Kratom: Miracle Herb or Public Health Danger?

Mitragyna speciosa
is definitely an herb from Southeast Asia. Traditionally, it has
been utilized by workers to help them convey more stamina during long workdays. A tea
would be brewed from leaves, and consumed throughout the day. In this form, Mitragyna has been used safely for hundreds
of years.

Over the past 20 years it's made its way into the Western
market. Anecdotally, Mitragyna is
able to do 2 things perfectly. It is a strong analgesic, thus used for chronic
pain. It may also help people get off opioids. Kratom has thousands of advocates,
and there are lots of testimonials from individuals who believe it has changed their
lives for the better.

Kratom is another controversial herb. The united states Food and Drug
Administration claims it's associated with deaths, and has even
tried to ban it as a Schedule I drug. Any quick search on the internet will discover
many articles claiming that kratom is a dangerous natural opioid. This is partly
due to its history. It was not sold as an herbal medicine in nutrition stores
or by practitioners; rather, it had been discovered through the smoke and head shop
industry.

Just being sold within this market might have contributed to a
perception that it's a dangerous herb, used only to get high. What is worse
is really a good reputation for low quality and adulterated products. For example, in 2009, 9 deaths
in Sweden were reported from people utilizing a kratom product sold as “Krypton.”
It was not pure kratom. It was intentionally adulterated with an opioid
analgesic, O-desmethyltramadol.1

On the other side of the controversy are thousands of kratom
consumer advocates who would like kratom available like a life-saving herbal medicine.
Both sides have flooded the web with information supporting their
perspectives, which creates a confusing situation for those simply looking for reliable
information.

This controversy found a head on August 31, 2023, when the
Drug Enforcement Administration published a Notice of Intent to put 2 alkaloids
in kratom – mitragynine and 7-hydroxymitragynine – on the list of
banned, Schedule I substances.2 They cited 33 deaths associated with
kratom use because the reason for carrying this out. The scheduling notice included
reference to the 9 deaths in Sweden without ever mentioning that the product
accountable for those deaths was adulterated.2

A large grassroots effort to battle the ban followed this
proposal. On October 14, 2023, the DEA withdrew the scheduling notice.3
It asked the FDA to produce, by December 1, 2023, an “expedited 8-factor analysis
” to justify scheduling of kratom. The FDA didn't do this. However, in
response, the American Kratom Association did. For an extremely detailed
review of a brief history and safety of kratom, this 126-page document can be obtained
online.4

Facts Taken Out of Context

There are a few common arguments produced by individuals who
believe kratom is dangerous and should be banned. These are that it's an
opioid, it is deadly, and it is addictive. Within the following, I'll review
these points.

Mitragyna contains over
25 different alkaloids, that provide it its medicinal properties. MG and 7-MG are
the 2 most well known of these alkaloids. MG is the reason 60% of total
alkaloids, and 7-MG about 2%. A smaller amount is famous about the other alkaloids.
Since kratom is usually not standardized either to of those alkaloids, the
actual percentages can differ from product to product.

Our bodies contain 4 various kinds of opioid receptors, including
delta, kappa, mu, and nor. Both MG and 7-MG are mu-opioid receptor agonists.
However, this does not make kratom an opioid. As based on the Controlled
Substances Act, opioids are substances having “an addiction-forming or
addiction-sustaining liability much like morphine or [being] able to
conversion into a drug [with such liability].”5

Black cohosh is really a mu-opioid receptor agonist. Yet nobody is
claiming it is dangerous, addictive, potentially fatal, and should be banned.6

Interestingly, inside a study conducted on the effect of those
alkaloids in rats, it was found that, “MG [the main kratom alkaloid] doesn't
have abuse potential and reduces morphine intake, desired characteristics of
candidate pharmacotherapies for opiate addiction and withdrawal.”7 So,
the research appears to confirm what's known from anecdotal use: kratom isn't
addictive.

To be fair, that very same rat study found that isolated 7-MG does
have high abuse potential in rats. Keep in mind that 7-MG makes up only 2% of
aklaloid total.7 Nature somehow chose to give us kratom with about
30 times more MG than 7-MG.

