The Essential Guide to Kratom
(Mitragyna speciosa, Ketum, Biak-biak, Kakuam, Thom, Ithang)
Mitragynine and 7-hydroxymitragynine
C23H30N2O4 and C23H30N2O5
Kratom is the common name for Mitragyna speciosa, a tropical evergreen native to the marshy jungles of Southeast Asia. It grows wild in central and southern Thailand, Malaysia, Indonesia, Myanmar, and elsewhere in the Pacific Rim.
Known for its hanging clusters of deep yellow flowers and reaching up to 42 feet (13 meters) in height, kratom has numerous uses in folk medicine. Traditionally, the broad green leaves are plucked by hand and dried in the sun, to be brewed as a tea or pulverized and swallowed with water.
Since the beginning of the 21st century, kratom has increased in visibility around the world. Regular users see it as an invaluable aid for mental and physical health, while others enjoy its dual recreational value as a stimulant or sedative-narcotic (depending on the dose).
History & Stats02
It’s not clear when kratom use began, but the practice is thought to be ancient. In its native growing regions, leaves from the plant may be used to numb aches and pains, soothe fevers, treat diarrhea, manage diabetes, and alleviate addiction. They have also been applied as poultices to wounds or spread across the abdomen to drive out worms.
Perhaps the most popular use has been to chew on the leaves for energy—similar to the way coca is used in the Andes. In Thailand, peasant workers have been known to chew up to ten times a day while working outside in the sun.
From at least as far back as the early 19th century in Malaysia, kratom has also been used as a sedative—especially as a replacement for opium.
Amid growing enthusiasm for kratom’s medical potential, the active constituent mitragynine was isolated in 1921 and tested on humans in 1932. It was likened to cocaine for its stimulant effects on the central nervous system.
By the early 1940s, the government of Thailand was seeing a massive decline in opium tax revenue. Evidently, addicts were turning to kratom—an unregulated drug—to manage their withdrawal symptoms. The Kratom Act was passed in August 1943, forbidding anyone from cultivating the plant and ordering all existing specimens destroyed.
Elsewhere, scientific interest prevailed. More than 20 alkaloids were isolated during the 1960s and, in 1994, the second of kratom’s primary active compounds was identified: 7-hydroxymitragynine. The following year saw the first synthesis of mitragynine.
Public awareness of kratom flourished throughout the early 2000s, mainly via online message boards. In 2005, however, both M. speciosa and mitragynine were scheduled in Australia, banning them for sale or possession without a license. Enforcement of the Kratom Act also ramped up in Thailand, where arrests quintupled between 2005 and 2009. In 2012, when Thai police ordered the destruction of hundreds of wild kratom trees in a protected area of forest in Satun Province, locals resisted their attempts.
In the United States, various advocacy and campaign groups, including the American Kratom Association, Botanical Education Alliance, and United Kratom Association, have sprung up to safeguard kratom’s legality. Thanks to efforts like theirs, the DEA was forced to withdraw an August 2016 “notice of intent” to place kratom into Schedule I of the Controlled Substances Act.
Interest in kratom continues to grow—having spiked when the DEA threatened to ban it. A survey conducted around the same time found that, of 6,150 kratom users, 51% used it for pain, 14% for anxiety, and 9% for opiate withdrawal.
Kratom is commonly sourced from online “legal high” vendors, but it’s far from widely used. In 2014, it ranked among the top 20 drugs only in Hungary, where just 1.5% of the sample had used it.
It does, however, remain popular in Thailand—despite its criminalization and the social stigma attached. Of 1,000 teenagers surveyed, 94% used kratom, mostly as an ingredient in “4×100” cocktails. This formidable homemade concoction blends kratom tea, Coca-Cola, cough syrup (including codeine or diphenhydramine), and an anxiolytic, antidepressant, or analgesic drug. Served ice cold, it may also contain road paint, pesticides, powder from fluorescent tubes, and pretty much anything else rumored to “enhance” its effects.
Among other phytochemicals, kratom contains the indole alkaloids mitragynine (9-methoxy-corynantheidine) and 7-hydroxymitragynine.
Mitragynine draws comparisons to psilocybin and ergine (LSA) for its 4-substituted structure, and was previously thought to be the primary active compound. More recently, however, the terpenoid 7-hydroxymitragynine has been found to be 46 times more potent, with greater oral bioavailability and blood-brain barrier penetration.
7-hydroxymitragynine is a highly selective mu- and kappa-opioid receptor agonist, acting mainly on the former subtype. Mitragynine is a partial mu-, delta-, and kappa-opioid receptor agonist, but can also act on the 5-HT2A serotonergic and alpha2-adrenergic receptors, as well as neuronal Ca2+ channels.
The mechanism behind kratom’s stimulant effects is unclear. Since both compounds interact mainly with the opioid receptors, there’s likely to be some other alkaloid involved.
