Kratom as an opioid addiction treatment: Benefits and limitations

Kratom is a plant that is widely used in the southeast part of Asia. It has been known for centuries as a remedy to relieve pain and stimulate cognitive processes. Today it is becoming more and more popular throughout the world as an opioid agonist.

What is kratom

Kratom (or Mitragyna speciosa) is an evergreen tree which belongs to the same family as the coffee tree and some other psychoactive plants. Kratom leaves have been used for a while by laborers and farmers who seek anesthetic and stimulating effect. They can be chewed, smoked, ground into powder or prepared as an infusion to boost a worker’s energy because it is a natural stimulator if used in low dosage.

Higher doses of kratom can bring the feeling of euphoria and relieve pain. This is because, pharmacologically, kratom acts on specific points in a similar way to other substances such as narcotics and yohimbine. The effect is, however, weaker and subtler. These medicine properties permit kratom to be a part of drug rehabilitation programs (find out more).

Although structurally related to yohimbine and other tryptamines, its pharmacology is quite different as it acts primarily as a μ-opiate receptor agonist. Kratom contains many alkaloids, including mitragynine (formerly thought to be the principal active ingredient), mitraphylline and 7-hydroxymitragynine (which is the main active chemical in this plant). In other words, kratom is structurally different from opioid drugs, but it is able to stimulate the same receptors in a person’s brain as opioids.

It is important to note that this plant is considered a “drug of concern” in the United States by the Drug Enforcement Administration, according to its 2017 report. Kratom has both advantages and adverse side effects, and the last ones are considered by the US government to be more dangerous than useful. While kratom plant is supposed to be a drug itself, it has a lot of admirers who prefer to use it as drug detox to fight the opioid crisis.

Kratom is included in the list of New Psychoactive Substances, a class of drugs defined by the United Nations Office on Drugs and Crime. In the 2013 World Drug Report, kratom took its place near khat, another addictive plant.

How does Kratom help to fight opioid withdrawal symptoms?

Kratom has the ability to make withdrawal less painful in people with narcotic addiction due to agonism of the μ-receptor of mitragynine and 7-hydroxymitragynine. As it is impossible to get the prescription in drug rehab facilities,  former drug users tend to order it online. Kratom is sold in the US and Europe in the form of pressed capsules containing powdered leaf.

Although kratom is relatively potent by dose, the strong euphoric effect is not its characteristic. The euphoric phase is quickly replaced by a sedative phase that provides no fun, unlike drugs like codeine. On the other hand, sedation relaxes the muscles which relieves a person during the period of abstinence.

It is said that kratom’s effect of analgesia is similar to that of less powerful narcotics like codeine, but the ‘hardness’ or ‘softness’ of a drug is reflected not in the power of effects but in the cravings that follow consumption. If kratom causes sedation, it is quite neutral regarding pleasure. Compared to the state caused by opiates, kratom does not provide colorful dreams, it does not give the impression of traveling (trip, psychedelic experience) as drugs usually do.

Kratom has a stimulating activity similar to that of Yohimbe and an immunostimulatory activity identical to that of Uncaria. The effects of kratom vary according to the origin, Bali kratom being the most sedative while the Thai is more stimulating. The euphoric effect of kratom is said to be of relatively short duration, usually disappearing in less than an hour to allow a sedation period of five to six hours. Some people experience nausea or vomiting after drinking an infusion of kratom; this may be partially related to either its very bitter taste that is not possible to correct or a dose bigger than 10 grams.

Advantages of kratom

The advantage of kratom is that it is legal in most countries of the world, and it is said to be one of the safest means capable of eliminating withdrawal symptoms. There are currently many reports of the successful use of kratom for detoxification. At the same time, people who have high hopes for using kratom in self-medication and drug addiction should clearly understand that kratom, although it is potentially safe and effective, with its uncontrolled and prolonged use is unlikely to be beneficial. To date, despite the full potential of kratom in the treatment of drug addiction, no clinic uses it in the treatment of its patients officially.

Kratom is likely to provide a large number of medicinal uses, for example, a mild analgesic, comparable to codeine or propoxyphene, or an alternative to methadone, cheaper and much safer. Grown in Asia, this plant is imported to other countries and is being used by persons suffering from chronic pain and fibromyalgia.

The metabolic effects of kratom leaves consist in boosting one’s immune system and increase energy. The 2009 research studying various alkaloids proves kratom to be effective against multiple causative agents. Those who have Chronic Fatigue Syndrome find kratom to be a natural solution to the lack of energy.

Less known characteristics of kratom include increasing of libido and decreasing of appetite.

The most controversial advantage of kratom is, indeed, its psychotic effect. It may represent a solution for patients who want to reduce anxiety, depression symptoms, mood swings, insomnia, sooth their nerves. The main reason is that this plant is capable of releasing the hormones controlling our mood: serotonin and endorphins. The same effect applies to people suffering from attention disorders. Kratom increases motivation and focus.

Kratom is believed to replace narcotic substances, in particular, opioids, efficiently. This substitute is highly accessible on the Internet, as opposed to other medications, such as Suboxone, Subutex, Mitragynine, and methadone, which makes it a perfect self-treatment medication. Other opioid agonists listed above are considered to be harder to come off in comparison with kratom.

People who believe that this plant has more advantages than dangerous effects are constantly creating petitions to the governments. For instance, in the petition named Keep Kratom legal in the United States Internet users tell their personal stories about kratom. One of them claims that kratom helps him to fight severe chronic pain after an accident.

