Is Kratom an Opioid? Uses, Classification & Controversies

Key Takeaways

• Kratom, scientifically known as Mitragyna speciosa, is a tropical tree from Southeast Asia with traditional medicinal uses.
• The leaves contain compounds like mitragynine and 7-hydroxymitragynine, which have mind-altering effects and are used for pain relief and as stimulants.
• Kratom has gained popularity in Western countries for its potential as a natural pain reliever with a lower risk of addiction compared to opioids.
• While Kratom is not classified as an opioid, it interacts with opioid receptors in the brain, producing similar effects such as pain relief and euphoria.
• The legal status of Kratom varies internationally and across the United States, with some states banning it and others regulating it.
• Despite its potential benefits for pain management and opioid withdrawal, Kratom’s safety, efficacy, and risk of addiction remain controversial.
• There is a lack of FDA approval and clinical trials to fully evaluate Kratom’s effectiveness and safety.
• Advocates argue for Kratom’s benefits, while critics point to its addictive potential and adverse health effects.

Origins and Traditional Uses of Kratom

Kratom, known scientifically as Mitragyna speciosa, is a tropical evergreen tree native to Southeast Asia, particularly Thailand, Malaysia, and Indonesia. It has traditionally been used in these regions for its medicinal properties. The leaves of the Kratom tree contain compounds that can have mind-altering effects, which is one reason for its historical use in religious rituals and as a stimulant by workers in Southeast Asia to increase energy and stamina and limit fatigue.

Traditionally, Kratom leaves were chewed, brewed into tea, or used in cooking. The primary uses of Kratom in its native environment include pain relief, treatment for opiate withdrawal and addiction, and as an anti-diarrheal. In some cultures, Kratom has also played a significant role in traditional medicine, used to treat various ailments such as fever, to improve mood, and to help with sleep disorders.

In recent years, Kratom has gained popularity in Western countries, particularly in the United States and Europe, as a substance that can offer similar pain relief to opioids but with a potentially lower risk of addiction. Its use has become a subject of public debate and scientific study due to its psychoactive properties and potential therapeutic benefits. However, it’s important to note that while Kratom is legal in some areas, it is illegal or controlled in others due to concerns about its safety and potential for misuse.

The Geographical and Historical Roots of Kratom

Kratom’s history is interwoven with the culture and traditions of Southeast Asia, where it has been used for centuries. The plant is recognized by various local names such as ‘Ketum’ in Malaysia and ‘Biak-Biak’ in Indonesia, reflecting its deep cultural integration.

Traditionally, the leaves of the Kratom plant have been used for their medicinal properties, offering relief from pain and distress. They have played a significant role in traditional medicine, with their leaves being dried and crushed into powders or pills. The plant’s use extends beyond medicinal purposes; due to its mood-enhancing and stimulating effects, it has also been utilized for recreational and social bonding activities.

The cultivation and use of Kratom have evolved, with the plant gaining international attention and sparking debates on its usage. Despite its modern popularity, Kratom remains a symbol of tradition and natural healing in Southeast Asian societies, with a history that dates back hundreds of years. As globalization has connected disparate regions, Kratom’s presence has expanded, leading to a mix of traditional and modern applications and ongoing discussions about its benefits and risks.

Historical and Traditional Uses of Kratom

The leaves of the Kratom tree contain unique alkaloids, primarily mitragynine and 7-hydroxymitragynine, which have been valued for their stimulant and pain-relieving properties. Traditionally, Kratom leaves were chewed by manual laborers to increase work efficiency, endurance, and tolerance to harsh climate conditions. In folk medicine, these leaves were used to soothe discomfort, boost energy, and improve appetite.

Moreover, Kratom has played a significant role in traditional healing practices, with the leaves ground into a paste for treating wounds and skin infections or brewed into tea to provide an analgesic and relaxing effect. It has also been utilized in various cultural and social ceremonies, indicating its importance in the cultural fabric of native societies. Despite its traditional uses, it is important to note that Kratom can have sedative effects at higher doses and carries the potential for misuse and addiction. In modern times, while the use of Kratom has spread beyond its native regions, its legal status remains controversial in many parts of the world.

