Kratom

What is Kratom?

Kratom is a psychoactive plant also known as Mitragyna speciosa. Its latin name comes from the fact that its leaves resemble a miter. It has been used in herbal medicine for at least a couple of centuries and is possibly the most widely used drug in Thailand.^[1] Although there are anecdotal reports on supposed benefits there are limited studies to support this. To prepare it for consumption, Kratom leaves are often dried. It can then be chewed or crushed to brew tea. It is also available in capsules or pills.^[2] Kratom has been used traditionally to relieve pain, increase energy and appetite.^[3] It has also been used for asthma, cough, deworming, diarrhea, fever and stomach ailments. Sometimes even to prolong sexual intercourse.^[4] Kratom is increasingly gaining popularity in western countries in Europe and North America where it is used as a nootropic. There are some indications that Kratom may be detrimental to your health, as such Kratom is illegal in some countries.

Where does Kratom come from?

Mitragyna speciosa grows in Southeast Asia from Myanmar through Malaysia to Papua New Guinea but can be cultivated anywhere under the right conditions.^[1] It was first described a Dutch botanist by the name of Pieter Korthals in 1839. It has been renamed several times before being given its current and final name mitragyna speciosa by George Darby Haviland in 1859.^[4] It has not only been used as traditional medicine but it also played a part in the culture and religion of Thailand.

What are the effects of Kratom?

Kratom has been used to treat a wide range of afflictions with varying success. Like with ashwagandha the effects of kratom must be attributed to a broad spectrum of different molecules. The main active compounds are different alkaloids of which at least 25 have been identified, including mitragynine and 7-HMG. ^[5] Some of these compounds are known to interact with the body’s serotonin and adrenaline system. Thereby having stimulant and depressant effects, producing sedation, pleasure and decreasing pain.^[6][7] Kratom has also shown promise in animal studies on alcohol^[8] and opioid withdrawal,^[9] pain suppression^[10] and opioid tolerance prevention.^[11] Kratom effects are different among different species of mitragyna speciosa and are dose dependent. Therefore the alleged effects might differ from product to product.^[5]

How to use Kratom?

Kratom is available in various forms, as supplemental pills, finely ground plant material or even dried leaves. Pills have the easiest way to dose but a limited ability to be finetuned. Powders seem to be the most widely available. Whole leaves are hard to come by in a lot of places. Powders are popularly used to brew tea which will have a very bitter taste. It can therefore be favorable to mix it with a flavoring like lemon juice or honey. All kratom forms can differ in effects from strain to strain which has to be considered accordingly.

How much Kratom to use?

User experience reports on kratom indicate using a teaspoon dose which corresponds to between 2 and 4 grams of powder. Higher doses ranging from 5 to 15 grams will have different effects. Potentially more anesthetic; comparable to other opiods like morphine or hydrocodone. Higher doses are also associated with more side effects and risks like addiction and withdrawal.

What are the side effects of Kratom?

Users report various side effects associated with frequent or high dose kratom use, ranging from mild to very serious. Common side effects include appetite loss, constipation, erectile dysfunction, nausea. More serious side effects can include addiction, decreased breathing, seizures and psychosis. Prolonged use of kratom can negatively impact liver function possibly leading to hospital admission.^[12] Furthermore it can lead to, amongst others, anorexia, insomnia, tremors, hallucinations and paranoia.

Interactions of Kratom

There are several substances which have dangerous interactions with kratom, some of which have led to fatalities in the past. Avoid combining kratom with carisoprodol, modafinil, propylhexedrine, datura stramonium, fentanyl, diphenhydramine, caffeine, morphine, O-desmethyltramadol, alcohol, amphetamines, benzodiazepines, nitrous and tramadol.^[13][14] Grapefruit can affect the metabolism of certain opioids and may increase the duration and toxicity of a kratom dose.

