Kratom

From wikipedia

Kratom:  From Wikipedia

In the last few years there has been an explosion in the use of an herb known as kratom here in the U.S.  Kratom comes from a tree common to South East Asia where it has been traditionally used for centuries.  Mitragyna speciosa comes from the same family of plants as coffee (Rubiaceae) and has been commonly used as a stimulant (in low doses), a sedative (in high doses), an analgesic, for its euphoric qualities, to reduce dependence on opiates, for increased concentration and to improve mood and wellbeing.

Kratom is easily obtainable at “head” shops and via the internet and many people are turning to this plant as an alternative to prescription based opiates , for pain relief and for recreational reasons.   As a therapist and an herbalist  I have increasingly worked with people who are taking this herb and have seen its effects, both positive and deleterious in the community.  The internet has an enormous amount of content in the form of blogs, sales and informational sites.  I also personally have an interest as I grew up partially in Thailand and the herb is from a tree that grows indigenously there.

In this article I want to explore this plant from a scientific perspective, from the vantage of a traditional herbalist and from a personal point of view as well.

 

Traditional Uses

 

Kratom is found throughout South-East Asia and IndoChina and is a deciduous tree that grows upwards of 50 feet high.  On the tree, oval leaves up to 7 inches long grow opposite each other and deep yellow flowers grow in clusters at the end of leaf axils.   The calyx of the inflorescence is cupped and rounded.

Traditionally, Thai people (especially from the South of the nation)  take kratom by stripping the leaves of its stem and generally chewing up to 50 of them a day.  This is peasant medicine and is usually consumed by laborers who work long hours in the field as a way to gain energy and to reduce pain.   They have also used it in traditional medicine formulas such as  teas for reducing diarrhea, as an anti diabetic, a cough suppressant, for intestinal deworming, pain management and for help in coming off of opiates.

The Thai government made kratom illegal in 1943, most likely due to its opiate like qualities and because it interfered with the illicit opium trade, of which the government made a handsome profit  via levies and taxes.  Thailand continues to prohibit this plant and in modern times it has become extremely popular with the Muslim community in Southern Thailand and with insurgents who commit terrorist activities.  Because of this the Thai government has tried to eradicate and cut down Kratom forests in Southern Thailand, angering the local environmentalists.

It is estimated that upwards of 94 percent of teenagers now consume kratom regularly in southern Thailand and that the consumption of kratom throughout South East Asia is widespread.

 

Modern Uses

 

Because it has not been made illegal in Europe and the U.S., kratom began to be shipped to the States in large amounts in the last decade and has made its way into Head shops and online retail stores.  There has been an explosion in use just in the last few years but still remains under the radar for most people, including health care practitioners and herbalists.  Though I have heard about it as a Thai herb for many years, I first started hearing about it as a popular U.S. herb in my work as a therapist in a psychiatric hospital setting.   I discovered that many of the people addicted to opiates such as vicodin, percoset and heroin had also been using kratom.

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One man told me how he quit heroin with the help of the herb but ended up becoming heavily addicted to kratom, consuming up to 30 grams a day (normal doses are around 2-5 grams).  He said that coming off kratom lasted longer and included more anxiety that a regular opiate detox and felt that a kratom detox was equally as bad.  I also met several people who extolled the virtues of kratom, saying that it had help them manage pain, anxiety and to avoid opiate dependence.  The feeling I got that is if one avoided taking large doses a day, that kratom was seen as an effective medicine in lieu of western pharmaceuticals.

It is important to mention that the primary way of managing pain in this country is through the consumption of a variety of pharmaceutical drugs.   Prescriptions for opiate medications such as vicodin and percoset have soared from 76 million in 1991 to 241 million prescriptions in 2014.  ERs throughout the country see more than 800,000 people every year due to prescription  opioid abuse.  The latest statistic in 2010 show there were 16,651 deaths attributed to opiate overdosing.   Over 2 million Americans abuse and/or have a dependence on prescription opiates and in 2012, we spent 8.34 billion dollars on opioid prescriptions.

In this environment, medical professionals and those in need of pain management or looking for a recreational high have been searching for alternatives to opiates that are easily addictive, often ineffective after tolerance is built and too often quite deadly.   Kratom has become popular not only due to its opiate like effects but also because it appears to not be deadly, with a marked dosage “cut-off” point where it induces nausea and vomiting.  There have been no reported deaths associated with kratom use alone (though there are some murky cases that appear to involve poly-pharmacy).  Because of this, kratom is seen as a far less dangerous substances that prescription opiates.  However, high doses have been shown to cause severe sedation, confusion and psychosis in some people.