The Rise in Kratom’s Modern-Day Popularity and Uses

Kratom has grown in popularity across the United States and beyond. While traditional uses of Kratom for pain relief and mood enhancement continue, modern applications have expanded due to its purported therapeutic benefits. Notably, Kratom’s active components, mitragynine and 7-hydroxymitragynine, have been identified to produce stimulant effects at low doses and analgesic effects at higher doses, which has contributed to its rising use as a natural alternative for managing chronic pain and anxiety.

Despite the lack of clinical trials to thoroughly evaluate Kratom’s effectiveness for chronic pain management, anecdotal evidence and a growing community of users advocate for its potential benefits. A 2020 study highlighted Kratom’s ability to increase acute pain tolerance, suggesting its analgesic properties. Additionally, the demand for natural remedies and holistic approaches to health has positioned Kratom as a popular choice among those seeking alternatives to conventional pharmaceuticals.

Active Alkaloids in Kratom

The two primary active ingredients in Kratom are mitragynine and 7-hydroxymitragynine. Mitragynine is the most abundant alkaloid in Kratom leaves, contributing to the stimulant effects at lower doses, such as increased energy and alertness. As the dosage increases, it can produce pain-relieving and sedative effects similar to opioids. This is due to mitragynine’s ability to bind to opioid receptors in the brain, albeit with a lower risk of respiratory depression, which is a common risk associated with traditional opioid use.

7-hydroxymitragynine, although present in smaller quantities (approximately 2% of the alkaloid content), is a potent compound that significantly contributes to Kratom’s analgesic properties. Studies have indicated that this compound has a strong affinity for opioid receptors, enhancing the analgesic and sedative effects, especially at higher doses. This has raised concerns about the potential for dependence and addiction similar to other opioids.

Despite the therapeutic potential, particularly in pain management, the lack of clinical trials and FDA approval means Kratom remains a substance with contested benefits and risks. Side effects reported include nausea, constipation, dizziness, and, in rare cases, more serious conditions such as seizures and liver problems. Fatal overdoses from Kratom alone are considered extremely rare. However, the combination of Kratom with other drugs increases the risk of adverse events significantly.

Mitragynine and 7-Hydroxymitragynine in Kratom

Kratom is known for its partial agonist action at the µ-opioid receptor, contributing to its effects. Unlike typical opioids such as morphine, mitragynine does not activate the β-arrestin-2 pathway, which is associated with respiratory depression, a dangerous side effect of conventional opioids. This characteristic makes mitragynine and kratom somewhat distinct in their pharmacological profile.

7-Hydroxymitragynine (7-OH), a metabolite of mitragynine, is approximately ten times more potent and is a key mediator of kratom’s analgesic effects. Both compounds have been shown to produce analgesia in rodent models, with 7-OH being significantly more powerful. The interaction of these alkaloids with opioid receptors suggests a complex pharmacology that includes opioid-receptor-dependent effects.

In vitro studies indicate that mitragynine has a lower affinity for the µ-opioid receptor than 7-OH, and while mitragynine acts as an antagonist, 7-OH is a partial agonist. This difference in action at the receptor level may explain their efficacy and potency variations. Furthermore, the metabolic conversion of mitragynine to 7-OH, which occurs in human liver microsomes, is an important factor in understanding the pharmacokinetics of kratom’s primary alkaloids.

Overall, mitragynine and 7-OH contribute to the analgesic and potentially addictive properties of kratom. Still, their unique pharmacological actions differentiate them from traditional opioids, warranting further research into their therapeutic potential and risks.

For more detailed information on the pharmacological effects of these alkaloids, readers can refer to the studies published in Molecules and the National Center for Biotechnology Information.