Safety and toxicity
Mitragynine shows negligible toxicity, even at high doses. For example, no fatalities were recorded in rats given 1000 mg/kg oral doses of kratom leaf extract or 806 mg/kg isolated mitragynine. Rhesus monkeys injected with 9.2 mg/kg mitragynine (IV) also presented no fatalities.
But this doesn’t mean kratom is totally safe. For one thing, different preparations may contain different amounts of phytochemicals and adulterants. There’s also been relatively little research into the long-term health risks of regular kratom use.
Of particular concern are reports of seizures, which increased fivefold in Thailand between 2005 and 2011. Most kratom-related seizures are attributed to adverse drug combinations, but they’re still a cause for concern.
Liver problems may also occur after two to eight weeks of regular kratom use. Symptoms include nausea, itching, dark urine, abdominal pain, and jaundice. Heavy users might notice a hyperpigmentation or darkening of the cheeks due to over-stimulation of melanocytes. Kratom might also be cardiotoxic; further research is called for.
Evidence suggests psychosis, including paranoid delusions, hallucinations, and confusion, may be caused by regular use spanning a decade or more. Animal studies have also highlighted a link between chronic use and memory/learning problems.
While a number of human fatalities have been linked to kratom use, there are usually other substances present. In one case, 0.6 mg/L mitragynine was detected alongside over-the-counter cold medicines and benzodiazepines.
Generally speaking, a moderate dose of plain dried leaf (powdered) is 3-6 g, but anything above 5 g is considered strong. Kratom is usually consumed with fruit juice or water. A popular method is the ‘toss ‘n wash’, which involves placing the powder in the mouth and chasing it down with a drink.
What to expect
On an empty stomach, the effects are noticeable from around the 15-20 minute mark, gradually building in intensity and peaking for two to four hours. Stronger doses may have a shorter onset.
Lower doses are often more stimulating. They may be characterized by increased motivation, talkativeness, and sociability, along with a feeling of euphoria and physical energy. Some people find the stimulant effects of kratom a little too “edgy” to be pleasant, at least at first. Other disagreeable effects—including sweating, nausea, dizziness, and dysphoria—can also be experienced during the onset period, but they usually give way in time.
At the higher, sedative dose ranges, users report a diminished sensitivity to physical and emotional pain, and a feeling of general contentedness. Some go into a kind of “waking-dreaming” reverie, especially when listening to music. Ethnobotanist and author Daniel Siebert likened this to the state prized by 19th-century Romantics, who used opium to keep one foot in dreamland and the other in the real world.
Additional effects might include mild visuals (both open- and closed-eye), a warming sensation, increased empathy, and possibly sexual arousal. The pupils are likely to constrict if they change size at all.
Some users get very thirsty during the onset, so it’s best to have water to hand. Any nausea that arises can be managed by keeping still until it passes. Swallowing kratom gradually can also help, however tempting it is to knock it back in one gulp to avoid the bitter taste.
Driving and other potentially dangerous activities should be avoided—even if you feel stimulated. The effects of kratom can change from stimulant to sedative without warning, so sometimes just turning on the stove could be risky.
Some “kratom products” may also contain adulterants, including morphine, hydrocodone, and fentanyl. In Sweden, nine people died from the “enhanced kratom preparation” Krypton—a blend of kratom, caffeine, and O-desmethyltramadol. The latter, a bioactive metabolite of tramadol, is a dangerously potent opioid. Other “kratom products” have been found to contain no kratom at all.
Another important consideration is the risk of addiction. Setting a personal limit of once or twice a week (or ideally once or twice a month) can be useful. Symptoms of addiction include anorexia and weight loss, insomnia, frequent urination, constipation, and darkened skin. Withdrawal symptoms, which can last about a week, include weakness, muscle pain, lethargy, cravings, nausea, jerkiness, insomnia, hallucinations, and diarrhea.
“Green- or white-veined strains are the most energizing”
Kratom “strains” are often distinguished by the color of the veins in their leaves. Green- or white-veined strains are said to be stimulating and red-veined strains more sedating.
It’s a convenient distinction but it’s also one without basis. Far from being different strains, green- and red-veined leaves are seen growing from the same tree. Differences in vein color have more to do with genetics, maturity, and exposure to sunlight.
“Strain rotation avoids tolerance”
Rotating strains throughout the week so that no strain is taken on two consecutive days supposedly circumvents tolerance. But in truth it’s more likely to increase it. While different strains have differing levels of the active indole alkaloids, those same alkaloids are nonetheless present in all. To avoid tolerance (not to mention addiction), it’s best just to moderate use.
There are no mainstream medical uses for kratom, but it shows great therapeutic potential.
