In January of this year the FDA announced that it was supporting the development, implementation, and evaluation of a human abuse potential study on the use of kratom. The FDA stated that “addressing the use of botanical Kratom is a priority as it works to characterize its abuse potential and subjective effects, given the absence of published literature and clinical evaluations despite increased human use”.
SAMHSA’s National Survey on Drug Use and Health, estimated a total of 1.9 million Americans, 12 and older reported using Kratom in 2022. So what exactly is kratom?
Kratom, derived from the leaves of the Mitragyna speciosa tree (closely related to the coffee plant) in Southeast Asia, is a natural substance that has gained worldwide attention for its various strains and potential therapeutic effects. These strains, categorized by their vein colors (Red, Green, and White), have distinct characteristics and effects on the body and mind. Mitragyna speciosa, also known as kratom, is found to possess promising analgesic effects on mediating the opioid receptors such as µ (MOR), δ (DOR), and κ (KOR). Users reported both a stimulant and sedative effects, believed to be caused by two compounds in the leaves, mitragynine and 7-hydroxymitragynine. Mitragynine, is a naturally occurring indole alkaloid that can be isolated from the leaves of the psychoactive medicinal plant. 7-Hydroxymitragynine (7-OH) is a terpenoid indole alkaloid, like mitragynine, appears to be a mixed opioid receptor agonist/antagonist, acting as a partial agonist µ-opioid receptors and as a competitive antagonist at δ- and κ-opioid receptors.
The leaves of the Mitragyna speciosa tree can be crushed and then smoked, brewed with tea, or placed into gel capsules. According to the DEA, Kratom has a long history of use in Southeast Asia, where it is commonly known as thang, kakuam, thom, ketum, and biak.
At low doses, kratom produces stimulant effects with users reporting increased alertness, physical energy, and talkativeness. At high doses, users experience sedative effects. Kratom consumption can lead to addiction. Some kratom products intended for sale in the US have been found to contain dangerous contaminants, such as salmonella and heavy metals. Several cases of psychosis resulting from use of kratom have been reported, where individuals addicted to kratom exhibited psychotic symptoms, including hallucinations, delusion, and confusion.
Kratom’s effects on the body includes nausea, itching, sweating, dry mouth, constipation, increased urination, tachycardia, vomiting, drowsiness, and loss of appetite. Users have also experienced anorexia, weight loss, insomnia, hepatotoxicity, seizure, and hallucinations.
Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin currently have a ban on mitragynine and hydroxymitragynine. However, there have been bills introduced in 4 of those states to replace the ban with regulations on the sale of kratom products. Tennessee has a ban on mitragynine and hydroxmitragynine but this ban is only for synthetic versions of the alkaloids.