Long-Term Risks of Kratom Use
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Kratom is a tree that grows in Southeast Asia and belongs to the same family of trees that produce coffee. Kratom’s scientific name is Mitragyna speciosa Korth. It also goes by several other names, including biak, ketum, kakuam, thang, and thom.
The leaves and shoots of the plant may be chewed or brewed into a tea. The effects of the leaves appear to vary depending on the dose or amount of the substance ingested. At lower doses, it appears that the effect is more stimulant-like; at higher doses, it is more sedative or opiate-like. The prominent psychoactive effects in kratom are caused by alkaloid substances, most notably 7-hydroxymitragynine and mitragynine. There may be some muscle relaxant or anti-inflammatory effects associated with the substances, and substances produced from kratom might be effective in treating chronic pain.
Kratom Use and Classification
In the United States, the substance has received some minor popularity and a cult-like following that even has an official organization associated with its use, the American Kratom Association. This organization lists numerous medicinal uses for the drug, but the claims of supporters are based on anecdotal reports and not on independent controlled clinical studies. The drug appears to be available from some Internet sources as a tea or in pill form.
The majority of individuals who use kratom are of Asian origin.
The United States Drug Enforcement Administration (DEA) has gone back and forth on determining the legal status of kratom. The drug was once listed as a drug of concern, but in 2016, the DEA announced plans to temporary classify the drug as a Schedule I controlled substance, thus claiming it has no medicinal purposes, it is extremely dangerous, and its use is outlawed in the United States except for very specialized research purposes. This resulted in a bit of an outcry from individuals and organizations like the American Kratom Association. Because the actual medicinal status of the drug still appears to be somewhat questionable, the DEA backed off this classification and suggested that the Food and Drug Administration (FDA) evaluate the medicinal effectiveness of the drug and then make recommendations.
At the time of this writing, it appears that the DEA still considers the substance to be a substance of interest and its actual classification as a controlled substance is still being determined. Even if the substance were initially classified as a Schedule I controlled substance, research studies that supported its use for medicinal purposes could result in this classification changing and the drug being made available.
The Effects of Kratom
Some of the best sources on kratom are books like Kratom and Other Mitragynines: The Chemistry and Pharmacology of Opioids that describe the effects of mitragymines and similar substances. According to these sources, the drug produces differential effects depending on the amount taken. When ingested at lower doses, the drug produces increased feelings of energy, results in increased focus and concentration, results in a decreased need to sleep, and produces significantly increased talkativeness. At moderate to high doses, the effects are different and include analgesic or pain-relieving effects, more sedative effects, and mild euphoric effects.
There appear to be numerous side effects associated with kratom. The DEA reports that the short-term side effects that most commonly occur include loss of appetite, nausea, and weight loss, which are very typical of stimulant-like drugs. In addition, individuals may experience increased sweating, dry mouth, itching, and constipation or frequent urination as the drug may have some diuretic effects.
Studies on the Long-Term Effects of Kratom
Individuals who abuse the substance for a significant length of time may experience:
- Chronic insomnia due to the stimulant effects of the drug
- Long-term decreased appetite and weight loss
- A darkening of the skin
- The development of psychotic features, including hallucinations (mostly visual hallucinations) and delusions
Research studies published in Drug and Alcohol Dependence and Substance Abuse presented data regarding the effects of long-term use of the drug, particularly in individuals in areas where the drug is indigenous. These effects appear mild, and the studies concentrate on the development of a mild physical dependence on kratom.
The symptoms of withdrawal appear to come on relatively quickly. According to the data, chronic users take kratom at relatively low doses, but use it frequently and often. They may experience withdrawal symptoms within a few hours after they discontinue its use.
The initial withdrawal symptoms appear to consist of:
- Cravings for the drug
- Mood swings
- Pains, lethargy, muscle weakness, and runny nose
- Nausea and vomiting, in some cases
- Tremors in the extremities, particularly in the hands
- Feelings of irritability, restlessness, and even aggression
- In rare cases, seizures and hallucinations
The withdrawal syndrome appears to peak relatively quickly (within a day or two). The duration of the withdrawal syndrome appears to be relatively short, and in most cases, it lasts between five and seven days.
Studies suggest that benzodiazepines may be useful in treating withdrawal symptoms associated with the drug. Other medications to treat specific symptoms such as pain are also suggested. The withdrawal syndrome associated with kratom appears to be the result of chronic daily use of the drug as a tea. Less frequent use may not lead to the development of tolerance and withdrawal symptoms.
Overdose and Abuse Potential
There is research that suggests that the major psychoactive substance in kratom, mitragynine, does have an overdose potential. In addition, there are research studies reported in the Journal of Forensic Sciences and the Journal of Medical Toxicology that report fatalities associated with kratom overdose; however, at least one of the studies indicated that the person had other drugs, such as benzodiazepines, in their system, although the level of benzodiazepines was not believed to be excessive.
At the current time, the formal status of the drug remains questionable. Based on the research, there are some concerns regarding the abuse potential of kratom despite the claims of its supporters that it has no abuse potential and cannot produce physical dependence.
The first concern is that any substance capable of producing physical dependence should have some formal controls placed on its distribution. This is because any medicinal substance that results in increased tolerance and withdrawal possibilities should only be administered under the supervision of a physician. Thus, despite the claims of many of its supporters it appears as if kratom is a potential candidate for the controlled substances classification utilized by the DEA, although placing it in Schedule I may be extreme.
Because the drug has potential to produce physical dependence and overdose, it should be regulated by the FDA and the DEA.
The second concern is that there is research to suggest that there can be significantly dangerous potential overdose effects associated with the drug. This is further evidence that the drug should be listed as a controlled substance.
Finally, legislating control over kratom products can ensure that the ingredients in the substance are what they are supposed to be. One of the problems with many herbal concoctions is that they are not regulated by the FDA, and this can result in individuals taking potentially dangerous non-regulated substances that are being marketed as kratom.
This would not be the first time that potential for such a mishap has occurred. There are numerous instances where potentially dangerous substances have been found in herbal dietary aids that are not regulated by the FDA.
Supporters of kratom want the drug to be available without any restrictions, but in addition to the above objections, the marketing of any herbal substance as some form of cure-all or dietary supplement can result in serious ramifications for users. If the substance is deemed to have medicinal uses, these should be outlined and supported by clinical trials, and these clinical trials should be submitted to the FDA for approval.