Friday, October 25, 2013

Kratom: Mitragynine For Beginners

An organic alternative to methadone?

A disclaimer: Everything I know about kratom, I learned on the Internet and in science journals. I have no real world experience with this opiate-like plant drug, haven’t used it, don’t know very many people who have. Although it comes from a tree indigenous to Thailand and Southeast Asia, and has presumably been around forever, a recent journal article referred to kratom as “an emerging botanical agent with stimulant, analgesic and opioid-like effects.” Which makes it sound like a combination of heroin, amphetamine, and strong weed. In reality, however, it is evidently a fairly mild stimulant with additional sedative effects when the leaf is chewed. If that sounds contradictory, it is, but the overall effect is reported to be more in league with coca leaves than injected morphine. Addictive? Erowid notes that the leaves can vary widely in potency, but yes, potentially addictive. It’s not entirely surprising that kratom has been used in Asia, and increasingly in Europe and the U.S., as a self-managed treatment for pain and for opioid withdrawal. You can find kratom for sale all over the web. You will also find it in smoke shops and herbal outlets. But is any of it legal? And, as with methadone and buprenorphine: Is kratom part of the problem or part of the solution?

According to one web site maintained by kratom aficionados, the legality of kratom can be hard to determine. It is definitely illegal in Australia, Malaysia, Burma (Myanmar), and Thailand. However: “In the United States, access to county, state, and federal laws are often available online and it’s a simple matter of reading through the material (dense as it may be) to determine the actual legality of Mitragyna speciosa…. the only state where kratom is illegal in 2013 is Indiana. That’s not to say other state legislators haven’t tried to get kratom scheduled as an illicit substance. States to keep your eye on, especially if you’re a resident, are: Iowa, Hawaii, Vermont, Virginia, and Arizona. Louisiana hasn’t outright banned kratom, but they don’t allow it to be marketed as ‘for human consumption’ and thus we suggest, if you live in Louisiana, you exercise extra caution in your purchases.” In addition, you may rest assured that kratom is on the U.S. Drug Enforcement Administration (DEA) list of “Drugs and Chemicals of Concern.”

In other countries, kratom is controlled through licensing and prescription, similar in certain respects to the medical marijuana market in the United States. Nations in this category include Finland, Denmark, Romania, Germany, and New Zealand.

Kratom (Mitragyna speciosa) contains several psychoactive ingredients. The plant can be chewed, smoked, brewed into a tea—or made into an extract for sale as capsules or tablets (with accompanying arguments about “full-spectrum” extracts vs. “standardized” extracts).  According to Erowid, it is “unknown how long alkaloids retain their potency after being isolated from kratom leaves,” and furthermore, “many manufacturers are clearly exaggerating the potencies and quantities of whole leaf kratom used in their extracts.”

The leaves contain a plethora of psychoactive alkaloids, but the two primary stimulators of opioid receptors appear to be mitragynine and 7-hydroxymitragynine. These two compounds are considered to be stronger analgesics than euphorics, although users do sometimes report visual effects. Kratom is not considered toxic, but overdoses can be quite unpleasant, Erowid relates. Chronic heavy use reportedly leads to insomnia, dry mouth, constipation, and darkening of the skin.  Importantly, Erowid says they are “not aware of any cases of severe poisoning or death resulting from its use. Animal studies have found even very large doses of mitragynine (920 mg/kg) to be non-lethal.”

Last year, writer David DiSalvo, who blogs at Forbes, turned guinea pig, experimented with kratom, and blogged about the results. DiSalvo purchased an entirely legal supply of kratom—Lucky, Mayan, Nutmeg, and OnlineKratom by brand—and ran the self-experiment for a few weeks.

Here are excerpts from DiSalvo’s report: “My overall takeaway is that kratom has a two-tiered effect. Initially it provides a burst of energy very similar to a strong cup of coffee. Unlike coffee, however, the energy I derived from kratom was longer-lasting and level…. The second-tier effect was relaxing, but fell short of being sedating. I never felt sleepy while taking kratom, but I did experience a level relaxation that was pleasant, and balanced out the initial energy-boosting effects nicely.” Not surprisingly, DiSalvo’s major concern was that “it’s not easy to nail down the specific amount to take.” As for withdrawal, DiSalvo ranked it beneath caffeine withdrawal for severity.

“Having now experienced the product myself for a number of weeks,” he wrote “I can see no reason why it should be banned, or on what basis such a product would be banned if people can walk into a typical coffee shop and buy an enormous cup of an addictive substance that’s arguably more potent than any kratom available anywhere.”

In September, Larry Greenemeier examined the case for kratom legalization in an article for Scientific American that tracks the herb’s “strange journey from home-brewed stimulant to illegal painkiller to, possibly, a withdrawal-free treatment for opioid abuse.” Greenemeier interviewed Edward Boyer, director of medical toxicology at the University of Massachusetts Medical School, who first became familiar with kratom after a software engineer who had been using kratom tea for pain ended up at Massachusetts General Hospital after combining kratom with modafinil and suffering a seizure. (The case was reported in the June 2008 issue of Addiction).