David Kroll, a contributor to Forbes, affirms that 95% of people he discussed advantages of kratom with are absolutely positive about its effects. He describes stories of persons who use this substance to relieve back pain, legs, migraines; amputees and people with cancer prove by their examples that kratom can manage the pain of any nature. This might be an essential benefit of kratom: there are no other drug substitutes that had so many positive personal stories behind.

Adverse effects of kratom

There is no denying that kratom has its side effects and its safety is for the moment controversial. Continuous use of this plant may lead to the phenomenon which is called ‘kratom hangover’, and is described as a state in which one experiences hallucinations, paranoia, nausea, and vomiting. Such adverse effects as liver dysfunction, seizures, hypothyroidism, hypertension, constipation, lung, and heart damage are also associated with kratom use.

There is no way one could ask for kratom in a rehab center. In 2017, Food and Drug Administration of the United States of America made a press announcement that kratom is unsafe and caused 36 deaths. The same document reports a ten-fold increase in calls related to poisoning by products which contain kratom to poison control centers during the period from 2010 to 2015. This can be connected to the fact that most kratom users treat their symptoms without consulting professional health care providers. Indeed, many conditions, from Chronic Pain Disorder to depression, must be confirmed and followed by a specialist, whereas kratom advocates use the substance according to their proper treatment plan. Kratom is also associated with an opioid crisis in the United States of America.

There are case reports published online which link the intentional use of products containing kratom to severe withdrawal symptoms which makes people go to rehab for kratom. If there is enough evidence to prove it, kratom should be recognized as a drug itself. However,  scientific data on the effects of kratom are quite limited.

Dependent users of kratom mention the following withdrawal symptoms: muscle pain, headache, arrhythmia, state of irritability, sweating, nausea, vomiting, diarrhea, anxiety, difficulties falling asleep, tremors, and others.

Most fatal cases, as well as intoxication reports, are related to the intake of high doses (more than 15 grams) or overdose of kratom. At the same time, long-term users of kratom report that in some time they need to increase the dosage, as it happens with other drugs. This permits to suppose that the longer a person uses kratom, the higher are the chances of negative consequences, sometimes lethal.

Death is more likely to result from a combination of kratom with other drugs. Several deaths reported in Sweden occurred from an intake of a product called “Krypton.” It consists of kratom and O-desmethyltramadol, the latter being the product of metabolism of tramadol, painkiller.

It is also worth noting that people tend to report different effects even after taking the same dose. From that follows that the properties of kratom are not studied to the fullest.

Although the plant has a long history in the life of people in Southeast Asia, it is prohibited in many countries of this part of the world, including Thailand, Malaysia, and Myanmar. The main reason given by governments is that it is as addictive as other banned substances.

Despite the fact that kratom in traditional medicine is not yet applicable, such alkaloids as 9-hydroxycorynantheidine and corynanthidine are very promising for a medical application, because the first is a partial μ-opioid agonist and the second one is an antagonist of μ-opioids. Both alkaloids can be found in the leaves of Mitragyna speciosa. The combination of a complete agonist (such as 7-hydroxymitragynine) with a partial antagonist or agonist is comparable to breaking the habit of use of a partial opioid agonist. An example of such a partial agonist/antagonist is buprenorphine, which is recognized by the FDA and is also used in drug and alcohol treatment centers.

Addiction to kratom

The use of kratom is likely to lead to habituation, and those who use it can regularly experience withdrawal syndromes when they stop to do it. Some daily consumers of kratom report the appearance of minor inconveniences, comparable to those induced by deprivation of coffee: nervousness, agitation, or, on the contrary, lack of energy. Defenders of kratom use often claim that this tree is of the same family as coffee which means that it is no more harmful than the aforecited beverage.

It does not seem, however, that the fact has really been established. No long-term human studies have been conducted, so any evaluation of the long-term consequences of kratom needs to be extrapolated from animal studies and a small number of reports by anthropologists.

Getting help

As in any case of oral opioid poisoning, after recent ingestion (less than an hour) gastrointestinal decontamination with activated charcoal is recommended. Studies in animals have shown conflicting results on the efficacy of opioid antagonists such as naloxone in reversing the effects of Mitragyna speciosa. However, given the safety profile and potential benefits of naloxone in the emergency setting, this antidote should be considered for patients with respiratory depression following the use of Mitragyna speciosa, in addition to usual support.

Persons suffering from withdrawal symptoms can follow a drug detox program in special drug rehab facilities. During withdrawal treatment, the medical staff is able to cope with effects that represent a medical risk for a patient (for example, high blood pressure).

Since dependence on kratom is not studied enough, there is no specific detox program for this kind of addiction. Medications that are used to treat withdrawal symptoms are the same applied to treat addiction from an opiate. They include dihydrocodeine (a semi-synthetic opioid analgesic much weaker in comparison with other opioids) and lofexidine (a non-opioid). After successful withdrawal from kratom, drug counseling professionals help patients to recover to the fullest.

All in all, more scientific evidence is needed to rate kratom’s benefits and limitations. Though governments tend to ban this plant, there are numerous personal stories which might prove that kratom is efficient such conditions as pain and withdrawal symptoms. Further research will permit to prevent kratom-related poisoning and deaths, and elaborate treatment plans for people addicted to it.

Sources

  1. Drugs of Abuse. A DEA Resource Guide. 2017 Edition
  2. World Drug Report 2013. United Nations Office on Drugs and Crime
  3. “The Benefits of Kratom, and Risks of Kratom Extracts, From the People Who Use the Botanical Medicine.” Forbes
  4. Finding the Best Alcohol and Drug Treatment Programs: A Complete Guide. Addiction Resource

About the Author

Thanush Poulsen is a Danish blogger who closely investigates the problem of addiction. His works aim to increase people’s awareness of addiction as a rapidly rising threat for the public health.


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