Kratom

Kratom

• What Is It?

  • Kratom or Mitragyna is a tropical plant indigenous to Southeast Asia and is consumed by preparing the leaves into a tea or grinding them into a powdery substance.

• How Does It Work in the Body, Usage, and Evidence?

  • Kratom has similar effects to opioids, including pain relief and euphoria, which can cause potential addiction.

  • It binds to the mu-opioid receptors, similar to other opioids with similar binding affinity. This suggests why Kratom has effects on regulating pain perception.

  • Low doses of Kratom have been shown to be a mood booster, and higher doses shown to relieve anxiety.

  • The most common use of Kratom is for pain relief, specifically back/spine pain, fibromyalgia, migraines, and rheumatoid arthritis.

  • Studies show that Kratom can be used as an opioid substitution. E.g., Coffee drinkers substituting this can improve social connection.

• Dosage:

  • Doses of 5 g of raw material are reported to exert stimulant effects.

  • Doses between 5 and 15 g are reported to lead to relaxation and analgesic effects [88]. Higher doses are reported to have more chances of side effects.

  • Effects of Kratom are generally reported 5-7 h after use, and optimal effects are felt within 2-4h.

• Adverse Effects:

  • Most common side effects:

    • Constipation

    • Nausea

    • Vomiting

    • Stomach irritation

    • Drowsiness

    • Dizziness

    • Sedation

    • Liver problems

    • Seizure

  • The biggest concern of Kratom is its potential for dependency and addiction in humans, which has raised big concerns regarding its usage.

  • A proposal was made stating that a large amount of Kratom use can be used as an alternative for more harmful substances such as narcotics.

    • There is convincing evidence that shows Kratom has less potential for addiction and overdose than original opioids.

    • Little evidence showing that Kratom is a good substitute with the same traditional effects.

  • Due to Kratom being an unregulated supplement, it can have numerous risks.

    • Reported documentation of Kratom being mixed with synthetic substances such as phenylethylamine, which has resulted in death.

    • In 2018, there has been epidemiological and laboratory proof that Kratom was the source of a multi-state Salmonella outbreak.

  • Kratom mixed with other illicit substances has been linked to several organ system injuries such as:

    • Kidney injury

      • Acute kidney injury

    • Cardiotoxicity

      • Arrhythmias

    • Thyroid

    • Respiratory

    • Reproductive

      • Neonatal abstinence syndrome

    • Hepatic (most common)

      • Elevated alkaline phosphatase and bilirubin

    • Neurologic

      • Acute brain injury, seizure, cognitive impairment

  • Centers for Disease Control and Prevention data from 2016 and 2017 linked Kratom to 152 deaths.

  • It is important to know that Kratom does have some therapeutic effects but can quickly cause harmful effects if not used correctly or mixed with other substances of abuse.

• Interactions with Medications:

  • Kratom should be cautioned if consumed with alcohol or opioids.

    • Especially with benzodiazepines which can cause respiratory depression.

    • Combine with stimulants because Kratom has stimulant effects as well.

  • A study shows that Kratom has Cytochrome P450 enzyme activity.

    • Increases the likelihood of herb-drug interaction with drugs that also are associated with Cytochrome P450 activity.

  • A study shows that the alkaloid portion of Kratom is an agonist from Alpha 2 adrenergic receptors.

    • This can result to accentuation and can lead to more dangerous side effects if mixed with sedative, hypnotic, and analgesic drugs.

  • An in vitro study showed that Kratom mixed with erythromycin, loperamide, and protease inhibitors can lead to Kratom toxicity.