In its natural state, Mitragyna speciosa is a flowering evergreen tree that can grow to 25 meters (82 feet) with a smooth grey bark, fanlike green leaves, and flowers that grow in clusters at the end of each branch. Native to much of south-east Asia, including Indonesia, Myanmar, Malaysia, Thailand, and Papua New Guinea, the tree's leaves have been widely used in traditional medicine for the treatment of intestinal infections, muscle pain, and diarrhea.
More importantly, M. speciosa leaves also contain a number of psychoactive ingredients including alkaloids similar to yohimbine and ibogaine. Acting on the body's m-opioid receptors as well as affecting the serotonergic and adrenergic systems. Also known as kratom or ketum, compounds made from M. speciosa leaves have a strong stimulant effect at low dosages as well as sedative properties at higher doses. Because of its role as an opioid agonist, it has also been used as an opium substitute in many places.
In recent years however, kratom has been gaining in popularity as a recreational drug as well. In the form of green powder, kratom can be easily mixed with other substances. One particular kratom "cocktail" combining kratom leaves with Coca Cola, ice, and cough syrup has become a major health problem in various south-east Asian countries and its use is spreading worldwide. In the United States alone, experts estimate that 4 to 5 million Americans have used kratom as of 2016 and it's becoming a common sight in head shops.
Since kratom use can lead to a range of serious side effects, international health agencies are warning that the growing kratom trade may lead to a new medical crisis. Side effects that have been reported include anxiety, nausea, tachycardia and, in higher doses, seizures and psychosis. While there is no solid evidence of any deaths solely due to kratom use so far, it has been suspected of contributing to drug deaths in the United States and Sweden though it's still too new a drug to have made the kind of inroads of more popular alternatives.
But there seems to be another reason for kratom's popularity with users. Not only is it being used as a do-it-yourself treatment for pain and depression (as well as a diet supplement), but, according to a recent article in Vice, it's become popular with addicts trying to wean themselves off opioids. Since research has identified two key ingredients that act on opioid receptors, mitragynine and 7-hydroxymitragynin, kratom appears to activate these receptors with fewer side effects than other opioids. As well, it takes longer to build up a tolerance to kratom and, though there are still withdrawal effects, they tend to be milder than with more powerful opioids as well.
Despite suggestions that kratom may become a useful alternative to methadone or buprenorphine, both of which are commonly used in opioid treatment, the Drug Enforcement Agency (DEA) has adamantly opposed any attempt at allowing its use for treatment. When the DEA announced in 2016 that kratom would be placed in Schedule I of the Controlled Substances Act, more than 140,000 people signing a petition in protest. As well, 51 members of Congress and nine Senators have already gone on record as opposing the move though the DEA remained adamant. Though they have since extended the review period to allow more public input, six U.S. states have already banned its sale and import.
As for whether or not kratom can be used in treating opioid addiction, consider the DEA skeptical. A statement by FDA Commissioner Scott Gottlieb issued in November 2017 outlined his concerns about hype surrounding kratom's supposed health benefits. "Patients addicted to opioids are using kratom without dependable instructions for use and more importantly, without consultation with a licensed health care provider about the product’s dangers, potential side effects or interactions with other drugs," he said. "There’s clear data on the increasing harms associated with kratom. Calls to U.S. poison control centers regarding kratom have increased 10-fold from 2010 to 2015, with hundreds of calls made each year. The FDA is aware of reports of 36 deaths associated with the use of kratom-containing products. There have been reports of kratom being laced with other opioids like hydrocodone. The use of kratom is also associated with serious side effects like seizures, liver damage and withdrawal symptoms."
Though the controversy continues, it seems unlikely to be resolved anytime soon.
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