As the opioid epidemic evolves, so do storylines in the media (most recently, various big pharma lawsuits and scandals). Depending on whom one talks to, the controversial herbal supplement kratom is either adding fuel to this fiery epidemic or is possibly its saving grace. One thing seems true: the current climate around pain management and addiction has made this psychoactive plant relevant today.

A Closer Look: An Evidence-Based & Personal Exploration Into Kratom

This blog will attempt to consolidate the available evidence, starting with what has been peer reviewed in the literature, and will also draw on anecdotal evidence from a widening population of users. These two sources highlight the need for more research into the risks and prospective benefits of this plant. Drawing, as well, from my own experience as a biologist in recovery with both positive and negative experiences with kratom, and with a more promising, long-lasting alternative- ibogaine, I hope to offer some brief personal insights.

The Jury Is Out & yet the Headlines Are Everywhere

However, while kratom is an important topic to address in the context of addiction and recovery, there is a lack of solid clinical data. Thus, much of the recent media coverage seems to offer little more than fear-mongering or sensationalism. Depending on one’s sources, kratom is either considered dangerous, addictive and potentially lethal or the new Holy Grail for opioid withdrawal and undertreated chronic pain. This lack of scientific data inhibits a comprehensive and fully objective cost/benefit analysis of kratom at this juncture. Nevertheless, our relative understanding of the pharmacology of kratom’s main alkaloids and countless anecdotal reports, suggest a tentative step into this arena needs to be initiated, which is the point of this article.

addiction withdrawal struggle painAs a clinical biologist and recovering polysubstance abuser myself, (my drug of choice being opiates), I feel a fair and open dialogue about all matters relating to this epidemic must occur. Currently, far too much misinformation about this powerful herbal drug is being disseminated by kratom advocates and opponents alike. Of particular potential harm are myths suggesting that kratom is completely innocuous and “safe to use” due to it being a plant, and therefore, non-addictive and safe to use over the long-term. Such ideas are proving to be particularly damaging to those individuals already in recovery and/or struggling to maintain their sobriety.

First Off, What is Kratom?

Leaves from the tropical evergreen tree, Mitragyna Speciosa, are commonly referred to as Kratom. A cousin of the coffee plant and native to South-East Asia, kratom is commonly used by day laborers for it’s stimulant and opioid-like properties.1 As we will see, many different alkaloids have been isolated from kratom including, but not limited to, “mitragynine, paynantheine, speciogynine, and 7-hydroxymitragynine.”2

Whole Leaf Kratom vs Extracts

The leaves of the Mitragyna Speciosa or Kratom plant can be chewed or brewed into tea. Chewing kratom is common among day laborers within the native populations of Thailand and Indonesia, however, in order to be available around the world, the kratom leaf is now being micronized into a powdered form. The reasoning behind micronization is simple- for the distributor it is easier to transport and preserve, and for the user, powdered leaf means greater amounts of active compounds coupled with the fact that, compared to chewing, brewing leads to faster absorption.

There are justified tensions and anxieties surrounding concentrated preparations of Mitragyina Speciosa available to the public. Certain brands of concentrate contain added mitragynine and 7-OH to boost potency. Since these compounds have not had to undergo any sort of clinical testing, little can be definitively said about their safety. However, anecdotal reporting strongly suggests a higher likelihood of abuse and tolerance development with regular use of kratom concentrates versus whole leaves.

Pharmacology of Kratom’s Alkaloids

Kratom is known to contain over 40 active alkaloids.3 An accurate and informed breakdown of the pharmacological actions of these alkaloids would help uncover the benefits and dangers of kratom use and how the active compounds in kratom act in the brain.

Mitragyinine and 7-OH are two of kratom’s primary alkaloids that have known mu-opioid receptor (MOR) agonist activity.4,5 This means they stimulate the mu opioid receptor in a similar fashion to other full agonists at the MOR such as morphine and heroin and provide euphoric and analgesic properties. In fact, 7-OH has been discovered to be several times more powerful than morphine! Despite such potency, it is important to note, 7-OH is normally found in very low concentrations in whole leaf kratom. In unregulated kratom-containing products, synthetic mitragynine and 7-OH occur in much higher concentrations, making these extracts far more potent than the whole leaf variety and resulting in rapid tolerance buildup and higher abuse potential.