Daniel Siebert described it as one of the most effective herbal analgesics, second only to opium. 7-hydroxymitragynine in particular is 13 times more potent than morphine and considerably less addictive. Withdrawal symptoms from kratom are also far milder and more short-lived. Mitragynine, meanwhile, is seen as a potential replacement for codeine, offering comparable analgesic effects without the fatal respiratory depression. Curiously, synthetic mitragynine is less potent than extracted mitragynine.
Kratom could also come to replace methadone in the treatment of heroin addiction—especially given its relative ease of production, making it ideal for poor and developing countries. It could be a viable alternative to alcohol too, since it promotes relaxation and sociability without the emotional/physical hangover.
At least one study supports the growing use of kratom to manage anxiety and depression. Mice injected with mitragynine were found to have lower levels of corticosterone, a hormone involved in the regulation of stress responses and energy. The open, introspective mindset that kratom creates may also be useful in psychotherapy.
Most users take kratom for pain, anxiety, or some other specific condition, but it’s also considered a “plant teacher”—a tool for exploration and growth. Described by one user as a “nurturing mirror,” it can gently draw attention to areas of personal and interpersonal dysfunction. These can be explored within the context of an emotionally honest, “entactogenic” high.
Some users report that kratom can reduce social anxiety, and even improve sexual performance.
Kratom isn’t federally controlled in the United States, but it is a “drug of concern.” Individual states, including Indiana, Tennessee, Wisconsin, Vermont, Arkansas, and Alabama, have banned the plant in various forms, while others have legislation pending.
In the UK, kratom is criminalized under the Psychoactive Substances Act. The plant and its active alkaloids is controlled by various measures in a number of EU member states, including Denmark, Poland, and Sweden. It’s also illegal in Australia, New Zealand, Malaysia, Myanmar, and Thailand, among other countries.
Can it be detected in a drug test?
Kratom won’t be detected by either standard or enhanced drug tests. And despite its similarity to opiates, it’s unlikely to trigger a false positive.
Specialist laboratory tests such as GC-MS (gas chromatography-mass spectrometry) are able to detect kratom in urine, but they’re not routinely used.
Can kratom cause psychological trauma?
Evidence suggests there may be a link between prolonged, regular kratom use (or addiction) and deluded thoughts. While moderate use isn’t likely to be problematic psychologically, some users have developed anxiety (although others use kratom to treat it).
The kratom “high” itself is actually pretty mild and manageable compared to many other psychoactive substances.
Are there risks?
Kratom is apparently safe for most healthy individuals. However, it’s always a good idea to start with a tiny test dose in case of allergies or adverse reactions. It may be especially risky for people with liver damage, due to the way it’s metabolized. Effects on pregnancy are unknown.
Is it legal to grow at home?
It depends on state law. But even in states where kratom is banned it may still be legal to grow for aesthetic purposes.
For growing tips, check out The Kratom User’s Guide.
What is the safest way to take kratom?
Most people take kratom orally, either washed down with or mixed into a drink. It can also be added to food. Strong, sweet flavors are good for masking the taste, so yogurt, applesauce, fruit juice, and chocolate milk are popular. Alternatively, kratom can be put into gel caps for easier dosing and consumption.
Smoking kratom isn’t recommended because it requires too many leaves. Usually, dried kratom has to be brewed, filtered, and evaporated before it can be smoked. The resulting substance—a kind of syrupy resin—is traditionally added to palas palm (Licuala grandis) leaves in the bowl of a long “madat” pipe.
Chewing fresh leaves is a more viable alternative. Effects may be felt from as little as half of a large, 8-inch leaf (or 1.7 g), although between one and three leaves is more common. The fibrous ribs and veins should be removed before chewing.
Various extracts, tinctures, and preparations are also available, but they could contain other ingredients.
What are the differences between strains?
Potency can vary substantially between the strains (e.g. Bali, Maeng Da, Red Vein Kali, etc.), but they all contain the same active alkaloids.
Can I use kratom to microdose?
Kratom may not be suitable for microdosing due to possible damage to the liver. It’s also unclear whether kratom is even active at sub-perceptual doses.
Does it produce tolerance?
With frequent use, i.e. more than once or twice a week, tolerance tends to build up. It may take several weeks of abstinence to return to normal sensitivity. There’s also a cross-tolerance effect with morphine.
Can I mix it with other drugs?
Negative experiences with kratom, including seizures and death, very often involve other drugs—so it’s advisable not to mix them at all.
Kratom certainly shouldn’t be mixed with other stimulants, including yohimbine, cocaine, amphetamines, and excessive amounts of caffeine. Nor should it be mixed with depressants, including opiates, benzodiazepines, and alcohol, due to the risk of breathing problems and death.
Monoamine oxidase inhibitors (MAOIs), including ayahuasca and some types of antidepressants, should also be avoided.
Find out more about risky drug combinations here.
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