1. [1] Rech, M. A., Donahey, E., Cappiello Dziedzic, J. M., Oh, L., & Greenhalgh, E. (2014). New Drugs of Abuse. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 35(2), 189–197. https://doi.org/10.1002/phar.1522
2. [2] Hassan, Z., Muzaimi, M., Navaratnam, V., Yusoff, N. H., Suhaimi, F. W., Vadivelu, R., Vicknasingam, B. K., Amato, D., von Hörsten, S., Ismail, N. I., Jayabalan, N., Hazim, A. I., Mansor, S. M., & Müller, C. P. (2013). From Kratom to mitragynine and its derivatives: Physiological and behavioural effects related to use, abuse, and addiction. Neuroscience & Biobehavioral Reviews, 37(2), 138–151. https://doi.org/10.1016/j.neubiorev.2012.11.012
3. [3] Cinosi, E., Martinotti, G., Simonato, P., Singh, D., Demetrovics, Z., Roman-Urrestarazu, A., Bersani, F. S., Vicknasingam, B., Piazzon, G., Li, J. H., Yu, W. J., Kapitány-Fövény, M., Farkas, J., di Giannantonio, M., & Corazza, O. (2015). Following
4. [4] Raffa, R. B. (2014). Kratom and Other Mitragynines: The Chemistry and Pharmacology of Opioids from a Non-Opium Source (1st ed.). CRC Press.
5. [5] Warner, M. L., Kaufman, N. C., & Grundmann, O. (2015). The pharmacology and toxicology of kratom: from traditional herb to drug of abuse. International Journal of Legal Medicine, 130(1), 127–138. https://doi.org/10.1007/s00414-015-1279-y
6. [6] Correction to Orally Active Opioid µ/d Dual Agonist MGM-16, a Derivative of the Indole Alkaloid Mitragynine, Exhibits Potent Antiallodynic Effect on Neuropathic Pain in Mice. (2019). Journal of Pharmacology and Experimental Therapeutics, 369(1), 142. https://doi.org/10.1124/jpet.112.208108err
7. [7] Pantano, F., Tittarelli, R., Mannocchi, G., Zaami, S., Ricci, S., Giorgetti, R., Terranova, D., Busardò, F., & Marinelli, E. (2016). Hepatotoxicity Induced by
8. [8] Cheaha, D., Keawpradub, N., Sawangjaroen, K., Phukpattaranont, P., & Kumarnsit, E. (2015). Effects of an alkaloid-rich extract from Mitragyna speciosa leaves and fluoxetine on sleep profiles, EEG spectral frequency and ethanol withdrawal symptoms in rats. Phytomedicine, 22(11), 1000–1008. https://doi.org/10.1016/j.phymed.2015.07.008
9. [9] Khor, B. S., Amar Jamil, M. F., Adenan, M. I., & Chong Shu-Chien, A. (2011). Mitragynine Attenuates Withdrawal Syndrome in Morphine-Withdrawn Zebrafish. PLoS ONE, 6(12), e28340. https://doi.org/10.1371/journal.pone.0028340
10. [10] Shaik Mossadeq, W., Sulaiman, M., Tengku Mohamad, T., Chiong, H., Zakaria, Z., Jabit, M., Baharuldin, M., & Israf, D. (2009). Anti-Inflammatory and Antinociceptive Effects of Mitragyna speciosa Korth Methanolic Extract. Medical Principles and Practice, 18(5), 378–384. https://doi.org/10.1159/000226292
11. [11] Fakurazi, S., Rahman, S., Hidayat, M., Ithnin, H., Moklas, M., & Arulselvan, P. (2013). The Combination of Mitragynine and Morphine Prevents the Development of Morphine Tolerance in Mice. Molecules, 18(1), 666–681. https://doi.org/10.3390/molecules18010666
12. [12] Kapp, F. G., Maurer, H. H., Auwärter, V., Winkelmann, M., & Hermanns-Clausen, M. (2011). Intrahepatic Cholestasis Following Abuse of Powdered Kratom (Mitragyna speciosa). Journal of Medical Toxicology, 7(3), 227–231. https://doi.org/10.1007/s13181-011-0155-5
13. [13] Holler, J. M., Vorce, S. P., McDonough-Bender, P. C., Magluilo, J., Solomon, C. J., & Levine, B. (2011). A Drug Toxicity Death Involving Propylhexedrine and Mitragynine*. Journal of Analytical Toxicology, 35(1), 54–59. https://doi.org/10.1093/anatox/35.1.54
14. [14] Nelsen, J. L., Lapoint, J., Hodgman, M. J., & Aldous, K. M. (2010). Seizure and Coma Following Kratom (Mitragynina speciosa Korth) Exposure. Journal of Medical Toxicology, 6(4), 424–426. https://doi.org/10.1007/s13181-010-0079-5