Inadequate information with regards to dosages, symptom profiles, durations of administration and other important variables further obscures the topic. There have been no concrete, clinical trials proving kratom to be effective at curbing or mitigating symptoms of opioid withdrawal. However, it is safe to say that anecdotal reports surrounding the impact of these 2 major kratom alkaloids suggests there should be. Safety and street logic are not always in synch and there are some important red flags emerging that need attention. Because kratom stimulates the MOR like traditional full-agonist opioids, opiate-like withdrawal symptoms can develop after extended periods of daily use. Thus, physically and psychologically dependent opiate/opioid users switching to kratom in the hope of relief are most likely simply trading one dependency for another.

Mitragynine Offers a Novel Mechanism of Action for Safer Opioid Painkillers

Despite all their negatives, opioids remain an incredibly effective tool in emergency room and acute care settings. While exciting research is underway on opioid alternatives (such as cannabinoid based painkillers), opioids are unlikely to surrender their exalted status in the practice of medicine any time soon.

One current goal of researchers is the creation of new opioid drugs with lower abuse potential and with less severe side effects, such as respiratory depression and death. Traditional opioids can overstimulate both mu and delta opioid receptors in the medulla which can lead to fatal overdose secondary to respiratory depression.6 Curiously, the active opioid-like compounds in kratom (primarily mitragynine) may inspire a new generation of opioid painkillers that might possibly elicit analgesia without the risk of respiratory depression. Such an advancement would pose a huge advancement in drug safety, a particularly huge concern among those currently treating acute and chronic pain.

Kratom works to simultaneously stimulate the mu opiod receptors (offering pain-relief and elicing euphoria) while antagonizing the delta opioid receptors in the brainstem (hypothetically preventing fatal overdose from respiratory depression). Such actions would surely make this leaf an encouraging subject for a case-study in potential mechanisms for opioid drugs.

Is Kratom Lethal? The FDA/CDC Say Yes, But Science Suggests Otherwise

Significant debate surrounds reports released by the FDA and CDC implicating kratom in almost 100 fatal overdoses.7 As previously discussed in this blog, limited studies of kratom’s alkaloids do not suggest that, unlike other opioid drugs, kratom use could result in respiratory depression and fatal overdose on its own. Again, due to the lack of available research, we are currently unaware of potential drug interactions between Mitragyna Speciosa and other compounds. Virtually every individual overdose cited in one recent report was complicated by the fact that a variety of different substances were found in each victim’s system, including other opioids known to cause fatal overdoses.opioid addiction syringes IV

Benefits of Kratom for Active Substance Abusers

Much more research remains to be conducted before a complete clinical and pharmacological profile of kratom can be established. Nonetheless, the following are some potential benefits kratom has to offer:

  • Safer than alcohol and prescription opioids/heroin pharmacologically and physiologically.
  • Has shown potential effectiveness in treating pain
  • May be effective for transitioning towards sobriety.
  • Can be effective for curbing addiction if used short-term, with awareness that kratom, itself, is powerfully addictive and should be used carefully.

Dangers of Kratom for Recovering Addicts

  • Currently there is very little research available, hence the pharmacology/biology/science of kratom is still not well understood.
  • Almost no high-quality studies done on humans.
  • a lack of industrial oversight and regulation opens up the very real possibility of issues like Salmonella contamination—an issue faced by kratom vendors in the past.
  • Misleading information suggesting kratom as a completely “benign” substance can lead to false assumptions regarding addictive potential.
  • Rapid increase in daily consumption has been observed in addicts.
  • Relapse potential to other opioid drugs, due to its similar pharmacological profile
  • The dopamine reward system is still being activated by kratom consumption—a system that ideally needs time and rest to rebalance after a period of drug and/or alcohol abuse.

 

A Note About Alcoholism and Kratom

While there are reports that kratom may relieve some cravings and partially reduce the severity of alcohol withdrawal symptoms, it is crucial to note that no supported evidence of kratom benefitting successful and safe alcohol detox has been reported. If you believe you are severely dependent on alcohol, seek medical attention immediately and do NOT try to detox by yourself. Acute withdrawal can result in seizures or other harmful withdrawal experiences and safety cannot be over-emphasized.

