supplements are more of a gray area clinically because they aren’t as closely evaluated, McCurdy says.
A 2019 report from the FDA found high levels of heavy metals, such as lead and nickel, in a sample of kratom products. Those taking higher doses may get unsafe exposure levels based on their use of kratom, their research found. Heavy metal poisoning can lead to kidney and nervous system damage, among other effects.
[See: Questions Doctors Wish Their Patients Would Ask]
Future Research
Despite its risks, there may be future uses of the drug that can harness its helpful qualities and minimize its riskier side effects, McCurdy says. Although his studies mostly focus on mice and rats, they provide a foundation for future human study models with kratom, he says. He also cites an ongoing study of kratom at the University of Florida to help dogs with osteoarthritis pain.
The National Institutes of Health has funded multi-million studies of kratom and related compounds to better understand how it works and its potential treatment for chronic pain and for opioid use disorder. Its potential to help overcome opioid abuse would be promising for many, according to researchers.
McCurdy has also spoken at both the United Nations and the World Health Organization about kratom, reflecting the world’s interest in discovering more about it.
“There’s a lot of medical potential for this, but we need to understand the benefits versus the risks. That will take some time,” McCurdy says.
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Understanding the Safety of Kratom: A Comprehensive Guide originally appeared on usnews.com