Kratom and Opioid Classification

While kratom is not classified as an opioid, it does contain compounds, such as mitragynine and 7-hydroxymitragynine, that interact with opioid receptors in the brain. This interaction can produce pain-relieving effects and a sense of euphoria, which are characteristics commonly associated with opioids. However, kratom is distinct in its chemical structure and is not derived from opium poppy plants, which are the source of traditional opioids like morphine and fentanyl.

Despite its therapeutic potential, kratom’s safety and efficacy have been topics of debate. The US House and Senate proposed legislation in 2023 to prevent the FDA from regulating kratom more stringently than dietary supplements or food additives, reflecting a desire to maintain consumer access. Yet, the FDA and the Drug Enforcement Administration have expressed concerns, citing kratom’s addictive potential and the risk of misuse. The FDA has not approved kratom as a dietary supplement, food, or food additive, and its legal status varies across different states and countries.

Advocates for kratom argue that it offers a natural alternative for pain relief and may help with opioid withdrawal. At the same time, critics warn of its potential for addiction and adverse health effects. As research continues, the classification and regulation of kratom remain complex and evolving issues, with ongoing debates about its benefits and risks.

Kratom and Its Opioid-Like Effects

The primary reason for similarities between Kratom and opioids lies in the way Kratom interacts with the body’s central nervous system. Compounds found in Kratom, such as mitragynine, bind to opioid receptors in the brain, which are the same receptors targeted by opioids like morphine and heroin. This binding action can produce effects such as pain relief, sedation, and a sense of euphoria, which are characteristic of opioid consumption.

Despite these similarities, Kratom is often considered to be a safer alternative to conventional opioids. However, this does not mean Kratom is without risk. The potential for side effects and addiction exists, albeit at a presumably lower level compared to traditional opioids. The risk is particularly notable when considering interactions with other substances, such as gabapentin.

Distinct Characteristics of Kratom Compared to Opioids

While both kratom and opioids interact with the body’s opioid receptors, kratom’s primary alkaloids, mitragynine and 7-hydroxymitragynine, have a unique mode of action. Unlike opioids, kratom at lower doses can produce stimulant effects, enhancing alertness and energy levels. At higher doses, it may offer sedative effects similar to opioids. Still, with a crucial difference: kratom does not cause respiratory depression, which is the leading cause of death in opioid overdoses.

Furthermore, while kratom may have the potential to alleviate pain and assist in managing opioid withdrawal symptoms, it is not devoid of risks. Users should be aware of side effects such as nausea, constipation, and the potential for dependency with prolonged use. Nevertheless, many individuals report significant pain relief with kratom, suggesting its potential as an alternative to traditional pain medications. The withdrawal symptoms associated with kratom are also reported to be less severe compared to those of opioids, which may contribute to its appeal for those seeking to reduce opioid dependency.

Legal Status of Kratom in 2024

Despite Kratom’s widespread use and reported benefits, the regulatory landscape is complex and dynamic. As of 2024, Kratom is not regulated at the federal level in the United States, which means it is legal federally. However, state laws differ significantly, with some states having bans or specific regulations.

• In states like Kansas, legislation such as the Kratom Consumer Protection Act (KCPA) is pending, which aims to regulate Kratom as a food product and ensure its safety for consumers.
• Other states, including New Hampshire and Florida (excluding Sarasota County), impose age restrictions or have localized regulations.
• Conversely, states like Michigan and Idaho have no specific prohibitions, making Kratom use legal for all adults.

Internationally, Kratom’s legal status also varies, with some countries having explicit bans and others having no clear regulations. The evolving nature of Kratom’s legality is influenced by ongoing research, public opinion, and legislative actions. Notably, in 2023, proposed legislation aimed to prevent more stringent regulation of Kratom by the FDA, suggesting a trend towards maintaining consumer access under conditions similar to dietary supplements or food additives.

Kratom Legal Status in the United States

The legal landscape for Kratom in the United States is complex and varies significantly from state to state. At the federal level, Kratom is not classified as a controlled substance, but some states have taken their own stances. States such as Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin have banned Kratom, classifying it as a Schedule I drug, which indicates a high potential for misuse and no accepted medical use. Conversely, states like Nevada, Utah, Arizona, and Georgia have legalized Kratom with regulations in place.

