At low doses, kratom acts as a stimulant and boosts energy. At higher doses, it reduces pain and may cause euphoria.
But it’s not without risks. And doctors should carefully consider these before recommending it to patients. This is particularly true for those who have opioid use disorder. Healio Family Medicine reports.
Bioavailability
Kratom (Mitragyna speciosa) is a tropical tree with dozens of active components that have properties that range from stimulant-like, energizing and uplifting to opiate-like, producing drowsiness and euphoria. At higher doses, it acts as an opioid by binding to and activating the opioid receptor system, which results in a wide array of effects including pain relief, anxiety reduction and feelings of euphoria.
The most potent chemicals in kratom are mitragynine and its derivative, 7-hydroxymitragynine. Both compounds have a high affinity for the main opioid receptor, the mu receptor, and at very high doses produce sedation, drowsiness and euphoria. They also show high affinity for the norepinephrine and serotonin receptor systems, which may account for some of kratom’s stimulating effects.
While kratom’s advocates argue that it can help people quit opioid use, some of its side effects are dangerous and even deadly. A 2008 report in Addiction by Edward W. Boyer and colleagues of the Division of Medical Toxicology at University of Massachusetts Medical School described a 43-year-old man who had a generalized tonic-clonic seizure after taking 10 mg of hydromorphone from crushed pills purchased from kratom vendors.
The FDA has made it illegal to sell kratom as a dietary supplement in the US, but it can still be found at gas stations and paraphernalia shops, as well as on the Internet, where it is advertised for soap-making and aromatherapy. The American Kratom Association has attempted to self-police, withholding details of more than 75 companies from public view when they make unsupported therapeutic claims.
Mood Enhancement
While kratom has been used by millions of Americans for thousands of years, researchers have recently renewed interest in its potential for mood enhancement. The plant is known to contain alkaloids that have opioid and stimulant-like effects, as well as anti-anxiety properties.
In a recent study, scientists examined the impact of a purified kratom alkaloid on brain circuit activity in rats. The researchers found that kratom increased neuronal oscillations in brain regions associated with pain perception, reward and memory. In addition, kratom altered the way neurons communicate with each other, triggering changes in brain cell function.
These results support previous studies that have linked kratom use to feelings of contentment and pleasure. They also highlight the importance of more research into kratom’s long-term effects, particularly because unregulated products can be contaminated with metals and harmful bacteria.
Despite these concerns, kratom remains popular in the United States. People report using it for pain relief, mood improvement and energy. They also use it to help manage drug withdrawal symptoms and as a substitute for more harmful opioids.
Primary care providers should be cautious about recommending kratom to their patients. They should ask if they’re using it for recreational purposes or to treat a medical condition. If the answer is yes, they should remind them that FDA-approved medications like buprenorphine, methadone and naltrexone can provide effective treatment for opioid use disorder.
Digestive Comfort
Despite a lack of regulatory oversight, kratom is widely available in the US and has been associated with serious health outcomes including opioid overdose and death. The FDA states that it has not approved any drug products containing mitragynine or its two main alkaloids (mitragynine and 7-hydroxymitragynine) for any medical use. The agency also warns that kratom is not safe for oral administration and can be toxic to the liver when taken in high doses. The FDA’s concerns about kratom’s potential for abuse and dependence are based on an extensive body of literature, including a number of human studies that have been limited to self-report and case reports of people using various kratom products with differing alkaloid content.
Although participants acknowledged the unknown of long-term kratom effects, they generally emphasized benefits that outweigh perceived risk. They reported consuming different strains of kratom throughout the day, focusing on those that provided energy and euphoria without sedation or anxiety. Some ate kratom leaves, while others preferred capsules, powders and extracts. Some reported purchasing their kratom from vendors they trusted based on their adherence to good manufacturing practices and their claims of lab-tested, quality products.
It is important to note that kratom does not show up on standard drug tests, which can make it easy for individuals to hide or rationalize their usage. If someone you know is using kratom, encourage them to get help for their addiction or work with a mental health professional to address anxiety. Patients with opioid use disorder have access to FDA-approved treatment options that include buprenorphine, methadone and naltrexone.
Safety
Kratom may contain alkaloids that can bind to opioid receptors in the brain, leading to physical dependence and addiction. It also has stimulant properties. It can cause nausea, sweating, tremors, and hallucinations. Kratom is banned in many countries because of these side effects. However, researchers have found that kratom can treat opioid withdrawal symptoms and pain associated with cancer. It also is used as an antidiarrheal, a cough suppressant, and an appetite booster.
It does not show up on standard drug tests, making it more appealing to people who want to avoid testing positive for alcohol or other drugs. This could lead to use among children. It is important to know what a person is taking and how much, and to use it responsibly.
An expert in the field says that if someone is using it recreationally, they should make sure they are obtaining it from reliable sources. They should also always have a sober friend with them while they are using. It is not uncommon for kratom products to be contaminated with opioids such as fentanyl. It is important to be aware of this risk and to carry fentanyl test strips and naloxone when using kratom.
Despite what the DEA and FDA say, a large number of kratom users do not experience serious negative effects. The website Erowid reports that for every 13 reports of bad experiences with kratom, there are 19 positive ones. This isn’t a scientific study, and it does not take into account people who report only about alcohol or other conventional psychoactive drugs, but it does suggest that negative outcomes are rarer with kratom than with some other, more familiar substances. Kratom capsules