Kratom

65Kratom (Mitragyna speciose korth) is a tropical forest tree indigenous to Malaysia, Thailand and Myanmar. It is also found in New Guinea, Borneo and the Philippines. The tree grows up to 25 meters high. It has elliptical leaves that are heart-shaped at the base, pointed at the tips and hairy on the underside nerves. The leaves are about the size of an average man’s palm when fully mature. The tree bears oblong-ovoid (egg-shaped) fruits and yellow flowers.

The bitter leaves contain psychoactive opioid compounds and have been consumed for thousands of years in Southeast Asia and more recently in other parts of the world for uplifting moods, boosting energy, mental clarity and pain relief. It is also believed to be an aphrodisiac.

Kratom is not an illegal substance in the U.S. and is easily available online, in head shops, convenience stores and gas stations in various forms e.g. small packets of green powder, chopped leaves (for steeping like tea) and capsules.  They are sometimes labeled “not for human consumption” much like bath salts. They are also available in gum or extract form. In recent years, kratom has been used as a herbal alternative for managing the cravings and withdrawal symptoms from addiction to alcohol and other opioids even if there are no studies and scientific backing for this application. There has actually been no controlled clinical trials to determine whether kratom is safe for human use. All available information comes only from experiments on animals and anecdotal reports from doctors and users alike.

While kratom contains alkaloids that bind to opioid receptors in the brain, they are not structurally related to opiate drugs and are therefore not detectable through opiate drug tests. That is not to say that these kratom alkaloids are not detectable in body fluids, because they are – it’s just that they are not normally tested for because kratom is not illegal.

In the workplace, standard drug test panels only test for cannabinoids, cocaine, amphetamines, opiates and PCP (SAMHSA 5). If employers have reason to believe that an employee may be misusing kratom and that its side effects may be affecting that employee’s productivity and the overall safety in their workplace, notwithstanding kratom’s legal status, said employers would be within their rights as may be provided for in their drug free workplace policy, to request for that employee to be tested. This should work in much the same way as testing for prescription drugs which are also legal.

Screening Cut-Off and Detection Time

In drug screening, the cut-off level is the minimum amount of drug residue that must be found in the sample in order for the test to be positive. It is important to remember that a negative sample does not necessarily mean that it is drug-free, only that it contains a drug at a concentration that is below the established cut-off.

Urine Drug Test Cut-Off Level Test Method
Mitragynine 1 ng/ml LC-MS/MS
  • Urine drug test – The average (high-dose) user takes some 5.3 days to completely flush out kratom alkaloids from the system, so trace quantities of metabolites may be detectable in urine for over a week.
  • Blood test – For kratom overdose cases, blood concentrations of Mitragynine typically exceed 300 ng/ml. Intoxication cases should have levels 100 ng/ml or higher. Mitragynine and its metabolites are likely to be detectable in blood for the first 24 hours of ingestion. For frequent users, the metabolites are likely to remain for several days.

DEA Drug Class

Kratom is NOT currently a controlled substance, but on August 31, 2016 the DEA announced its intent to put the main psychoactive constituents in kratom particularly 7-hydroxymitragynine and mitragynine into Schedule I of the Controlled Substances Act by September 30, 2016. This is an initiative that is meant to avoid imminent hazard to public safety. It was later deferred until further notice. On October 12, 2016 the DEA finally issued a withdrawal of intent, opening instead a period of comment for the public until December 1, 2016.

Other examples of drugs that fall under Schedule I include:

Kratom Drug Type

Kratom is unique in that it is both a stimulant and a sedative, with what many users say opiate-like effects as well. Whatever effects are felt by the user are largely dose-dependent. Kratom at low to moderate doses often (although not all the time) act as a stimulant, while at high doses it will most likely act like a sedative. Other than the dose, individuals react differently to different drugs, and each individual’s response will be a factor of his/her weight, how much they have eaten recently and their overall physical condition.

Forms and Routes of Administration

In Southeast Asia where kratom originated from, it is traditionally consumed in its natural form – fresh or dried leaves either chewed-on or steeped into tea. In the West these days, kratom is available in raw powder form, crushed leaves, capsules, gum, resin and extract.

The usual form of administration is oral, either making tea from the leaves and drinking it, chewing on the leaves or mixing powdered or crushed leaves with food and drinks. Some users smoke kratom leaves using pipes and other gadgets.