In states where Kratom is legal, there are often age restrictions to prevent its sale to minors. For instance, Arizona, Georgia, Illinois, Minnesota, Nevada, Oklahoma, Texas, and Utah restrict Kratom sales to individuals over the age of 18. Meanwhile, states like Colorado, Florida, Louisiana, Oregon, South Dakota, Tennessee, Virginia, and West Virginia have set the age limit at 21. It’s important to note that even within legal states, there can be local variations, such as in Florida, where Kratom is legal, except in Sarasota County.

International Legal Status of Kratom

In Australia, Kratom is classified as a Schedule 9 substance, indicating it is a prohibited narcotic, making its use, possession, or transportation illegal. However, a legal provision may allow its use strictly for research purposes. Across Europe, the legality of Kratom is diverse, reflecting the complex fabric of national laws. Some European countries permit the sale of Kratom with the stipulation that it is not labeled for human consumption.

Kratom’s legal landscape in Southeast Asia, where It originates, is equally complex. Thailand, for example, has recently moved to decriminalize the plant after years of strict prohibition. Indonesia, a major producer of Kratom, has seen governmental crackdowns, but a proposed ban has been postponed until at least 2024. This postponement allows for continued legal production and export amid uncertainty regarding future regulations.

The Kratom Controversy: Benefits and Risks

The debate around Kratom is fraught with controversy due to its varied effects and potential risks. Advocates highlight its traditional use in Southeast Asia for pain relief and energy, while opponents raise concerns about its safety and consistency. A significant risk is the lack of regulation, leading to variability in the strength of active compounds like 7-hydroxymitragynine, which can cause seizures at high doses. Kratom’s legal status is contentious, with some states banning it while others consider regulatory measures. The FDA has not approved Kratom as a dietary supplement or food additive, citing safety concerns.

Proponents argue for Kratom’s benefits, such as pain management and opioid withdrawal aid. At the same time, critics point to its addictive potential and associated health risks, including seizures and death in extreme cases. The substance has been at the center of wrongful death lawsuits, exemplifying the gravity of the debate. Despite the controversies, legislative proposals aim to prevent the FDA from imposing stringent regulations on Kratom, intending to keep it accessible.

Potential Benefits of Kratom Use

Advocates for kratom highlight its ability to provide pain relief, which is particularly significant given its lower risk of causing respiratory depression—a severe side effect associated with traditional opioids. This characteristic positions kratom as a possible alternative for managing pain with a reduced risk profile.

Furthermore, kratom contains compounds like mitragynine and 7-hydroxymitragynine that interact with opioid receptors in the brain. This interaction suggests kratom may have a role in alleviating symptoms of opioid withdrawal, thereby aiding in the treatment of opioid use disorder. Its use is backed by anecdotal reports from individuals who have found relief from chronic pain, depression, and anxiety, contributing to its popularity.

Risks and Concerns Associated with Kratom Use

Despite its growing popularity, kratom has been the subject of considerable debate due to its potential risks and dangers. The FDA has not approved kratom for any medical use and continues to warn about its safety. Concerns have been raised regarding the substance’s potential for addiction, given its opioid-like effects. Notably, the Drug Enforcement Administration (DEA) lists kratom as a drug and chemical of concern. Some reported side effects of kratom include weight loss, dry mouth, chills, nausea, and vomiting. Moreover, there is a lack of robust clinical trials evaluating kratom’s efficacy in managing chronic pain, and its safety profile remains under-researched.

Recent incidents have heightened scrutiny on kratom, such as a significant seizure of kratom valued at $3 million and a wrongful death lawsuit associated with kratom use, where a jury awarded a $2.5 million verdict. These events reflect the growing concerns about kratom’s safety and its implications for public health. Additionally, the controversy surrounding kratom has led to a patchwork of legal statuses across different states and countries, underscoring the uncertainty and divided opinion on its use.

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