Kratom- Potential Opioid Saviour?

4 minute read
Originally posted here: https://mcgill.ca/oss/article/health-general-science/kratom-potential-opioid-saviour

Kratom is rapidly becoming a choice recreational drug, but there’s a good chance you’ve never heard of this substance, which can cause sedative effects like morphine at high doses as well as stimulating effects, like caffeine or methamphetamine at low doses. This drug is not new, though regulations concerning it are (at least in North America), and not everyone is pleased about them.

Mitragyna speciosa, commonly known as kratom or ketum, is a tropical evergreen found in Southeast Asia. Its leaves are chewed fresh, or dried, powdered and put into capsules, extracts, slurries or drinks. A user feels the affects about 30 minutes after taking the drug, and they last roughly 6 hours, though the dosage and timings are highly strain dependent. The leaves contain several active compounds, most notably mitragynine and 7-hydroxymitragynine which act as alkaloid opioids. An alkaloid is any molecule that contains nitrogen, and has a biological effect. In these chemicals’ cases, that biological effect is achieved through acting as μ-opioid receptor agonists. These molecules bind to, and activate the opioid specific receptors, much like other opioids such as morphine, codeine or fentanyl. 7-Hydroxymitragynine has a potency equal to 17 times that of morphine, and as well as the molecules mentioned, kratom contains about 25 other alkaloids, each which will affect the body in some way.

Unlike these other opioids however, kratom remains largely unregulated in most of the world. Here in Canada it’s possible to purchase kratom in bulk online, though illegal to advertise it for consumption. While America has had a slightly more complicated relationship to the drug, as of October 2016 the DEA has rescinded its August 2016 move to place mitragynine and 7-hydroxymitragynine on the schedule 1 drug list. Around the world policies vary country to country- unregulated in most African countries, but regulated in Sweden, the UK, Australia and Denmark. Kratom remains entirely illegal in Thailand, where it’s been a controlled substance since 1943. Prior to this regulation, kratom leaves were often chewed fresh to achieve a small stimulation similar to that of coffee.

It’s worth exploring why public outcries to banning kratom have been so fierce, especially when the regulation of other opioids has been met with favourable responses. There is a distinct lack of studies performed on kratom and its effects, and it seems that most studies that were performed conclude by pointing out how it`s too difficult to draw conclusions based on so few studies. The DEA and other law enforcement agencies point to the questionable purity levels of kratom products, the potential for abuse and how leaving drugs unregulated leaves them in reach of young adults. Of concern is the fact that kratom is not detected on standard drug tests, its low cost, its wide availability online, and like any drug, its potential to be cut with dangerous chemicals. Considering the fentanyl crisis currently sweeping BC, a fear of opioids makes sense, but whether the concern is warranted remains to be seen.

While kratom is itself addictive, with even the user guide sites for it instructing users to not take more than 1 or 2 doses a week, there is growing evidence that it could serve as a stepping stone for opioid addicts on the path to getting clean. Studies have shown that kratom may be effective to wean addicts off their opioids of choice. When kratom is fermented, an additional bio-active chemical is produced- mitragynine pseudoindoxyl. This substance has been the subject of much scientific excitement, as it has been shown to be an antagonist for the delta opioid receptor, a process which has been correlated with reduced withdrawal symptoms, and reduced morphine tolerance. The withdrawal symptoms of kratom, which include anxiety, restlessness, tremor, sweating and cravings for the substance, are generally considered to be milder than the withdrawal symptoms of other opioids, though longer lasting.

Studies have shown that tolerance to kratom is not built over time as it is with other opioids. This, combined with its potential to lessen withdrawal symptoms, while still providing the painkiller effects that most patients take opioids for, makes me really look forward to the kratom research that will take place in the near future. It undeniably has potential that warrants study, but at present it is far too soon to start referring addicts to Madam Kratom’s online emporium. The toxicity of kratom has not been properly studied, nor has its interactions with other drugs (legal or otherwise), its long term effects, or even really, its short term effects. While the promise is present the science is not, and it would be truly foolish to rush to the kratom bandwagon without knowing how it will affect most major organs, amongst other things.

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