Pharmacological scientific studies are often quoted from context. It is
simple to find statements that kratom's alkaloids are 5 or 13 times more potent
than opioid drugs. These numbers are repeated by different articles and
websites that reference each other. Content is written to own reader the
impression that using kratom as a whole herb is many times stronger and
more dangerous than actual opioid drugs.

Getting back to the initial research, this perspective relies
on studies by which isolated alkaloids are injected into rodents. Twitch
response and response to pain stimuli are then measured.8 Rodent research
does indicate an addictive and opioid-like effect from the 7-MG alkaloid. So
how much kratom would an individual have to consume in order to get this effect?

Isolated alkaloids from Mitragyna
are not easily available. Research labs might have the equipment and expertise
to extract the alkaloids, but it is not realistic for a typical consumer to do
this. Unlike substances typically accustomed to get high, kratom is not injected or
smoked. In the usa it is usually sold as bulk powdered leaves or
capsules. Occasionally, it is sold as a tincture.

Since the oral route may be the only one available to consumers,
huge quantities of kratom would need to be consumed to be able to match the
effect in animals which are injected with isolated alkaloids.

The AKA 8-FA cites research that demonstrates how much kratom a
person will have to consume to get a morphine-type reinforcing dose from the
alkaloid MG.9 The end result found 200 grams for MG, making up
60% of kratom's alkaloids. There is about 30-times less 7-MG in kratom. Someone
would need to consume huge amounts of grams of kratom to get a
reinforcing dose of 7-MG. It is past the scope of this article to go through
the mathematics at length; however, the AKA 8-FA is freely available online for anyone
who wants to appear regarding this.9

Taking several too many grams may cause symptoms for example nausea
or upset stomach. The oral dose of kratom necessary to potentially mimic the
effect noticed in animals injected with isolated alkaloids doesn't seem possible to
achieve.10

Regardless, websites still warn the public that
“7-hydroxymitragynine is 13 times stronger than morphine milligram for
milligram,”11 and with no discuss how unrealistic it is to
obtain the same milligram dose of isolated 7-MG.

Misleading Press Releases

An understanding of MG and 7-MG can also be important
in understanding laws surrounding kratom.

An Arizona bill regulating kratom, which passed in 2023, limits
the amount of 7-MG in kratom products to 2%. The bill also forbids sales of
kratom to minors and establishes that the percentages of MG and 7-MG must
clearly be labeled on kratom products.12

The FDA has cited numerous deaths associated with kratom. In
actuality, these deaths have took place people with underlying medical
conditions and/or who have been engaged in polydrug use with medications for example
opioids. For this reason you will always read “associated with kratom.” Association
doesn't prove causality.

I found the following report an illustration of this the types of
deaths which have been associated with kratom. A 2023 case study is headlined
“Fatal mitragynine-associated toxicity in Canada.”13 The article
describes a 56-year-old woman who died after utilizing a kratom product. She also
had a history of COPD, developed bronchopneumonia, and was prescribed acetaminophen
with oxycodone. Investigation showed that she has used many more pills than
directed in the prescription. The toxicology report found blood amounts of
oxycodone at 0.19 mg/L . Other
substances found in her system were lorazepam and significant amount of mitragynine.
The investigators concluded that it was “a case of accidental / accident death secondary
to multidrug toxicity whereby mitragynine toxicity is primarily implicated.”13

We do not know if mitragynine were built with a synergistic effect with the
illnesses along with other substances this woman was using. It is all speculation.
What we can say for certain is that a lady with COPD and bronchopneumonia took what would
happen to be, alone, a near-fatal dose of acetaminophen/oxycodone and died.
Yet the article headline primarily implicates kratom.

Mitragyna doesn't recruit beta-arrestin to opioid receptors.
This is actually the mechanism through which opioid drugs purportedly cause respiratory
depression.14

A well-publicized case from 2023 is Ian Mautner – a
child having a history of emotional issues and substance abuse. At 19 years of age
he jumped to his death in Florida. The media sensationalized the story,
claiming it's kratom addiction that led to his suicide. His mother,
Linda Mautner, had since been advocating against kratom.15

This case was covered in the documentary film about kratom, Leaf of Faith. What's not made clear is
why, with everything else going on within this young's man life, kratom has been singled
out as the cause of his suicide?16

Data from the National Survey on Drug Use and Health is
accustomed to monitor substance-use trends and also to estimate the need for treatment and
inform public health policy. In 2023, the NSDUH reported opioid misuse among
10.3 million people aged 12 or older within the past year.17 There
wasn't any mention of kratom any place in the report.