  • kratomKratom Powder – raw or non-extract powder are recommended for new users as they are less potent than the powdered extracts.
  • kratomCrushed leaves – this is the most natural form of kratom aside from fresh raw leaves. This form is also less potent than extracts and is more recommended for new users.
  • kratomKratom Capsule – crushed leaves or powder are placed inside veggie or gel capsules to help mask the bitterness of the powder, but they also make the product more expensive.
  • kratomKratom Extract – more potent and usually more expensive, made by boiling down the crushed or powdered leaves, letting the water evaporate and filtering to leave a thick paste that has a higher concentration of the kratom alkaloids such that even a smaller dosage will be as effective. Extracts are usually denoted by a number followed by an “x”. The number indicates the weight of the kratom leaves from which the extract was made. An extract can then be pound into powder form.
  • kratomResin – is just an extract that has been left to solidify until it turns into a black glass-like lump that resembles tar. It is a highly concentrated form of an extract.
  • kratomGum – this is a chewable version of kratom, laced with caffeine for added effects.

Many kratom users are not happy with the availability of kratom extracts, resins and other forms of concentrated kratom, including gum forms that are laced with other ingredients; arguing that kratom has so far been able to stay legal because all the deaths connected to it were either due to the presence of other drugs or due to the person’s pre-existing mental health conditions (suicidal tendencies). People who have benefited from kratom’s medicinal properties, particularly for pain relief prefer using raw, non-extract powders hope that they remain in these safe preparations.

Brand Names for Kratom

  • B.Sixx Kratom
  • Bali Halus
  • Club 13
  • Divinity Kratom
  • Eden‘s Ethnos Kratom
  • Experience Kratom
  • Feng Shui Herbals
  • Full Spectrum Isolate Extract
  • Golden Reserve Extract
  • Green Vein Borneo
  • Kratom Infusion
  • Kratom Kaps
  • Kratom Tea
  • Kratom Therapy
  • Kryton
  • Liquid Kratom
  • Lucky Kratom
  • Mayan Kratom
  • Maeng Da
  • Mojo Kratom
  • O.P.M.S. Kratom
  • Phoenix Kratom
  • Red Vein Bali
  • Red Vein Borneo
  • Red Vein Indonesian
  • Red Vein Thai
  • Remarkable Herbs
  • Subtropical-Topicals
  • Super Green Malay
  • UEI ACE Extract
  • UEI Extract
  • United Kratom
  • White Indonesian
  • White Rabbit Kratom
  • White Vein Borneo
  • XXX Kratom
  • Zen Kratom

What is Kratom Used For?

The traditional medicinal effects of kratom vary widely due to its unique alkaloid profile, quite unlike any other plant life known to man.

  • Anti-anxiety
  • Anti-depressant
  • Anti-inflammatory
  • Anti-leukemic
  • Anti-malarial
  • Boosts energy
  • Boosts sexual appetite
  • Enhances cognition
  • Helps manage opiate withdrawal
  • Improves mood
  • Lowers blood sugar
  • Opiate maintenance
  • Pain relief
  • Relieves insomnia
  • Stimulates immune system

Kratom Street Names

  • Biak-biak
  • Herbal Speedball
  • Ithang
  • Kahuam
  • Ketum
  • Thom

Kratom Side Effects

There are 2 compounds found in kratom leaves that bind to the opioid receptors in the brain, 7-hydroxymitragynine and mitragynine. Consuming large amounts of the leaves cause sedation, produce sensations of pleasure and dulls the perception of pain, with some unpleasant side effects. The compound mitragynine in particular is a stimulant and 7-hydroxymitragynine is a sedative with analgesic effects. Taken in small amounts, kratom boosts energy, alertness and sociability. High doses cause sedation and euphoria with opium-like narcotic analgesic effects.

Short-Term Kratom Effects

The short-term effects of kratom are variable and complex at best. What determines the effects, whether it will act as a sedative, as a stimulant or produce opiate-like effects is heavily dependent on the dose taken and the physical condition of the person taking it.

At the stimulant level (low dose: 1-5g), the effects kick-in within 10 minutes and last from 1 to 1.5 hours:

  • the mind is rendered more alert
  • mood is improved
  • the person becomes more sociable, talkative and friendly
  • sometimes sexual appetite increases along with the general physical energy boost.