According to Boyer, mitragynine “binds to the same mu-opioid receptor as morphine, which explains why it treats pain. It’s got kappa-opioid receptor activity as well, and it’s also got adrenergic activity so you stay alert throughout the day.” As if that weren’t enough, kratom also binds with serotonin receptors. “Some opioid medicinal chemists would suggest that kratom pharmacology might reduce cravings for opioids while at the same time providing pain relief. I don’t know how realistic that is in humans who take the drug, but that’s what some medicinal chemists would seem to suggest…. So if you want to treat depression, if you want to treat opioid pain, if you want to treat sleepiness, this compound really puts it all together.”

And again, unlike heroin and prescription painkillers, which can lead to respiratory difficulties and death, “in animal studies where rats were given mitragynine, those rats had no respiratory depression,” according to Boyer.

However, Boyer cautions that, like any other opioid, kratom has abuse liability. “Heroin was once marked as a therapeutic product and later was criminalized,” he reminds us. 


Cynthia Slagle said...

With the burst of energy and then the relaxation feeling to follow, it sounds like if you took an Adderall and some marijuana and combined them into one drug. I feel like it is a drug that isn't widely known about, used, or produced... yet.

Anonymous said...

I'm a PhD student and I use Kratom fairly regularly. I want to correct one mis-impression that you readers might get from David DiSalvo's post about Kratom. The withdrawal effects are definitely more severe than caffeine withdrawal. He didn't do it long enough or (probably) in high enough dosages to know that. I would put Kratom withdrawal somewhere between Codeine and Hydrocodone withdrawal. It's certainly nothing like heroin withdrawal (I had personal experience with that in my teens). The main symptoms are a flu- or cold-like feeling, including weakness, extreme fatigue, that feeling you get in your head when you have a cold, the sniffles, and some stomach problems and diarrhea, mostly owing to that fact that you stopped taking a drug that causes moderate constipation and now the body is doing it's best to void itself of all feces stored up in the lower intestines. Accompanying those effects are some irritability, depression, and for some people, anxiety. Those tend to dissipate within 4-5 days.

I hope that the U.S. federal government does not schedule kratom. Despite the potential for addiction, it is incredibly safe, perhaps the safest drug I have ever used (along with Marijuana), and in my teens I explored everything from research psychedelics (Shulgin's creations) to dissociative anesthetics. I find that kratom completely abolishes my social anxiety, and most anxiety in general, which graduate school tends to induce.

There seem to be an uptick in the number of ER visits related to Kratom, but most of them seem to involve people taking too much (harmless but very uncomfortable, particularly the dizziness, nausea, and anxiety) or people going through withdrawal and being scared by the effects.

In the past I have taken 7-10g of Kratom everyday for months, and aside from the persistent constipation, occasional nausea (not uncommon with opiates) and the withdrawal effects, I have experienced no negative effects. I do wonder what my liver enzymes might be like, though.

For me, Kratom combines the best aspects of a weak stimulant (say 10m-20mg of amphetamine, or a strong cup of coffee) with a weak opiate (lowish dose of hydrocodone) with very little of the peripheral side effects that plague stimulants. I do caution people about combining Kratom with anything stimulating, including caffeine (a cup of tea with it is OK, coffee not so much). Also, I would be wary of combining it with MAOIs or anything serotonergic until we know more about those interactions.

In all honestly, I don't know how I would make it through the very challenging and time-consuming science PhD program I am currently in without a few doses of Kratom a week.

Dirk Hanson said...

I've now heard from others as well on the subject of kratom addiction and withdrawal. Like any drug that tweaks opiate receptors, serious kratom use can lead to serious dependency and detox issues.

Marie said...

I have found that Kratom, although has similarity's to other substances isn't exactly like anything out there. I use Kratom mainly for pain relief as I have been diagnosed with Lupus. On top of this being all natural it really allows it to be long lasting. It allows that pain relief as well as an energy just that doesn't just stop and leave you worst than you started, as well as a positive attitude. Which really helps me get through my days. Also with this being all natural it makes me thankful because i am getting my relief and no damaging effects on my liver. They say Kratom is about as addictive as coffee which I know if I ever decide to stop taking this for any reason I will be ok and able to stand any type of withdrawal like symptoms.

Anonymous said...

You are all underestimating this product. IT KILLED MY WIFE at age 45. The medical examiner could not find any other issues other than the presence of this crap in her system and also stated she was the healthiest person she had examined in a long time. It is addictive and clearly can be fatal!!!

Robert Schrock said...

Been ordering kratom leaves from and it's solved all my pain, previously I was taking vicodin daily for years and just knew it wasn't good for me, so I turned to Kratom and it is fantastic. I am even able to skip days entirely without needing to take anything. It's been a life saver we really need to stop kratom from being banned as the pharma companies are trying their best to get rid of the competition.

Anonymous said...

I was heavily addicted to opiates. Then I decided to quit using them. I learned about kratom (Mitragynine) through a friend. It was an answer to my prayers! Overall, it helped with the terrible withdrawals but more importantly it was more than successful treating my years of pain. I was shocked that my depression lifted and my anxiety wasn't controlling my life any longer.