Pharmacology

 

There has been quite a bit of research done on kratom , its complex pharmacological constituents and effects. Over 25 alkaloids and active compounds have been isolated from kratom and many exhibit analgesic, antitussive, immunostimulant, opiate, antihypertensive and sedative properties.  Two of the most active ones include the alkaloids mytraginine and 7-hydroxy-mytraginine.  Both of these alkaloids have strong opiate receptor affinity.  Activity here leads to strong pain relieving effects.  It also blocks 5-HTP receptors and activates noradrenergic and serotonergic pathways in the spinal cord.  Finally, mytraginine also stimulates adrenergic receptor sites, eliciting a sympathetic response and giving kratom its stimulating effect.

7-hydroxy-myrtaginine is found in very small amounts in kratom leaf but has 13 times the potency of morphine.  Together these main constituents, along with a number of other ones help cause its analgesic effect.  Interestingly, these main alkaloids have a similar morphology to the hallucinogenic trytamines (LSD, psilocybin) but work on different pathways from those chemicals.

Because of the ability of some of its constituents to bind opiate receptors, its addictive potential is also apparent.  When people stop taking kratom after consuming it for a period of time, similar withdrawal problems akin to opiate withdrawal will happen, including increased anxiety, pain, insomnia, cravings and depression.  Similar to opiates, kratom also causes constipation and is a traditional medicine for those who have diarrhea.  The half life of these main constituents with opiate like affinity is about 3.5 hours.  That means the duration of the main effect is about 5-7 hours.   Other active alkaloids have shorter half-lives.  Kratom does not show up on any drug screen as they are not true opiates, but simply bind to opiate receptor sites.

Besides these psychoactive constituents, kratom also contains epicatchin, one of the most potent antioxidants also found in green tea and dark chocolate.  Antioxidants are known for their ability to inhibit oxidation and reduce the risk of degenerative illnesses.

Herbal Energetics

 

Though this has been used commonly as an herb in Thailand for many centuries, it has only become commonly known in the West for the last ten years.  Because of this, herbalists have not become acquainted with it greatly and are still researching its properties.   There are a number of different varieties of kratom leaf with their own specific properties.  Kratom can generally be categorized into country of origin (Bali, Indonesia, Thailand) and three main groups-  red , green  and white leaf.  Green and white leafed kratom tend to be more energizing and stimulating and some say that green is especially useful for those with anxiety and depression.  Green strains tend to be powerful and long lasting.  White strains tend to be the most energizing and last the shortest time.  Red vein leaf varieties are more sedating and these varieties are more commonly used for detoxing off of opiates.

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Maeng Da variety of Kratom

Most varieties will cause an effect that lasts between 3 to 6 hours with some extending their effect for 8 hours.  Peruse an internet site and you will find mention of dozens of varieties.  Like marijuana, each varietal is extolled for its particular virtue (longer effect, more sedating or stimulating, etc.)   Popular varieties include Maeng Da, Green vein Bali, white vein Thai, etc.

The herb is sold primarily in powder form where it can be consumed in capsules or added as a powder to drinks.  It is also sold as a crushed leaf that is consumed as tea.  Tea is usually made by adding the leaves to hot water and then simmering for 15 minutes.  This is sometimes repeated 2 to 3 times.  The tea is boiled down to a small cup so that it can be consumed quickly as it is very bitter.

Dosages range from 2-15 grams per use.  1-3 grams is a small dose, and often causes more stimulating effects at that level.  4-6 grams is a moderate dose, 7-10 grams is a strong dose and anything after that is extremely strong (except in the case of habitual users) .  Strong doses not only tend to be sedating but can bring on heightened states of euphoria. There is also increasing potential for nausea and vomiting as the dosage increases.    Tolerance to the herb grows quickly and most people do not feel its euphoric effects if taken daily.

Finally, the internet is now rife with wholesale sellers of both the powder as well as extracts, usually in resin and tincture form.  Extracts  are high potency concentrates usually made by boiling down , purified and tinctured to make the kratom highly potent.  Usually, the leaf is boiled in water until it is evaporated off, leaving a paste that is highly concentrated with pharmacologically active alkaloids.  The extract then is made into a powder, a resin, a tincture or an oil.   Those who study the pharmacology of the plant promote extracts that carry a full spectrum of the active constituents in proper balance, or what is known as a Full Spectrum Balance extract.  The potencies are often designated by 1x, 5x, 10 x, 15 x and higher.   15 x would mean that the plant has been reduced from 15 grams of leaf to one gram of extract.  Extracts are notably potent, addictive and often carry a much higher risk of side effects and complications, especially if taken with other drugs or alcohol.