How one thing kratom is both a dangerous, addictive opioid
substance – which should perhaps be banned like a Schedule I substance – and at
the same time can be used by huge numbers of people but goes unnoticed by a government
system made to track trends in substance abuse?

From 2011 to 2023, there have been 1807 installments of calls to poison
control centers about kratom. However, for the entire group of herbs and
dietary supplements, there have been 275 000 such calls about health supplements
from 2000 to 2012.18,19

The Importance of Education

Reporting calls to poison control centers about kratom
as reason for alarm, without reference to the whole dietary and supplement
industry, takes the reality out of context. As naturopathic doctors, we
must be aware that herbs are not always safe. Even generally safe herbs might have
adverse effects when used improperly or by the wrong person.

People who use herbal medicine can experience adverse effects. Much
of the means to fix this is proper education and guidance on how you can properly use
herbs. This really is currently significantly lacking when it comes to kratom, which
although widely used, is not well-known among natural healthcare practitioners.

One of the interesting observations within the AKA 8-FA is that
kratom is traditionally used to enhance occupational demands and social
functioning. It does not inhibit people's capability to work, as taking actual
opioid drugs do. If someone is looking for a medication to assist them to escape from
life, kratom is an extremely bad choice. Other drugs, such as alcohol, cannabis, or
opioids, will suit that purpose much better.

The 8-FA likens kratom to tea and coffee – a stimulating herb
that can help people get through your day. Like coffee, it's also easy to
develop a dependency on it. Practitioners should be aware of this, also it may
be best to caution individuals regarding the amount of kratom they will use, in order to
steer clear of the development of a dependency. An addiction like this with coffee
implies symptoms of tolerance and withdrawal. Addictive substances will also be
associated with behavioral changes. A dependancy causes irrational behavior when
addicts no longer possess the drug within their system. We don't see kratom cause
alterations in personality.

One from the frustrating things about researching kratom is the fact that
it's not area of the traditional herbal library with which we're most
familiar. It was never used in Europe, nor will we have descriptions from
Ayurveda or TCM that go back hundreds of years.

Therefore, I do think some caution is warranted with kratom. If
someone is available in with low energy during working hours, I am not going to
recommend kratom over other herbs such as ashwagandha or rhodiola, which we
know a lot more about.

However, if someone is applying this herb and feels benefits from
it, they should 't be given wrong information about its supposed dangers.

The potential dangers of kratom must be balanced with its
benefits. Opioid addiction and chronic pain are serious issues. Naturopathic
doctors should know kratom and that it has anecdotally helped thousands
of people that otherwise don't have easy solutions of these problems.20
For many people, this is a life-saving herb.

A confusing facet of kratom may be the number of strains it comes down
in. Some online retailers carry a large number of different strains, each with supposedly
different qualities. Dosing recommendations may also vary widely.

In a 40-minute discussion I'd with the head of kratom
wholesaler, I had been told the next: There are really just 4 different types
of kratom. The white and green strains offer a similar experience, and therefore are the best strains
to enhance energy and enhancing mood. These strains have higher amounts of MG
and 7-MG alkaloids. Red kratom is higher in other alkaloids and it is the best for
pain. Yellow kratom, that is fermented and dried longer, is within between these
other strains in terms of effects. Dosing should be individualized. He
recommended that individuals take the minimum amount that works for his or her symptoms.
Once the right dose is located, taking more will not produce better results.

Due to issues with quality and adulterated products, the AKA
has started a GMP standards program.21 Getting products
through companies that are approved by this program is one way to insure a high-quality
product.

Closing Comments

In summary, Mitragyna
speciosa has been an unfairly maligned
herb. It is time for kratom to leave the smoke shops and be treated just like
any other herbal medicine. Lots of people claim that this herb is different
their lives for that better. Individuals will be entering your workplace either
asking about it or already using it. Naturopathic doctors have to be familiar
with kratom.