At the analgesic-euphoric-sedative level (moderate to high doses: 5-15g), the effects last for several hours and are less intense than those caused by other opioids:

  • becomes less affected by physical or emotional pain
  • constipation
  • cough suppression
  • dizziness
  • drowsiness
  • feels an overall sensation of comfort and pleasure
  • flushed look
  • increased appreciation of music
  • less intense opioid withdrawal symptoms
  • looks and feels calm
  • loss of motor control
  • may become dreamy while staying awake
  • nausea and vomiting
  • some sweating or skin itching
  • the pupils may become slightly constricted

The effects from extremely high doses that go more than 15g mimic those caused by high doses of opioids. These include:

  • Extreme sedation
  • Unconsciousness
  • Seizures

The plant itself has not been associated with any fatal overdose, but commercialized products are sometimes laced with other dangerous compounds that have been proven fatal in some cases.

Long-Term Kratom Effects

Being an emerging drug in the United States, there is limited research material on the long-term effects of Kratom other than those obtained from users in Thailand:

  • Hyperpigmentation, or darkening of facial skin
  • Anorexia and weight loss
  • Psychosis

No evidence has so far indicated that chronic kratom use causes permanent internal organ damage.

Kratom Addiction

Long-term use of kratom can and will lead to dependence and addiction. As some alkaloids found in kratom bind with opioid receptors in the brain, they help ease the withdrawal symptoms caused by real opioids like oxycodone and heroin. These very same properties that make kratom a detox aid also make it an addictive agent.

It has been reported all around the world, in Southeast Asia where the plant originated, in Europe, the United States and the rest of the western world that long-term users develop tolerance to kratom, making them take progressively larger doses to achieve the desired effect. Tolerance eventually escalates to dependence and eventually a kratom addiction, where they are unable to stop regardless of adverse physical effects and negative consequences in their personal, professional and social lives.

Kratom Withdrawal Symptoms

One study showed that over 50% of participants who used kratom regularly for 6 months developed dependency to it. The physical kratom withdrawal symptoms are similar to those experienced by opiate-dependent people.

  • Diarrhea
  • High blood pressure
  • Insomnia
  • Intense craving for kratom
  • Irritability
  • Joint pains
  • Muscle pains
  • Nausea
  • Runny nose
  • Sweating

Kratom dependence hasn’t been around for very long, at least not in the United States.  Understandably there are no specific treatment programs for kratom addiction and withdrawal. Scientific literatures are still limited to mentioning a few medications for kratom addiction/withdrawal management and treatment. These include a weak opiate dihydrocodeine and a drug used for high blood pressure, lofexidine.

History of Kratom

Kratom was discovered by Dutch botanist Pieter Willem Korthals. He was the official botanist of the Dutch East India Service from 1831-1836. Earlier Dutch traders described how it was used by the Malaysian people in their traditional medicinal practices. The natives of Thailand also traditionally chewed on the leaves for its stimulating effects, helping them cope with the fatigue that comes from hard labor. They also used it as an opium substitute.

In 1943, Thailand decreed planting of the kratom tree illegal by passing the Kratom Act 2486. In 1979, Thailand enacted the Narcotics Act B.E. 2522, putting Kratom a Category V narcotic analgesic, alongside marijuana. Despite prohibition kratom remains the 3rd most popular drug in Southern Thailand, next only to marijuana and methamphetamine.

Kratom leaves eventually reached other parts of the world, finally resulting to its widespread use in the west. The American Association of Poison Control Centers reported only 2 exposures to kratom in the entire 5-year period between 2000 to 2005. After a decade, from 2010 to 2015, U.S. poison centers reported 660 calls due to kratom exposure. From February 2014 to July 2016 at various ports of entry into within the U.S., law enforcement officers have encountered some 55,000 kilograms of kratom material, with another 57,000 kilograms awaiting imports are admission by the FDA. Combined, this amount of material is enough to produce 12 million doses of the drug. While kratom is not illegal, it has long been on the DEA’s list of drugs and chemicals of concern especially since there have been 15 kratom-related deaths between 2014 and 2016.

Today, the future of kratom as a non-controlled substance is the subject of a DEA plan to have it included as a Schedule I substance. By December 1, 2016, a final decision will have been made.