 

Personal Experience

 

After hearing about the common use of this plant, and seeing that it was both legal and not dangerous in low doses (if one doesn’t drive), I decided to buy some to test it out myself.  I purchased Maeng Da, a green leaf variety known for its potency.  I bought it from a small herb store in the Hawthorne district in Portland.  The owners said they were unable to discuss kratom due to the potential for the FDA to crack down.  There have been cases of recent confiscations of kratom by the government and a couple states that have partially made it illegal.  I bought a 1 ounce bag (28 grams) for 15 bucks.  Prices and effectiveness of the herb vary considerably and there is quite a bit of discussion on line about the best place to buy, the potency of each product, etc.

I then placed four grams of the powered herb in capsules and took them on an empty stomach (as has been suggested.)  The kratom took effect within an hour and started out as a low level stimulation and a feeling of smoothness and slight visual brightness, as if there was a level of gloss on the world around me.  I went walking through a park and sat down next to a tree.  By hour two the effects were much more noticeable, with a sense of pleasure, relaxation and a heightened feeling of sensing the beauty in the world around me and some opiate like sensations (though I haven’t been in pain lately).   Within the next hour I could sense a burgeoning but subtle feeling of euphoria that diminished by the end of the hour.   Afterwards and for the next few hours, the effect diminished but continued to last as a sense of relaxation and general pleasure.  I did not feel inhibited cognitively, and my physical abilities were not diminished.  I could easily carry on a conversation and never felt overwhelmed.

That night I slept very well but I did notice a small “hangover” the next day in the form of some mildly increased anxiety and irritability.  From my “experiment” I can well understand why people are interested in taking kratom as it certainly produces analgesic, sedative and even euphoric effects at moderate doses.  At the same time, from the reports I have heard from some, I can also understand its addictive potential.  Because it seems unlikely to be extremely toxic and deadly, I think it would be unwise to make it illegal, though I would be extremely cautious of extracts, which seem to me akin to much more potent and concentrated pharmaceutical drugs.

Contraindications

 

There is very little besides anecdotal information about the contraindications of this herb but I would avoid if taking other pharmaceutical medications in general and especially  avoid when taking opioid drugs, benzodiazapenes, tranquilizing agents, alcohol, narcotics, z-drugs and other sleeping pills or when pregnant or breast feeding.  Long term and chronic use of this herb is associated with dependence and usual opiate like withdrawal effects.

 

Final Thoughts 

 

As someone who has worked in clinical areas and in private practice as a therapist I have seen a lot of people with high degrees of pain management issues as well addiction issues.  Opiate prescription and dependence is extremely common and is a major problem in the US.   As an herbalist I generally promote gentle nourishment with the help of good diet and nourishing herbs, along with lifestyle and exercise habits that promote pain relief primarily.  There are also numerous analgesic, anti-inflammatory, circulatory and nervine herbs that can be helpful on a short term basis for pain without the more complex dependency and side effect issues of kratom.  Some of these include jamaican dogwood, devil’s claw, turmeric, cramp bark, feverfew, ginger, licorice, bleeding-heart and california poppy.

However, for some people, they may feel that the stronger effect of kratom is warranted and needed, especially for intermittent use as one of many tools for managing pain.   Some may also choose to take it simply for recreational enjoyment.  We are a culture with complex feelings about using plants and plant extracts for pleasure.  While we endorse coffee ( a botanical relative of kratom), alcohol and now marijuana, we are not comfortable with addictive plant extracts like cocaine and heroin.  Kratom straddles the line in being habit forming but also medicinal in nature and without the potential for a deadly overdose.  I believe this is an herb that should be treated with caution and one to be taken intermittently in whole form and not daily if there is interest in its properties.    I certainly don’t think  the leaf should be illegal and shows quite a bit of promise as an alternative to prescription drugs.

Though kratom potentially acts as a good (and far less potentially lethal)  step down from strong opiates, it should only be considered as a stepping stone..  It should also not be seen as a replacement for the harder work of healing from pain and anxiety.  If those underlying issues exist they should be examined at a root level.  That means working with professionals to address underlying illnesses as well as complex dietary, environmental, and structural issues that are often interrelated.  Simply taking kratom is a momentary bandage for addressing those underlying root concerns.

On another level, I believe kratom holds great promise for managing opiate dependence and tapering off of them as a way of harm reduction and as a step down process towards full abstinence from opiates.  This has been an effective strategy in traditional Thai culture and one that is being explored on a clinical level there.  We as a society need to address the perils of prescribing hundreds of millions of opiate drugs to eliminate pain and look for better, more healthy and less deadly options.