I do see that kratom could become habit forming. You must keep in mind that "less is best" while taking kratom. I would suggest only dosing twice a day. Once in the morning then again in the evening. The red blends are perfect for pain and relaxation. I dose my kratom an hour before I go to bed. Green malay works perfectly for energy and lifting the mood. I enjoy taking mine roughly an hour after I've been awake.
Kratom is NOT bath salt related what do ever!! It's very sad that there's so much FALSE information concerning kratom. I hope the government doesn't ban kratom. I feel like science could perhaps benefit from kratom as well. Those that support kratom should be very active in protecting our rights to use kratom or any other supplement. It's our body - our choice!

Anonymous said...

I'm living in southern Thailand where Kratom is a famous drug. Older people like chewing it, especially farmers who have to do hard work in the sun. Youths like to brew a mix which is called "Nam Tom". You cook the leaves to a tea, then cool it down and mix it with Coca Cola and cough syrup that contains chlorphenamine. It makes you relaxed and euphoric, similar to heroin, but less intense and far less dangerous. Of course it's addictive, but without severe withdrawal symptoms. Has a good effect if combined with smoking weed. It's illegal in Thailand but was generally tolerated. Since taking Kratom leaves to brew "Nam Tom" has become widespread in southern Thailand, the police has become more concerned about it, but it's still available everywhere.

Anonymous said...

Just wanted to inform everybody who might read this that those who tend to abuse other substances may also tend to abuse Kratom. Kratom abuse just cost a friend of mine his life. He had apparently been using it for some time. While using Kratom, he lost significant weight and his skin darkened after a significant period of use. He had been suffering seizures for the past few years while using Kratom. These seizures were happening closer and closer together within the months leading up to his death. He had a history of opiate abuse and alcohol abuse but had apparently stopped using everything but Kratom according to medical records. This was further evidenced in the postmortem toxicology report as the only thing detected was a very high dose of Mitragynine (HPLC/DAD) Liver 85 mg/kg. Autopsy Report reported "CAUSE OF DEATH: ACUTE MITRAGYNINE INTOXICATION".

I am not interested in the should it or should it not be controlled or legal or illegal etc. issues. I am posting this information to let people know that this substance can be addictive for some people, can cause seizures, can be fatal if misused, and that people should be cognizant of these potential consequences should they choose to use Kratom. I acknowledge that my friend died of a massive dose and am not saying that any use of Kratom will lead to this end. It is also worth noting that he did not take this massive dose early in his use of Kratom. Much like most opiate abusers, his dosage increased over a period of time (approx. 3 years from what I understand). As his body gained an increased tolerance for the substance it required progressively more to induce the desired effect. I put this out here in the hopes that it will help someone......anyone in evaluating whether or not Kratom is right for them. Be safe. Take care.

Dirk Hanson said...

Thanks for the reminder that Kratom is not without its dangers.

Anonymous said...

To those people claiming to have lost friends or family. I'm sorry, but posting this as an anonymous person doesn't carry a ton of weight. If bet dollars to donuts, those individuals, assuming those events occurred were using research chemicals as well. The seizures are a classic result from overdoing one called etizolam. And it absolutely does not get detected in bloodwork. Additionally, to have that many milligrams of mitraginine in his liver he would have had to consume 2.6 kg of kratom within 24 hours. It is impossible to consume more than maybe 12 grand every five hours. Either he got into some crazy extracts, your story is untrue, or the ME meant nanograms, and since that was the only thing he found ruled it was toxicity. Mitraginine is toxic at a level of 5 mg/kg, so please explain to me how he... Never mind. People, especially the ones screaming for doing realize that you cannot consume a massive dose of kratom. You will vomit immediately. It is 100% impossible to overdose on kratom. Maybe some super strong extracts or pure mitraginine could get you in trouble, but studies as recently as 2015 have all stated that the very few number of deaths where kratom was found in the system 3 out of four had other drugs in their system and and the others had such low levels of kratom alkaloids that linking in anyway to "kratom toxicity" was incorrect of the medical examiner. Also "kratom toxicity " isn't a thing. If you two posters would please be so kind as to name the individuals so the author could verify what you are saying, then I will consider believing you.

Angela said...

It was supposed to be such an innocent couldn’t be that hard to get off. Withdrawal symptoms from Kratom are usually heavy sweats, hot and cold, but I had that covered with Clonidine. Insomnia is another symptom but I got plenty of sleep by taking benzos that were left over from my prodigious pill-popping days—despite the fact they were five years over the expiration date. I suffered no nausea or diarrhea either, because I had plenty of Imodium (the only anti-nausea drug that’s effective, because it works on the opiate receptors in your stomach). But there were two things I wouldn’t be getting out of: one, were the excruciating aches and pains. Walking across the room was a task of epic proportions. Doing the dishes was as big a deal for me as working a 10-hour shift of heavy labor. The second thing was my energy level: it was a big fat zero! After day 10, I was still not getting any better. For more information: Kratom

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