Over the last week, I’ve had a handful of patients entering opioid addiction treatment tell me they were taking kratom along with other opioids. For the most part, these patients say they use kratom as a back-up when they can’t find other opioids, in order to ward off opioid withdrawal.
Patients say they buy it online or at head shops. Most say they buy it in a powdered form, to dissolve into hot water and drink as a tea, or take capsules packed with the greenish powder. Some patients say liquid forms of kratom are also available.
I’ve blogged about kratom before, but only in the last few weeks have I seen patients who have used it.
Kratom (also called ketum or kratum) is a tree in the genus Mitrogyna, which is related to the coffee tree, and found in Southeast Asia. Kratom leaves have been used for thousands of years by natives of the area to produce stimulant and opioid effects. Fresh leaves can be chewed, or broken up to make a drink, or steeped in hot water to make a tea, as described above. Dried leaves can be smoked by users, who say low doses of kratom cause a stimulant effect. Higher doses are said to cause sedation.
Kratom’s active ingredient is mitragynine, which activates the mu opioid receptor in the human brain to cause an opioid-like effect. Like other opioids, this compound in the kratom tree relieves pain and causes euphoria. Some rat studies demonstrated more potent analgesia from mitragynine than morphine. It’s structurally different than other opioids, and unlikely to show as an opioid on traditional drug testing.
Rat studies also showed less respiratory depression than other opioids, possibly be due to kratom’s activity at the kappa opioid receptor. This drug also has adrenergic and serotonergic activity, so it has a complicated method of action. The increased adrenergic effect of the drug may give users a feeling of energy, like the other stimulants cocaine and amphetamines. This property has led some people to say kratom could be a treatment for methamphetamine addiction.
Because of its opioid-like effects, kratom can be used recreationally for the high it produces.
If you google “buy kratom,” more than a million websites appear, offering to sell all sorts of varieties of kratom, and extolling its properties of, “Pain relief, Energy, Prolonged Sexual Intimacy, and Mood Support.” The websites attempting to sell kratom say it’s safe because it’s natural, and that it is a treatment for both pain and addiction.
So is it safe?
First of all, just because a substance is found in nature does not mean that it is safe for human consumption. That’s ridiculous. Plenty of plants, herbs, and other substances found in nature are harmful, even lethal. Hemlock, deadly nightshade, castor bean, oleander…those are a few that come to my mind.
Secondly, “natural” does not mean non-addictive In fact, many of our addicting drugs are derived from nature, like opium, cocaine, alcohol, and nicotine. We learned to concentrate the active ingredients over the years to make them even more addictive.
We don’t have safety data on whether kratom is safe or not, because we don’t have studies about this substance. Like so many medications that are derived from plants, it is possible the mitragynine found in this plant could have helpful properties, and I would favor further investigation. But right now, we don’t have information about safety. For further reading, I’d suggest this excellent review article: http://www.hindawi.com/journals/bmri/2015/968786/
As above, there has been some suggestion in animal studies that mitragynine causes less respiratory depression, so it is possible it’s less risky than other mu opioids.
If you go online, you can find testimonials from people saying it helps them with pain and addiction.
Also consider that there’s no quality control of the stuff being sold as kratom. Online or in head shops, what’s labelled as kratom may or not contain kratom.
For the patients I’ve seen, they appear to use kratom as one opioid of many, and I haven’t heard any of them say it’s helped them come off of opioids. (But then, I wouldn’t expect to see people with that experience, would I? If a person was able to stop opioids with kratom, they wouldn’t come to an opioid addiction treatment center.)
To me, kratom seems like another opioid-like substance with the potential to cause addiction, and there’s no way to know what you are really buying, either online or at head shops.