 

 

 

More reading

  

Research Studies:

http://www.ncbi.nlm.nih.gov/pubmed/22133323 - Herbal Medicines For Management of Opioid Addiction
http://www.ncbi.nlm.nih.gov/pubmed/22018854 - HPLC Analysis of Mitragynine, Codeine, Caffeine, Chlorpheniramine and Phenylepherine
http://www.ncbi.nlm.nih.gov/pubmed/21817918 - Kratom and Hypothyroidism
http://www.ncbi.nlm.nih.gov/pubmed/21528385 - Intrahepatic Cholestasis w/ Powdered Kratom Use
http://www.ncbi.nlm.nih.gov/pubmed/21513619 - Fatal Intoxications of Mitragynine and 0-desmethyltramadol
http://www.ncbi.nlm.nih.gov/pubmed/21450536 - Metabolism Studies of Kratoms Alkaloids
http://www.ncbi.nlm.nih.gov/pubmed/21249338 - Metabolism Studies of Speciociliatine
http://www.ncbi.nlm.nih.gov/pubmed/21219704 - Fatality from Mitragynine and Propylhexedrine
http://www.ncbi.nlm.nih.gov/pubmed/21153588 - GCMS Monitoring of Kratom and Krypton Intake
http://www.ncbi.nlm.nih.gov/pubmed/21112167 - Kratom Alkaloids and 0-desmethyltramadol In Urine of Consumer
http://www.ncbi.nlm.nih.gov/pubmed/20967737 - Phase I/Phase II Metabolites of speciogynine
http://www.ncbi.nlm.nih.gov/pubmed/20857386 - Herbal Mixtures Containing Synthetic Compounds as Psychoactive Compounds
http://www.ncbi.nlm.nih.gov/pubmed/20798544 - Case Report of Inpatient Following Kratom Detoxification
http://www.ncbi.nlm.nih.gov/pubmed/20683389 - Chemistry, Pharmacology, and Metabolism of Emerging Drugs
http://www.ncbi.nlm.nih.gov/pubmed/20650576 - “Legal Highs” on the net-Evaluation UK Websites
http://www.ncbi.nlm.nih.gov/pubmed/20411370 - Seizure Following Kratom Exposure
http://www.ncbi.nlm.nih.gov/pubmed/20371282 - Neuromuscular Blockade Produced by Mitragynine and Methanol Extract of Kratom Leaves
http://www.ncbi.nlm.nih.gov/pubmed/19902190 - HPLC/MS Metabolism Study of Paynantheine
http://www.ncbi.nlm.nih.gov/pubmed/19731590 - Phytochemical Characterization of Mitragyna Speciosa Leaves Grown in the USA
http://www.ncbi.nlm.nih.gov/pubmed/19577523 - HPLC/MS Analysis of Mitragynine in Human Urine
http://www.ncbi.nlm.nih.gov/pubmed/19536806 - HPLC/MS Metabolism Study of Mitragynine in Human and Rat Urine
http://www.ncbi.nlm.nih.gov/pubmed/19393795 - Prevalence of Psychoactive Drug Among Drivers in Thailand
http://www.ncbi.nlm.nih.gov/pubmed/19294483 - The Botanical Origin of Kratom
http://www.ncbi.nlm.nih.gov/pubmed/18482427 - Self-treatment of Opioid Withdrawal Using Kratom
http://www.ncbi.nlm.nih.gov/pubmed/18259963 - Opioid Receptors and Legal Highs: Salvia Divonorum and Kratom
http://www.ncbi.nlm.nih.gov/pubmed/18191353 - Inhibitory Effects of Kratom Extract on GI Tracts in Rats
http://www.ncbi.nlm.nih.gov/pubmed/17882605 - Self-treatment of Opioid Withdrawal With A Dietary Supplement
http://www.ncbi.nlm.nih.gov/pubmed/16107269 - Inhibitory Effect of Mitragynine on Neurogenic Contraction of the Vas Deferens
http://www.ncbi.nlm.nih.gov/pubmed/15822540 - Energy Drink Consumption Among Male Construction Workers in the Chonburi Province
http://www.ncbi.nlm.nih.gov/pubmed/9061050 - Inhibitory Effect of Mitragynine on Electrically Stimulated Contraction of Iso. G-Pig Ileum

 

References:

 

 The Soaring Cost of the Opioid Economy

Newly Born and Withdrawing from Painkillers

 

Scientific American: Should Kratom be Legal? 

From Erowid 

Pharmacology of Kratom 

From Wikipedia

Kratom making presence felt in US emergency rooms 

Kratom Guide from Sage Wisdom 

Kratom leaf for drug cocktail adds to thailands woes

 

 

 

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This article written by Jon Keyes, Licensed Professional Counselor and  herbalist.  For more articles like this, please go to    www.Hearthsidehealing.com.

 

 

 

You can also find me at the Facebook group Herbs for Mental Health.

 

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