Acute or light alcohol consumption stimulates the release of endogenous/natural opioids in the brain, similar to substances like morphine, hydrocodone (Vicodin) and herion.8 However, long term, chronic exposure to alcohol causes a “central opioid deficiency” which may be perceived as “opioid withdrawal” and encourage further alcohol consumption through mechanisms of negative reinforcement. Thus, since kratom’s major alkaloids stimulate the release of the brain’s natural opioids, widespread reporting of kratom being effective in ceasing use and continued abstinence from alcohol may be misinformed, increasing the risk for dangerous behaviors.

Would Making the Jump From Opiates to Kratom Be Right For Me?

Is switching from opiates to kratom (especially for maintenance) a beneficial move for patients looking to cease their use? Many opiates are potentially more dangerous than kratom. Still, advocates of this herbal remedy would reply with a resounding yes! Yet, for the moment, adequate scientific data to vouch for the safety and viability of kratom as an effective alternative to prescription opioids is lacking. As we further explore the complexities of this plant, a case may still be made for kratom’s inherent safety over illicit opioids like heroin, but that remains to be seen. The opiate crisis has been complicated by the widespread adulteration of street heroin with the deadly opioid fentanyl, leaving hopeful advocates of kratom betting on it providing a much safer option than it does. Ultimately, however, as with most addictive drugs, users will rely on a daily dose for relief rather than undergo painful withdrawal symptoms. For those truly ready to make the leap towards true sobriety, there seems to be a better option: Ibogaine.

Why Ibogaine is a Better Long Term Solution For Those Ready to be Free

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image credit: https://awakenyoursoul.co/iboga-costa-rica/

Another fascinating plant medicine gaining rapid popularity due to powerful anti-addictive properties is the psychedelic West-African shrub, iboga, and its derivative, ibogaine. Unlike with kratom, a swath of new clinical studies are highlighting ibogaine’s effectiveness in transitioning individuals from active addiction to sobriety. News of ibogaine’s unique efficacy in eliminating acute opioid withdrawal symptoms has been spreading and slowly attracting scientific notice. When administered in a professional, safe and controlled manner, such as in clinics like IbogaQuest, ninety minutes outside Mexico City in the town of Tepoztlan, Mexico, Ibogaine has repeatedly shown its potential to radically transform the lives of addicts over the last ten years. Studies have shown that the odds of successful recovery are greatly enhanced in individuals who have undergone treatment with ibogaine. To learn more about the role of ibogaine in addiction interruption, check out this treasure trove of resources on IbogaQuest’s website.

Personal Experience: Kratom Offered Some Flexibility, But Ibogaine Gave Me Freedom

Having used both these tools in my path to recovery, I would like briefly offer my personal experience. I personally found kratom to be an effective alternative to traditional opioids to manage withdrawal and mild to moderate pain when I was actively using. However, in recovery, I find kratom to be far more potent and “mind-altering” than the innocuous “cup of coffee” it’s often compared to. In my experience, it is much to easy for me to get in the habit of using kratom daily. Unfortunately, after a certain point of regular use, withdrawal symptoms are inevitable for me and this is never a pleasant situation. For this reason, I personally choose to abstain from using kratom in my recovery.

It seemed to me that ibogaine somehow offers deeper psychological and spiritual insights into the roots of my addictive habits, while also eliminating any and all acute withdrawal. I truly believe that when iboga therapy is conducted in a safe and nurturing setting with professional and trained caregivers (like those at Ibogaquest who cared for me), there is real potential for the beginning of a lasting recovery. For those ready to make the leap, this recovering biologist certainly recommends further investigation into the clinically documented benefits of iboga and the professionals at IbogaQuest for the very best and compassionate treatment.

Closing Thoughts

It is critically important to acknowledge the very real dangers and risks associated with kratom use, especially for those in recovery, as well as its possible benefits. The lack of good research supporting or completely negating its potential role as a magic bullet to help curb this raging epidemic remains an issue. However, the current climate surrounding pain management and addiction has fueled interest in this psychoactive plant, making it an important topic to address. Unfortunately, too much of the media coverage, especially as of late, offers little more than fear-mongering, false hope or sensationalism. When it comes to the psychoactive herbal supplement, kratom, there’s an enormous amount of misinformation abound. As a passionate biologist in recovery myself and that has some direct experience with kratom, I hope this piece offers deeper insight into Mitragyna Speciosa and its role in addiction. Hopefully, further clinical trials and scientific studies will shed more light on kratom as well as the science behind other plant-based addiction treatments such as Ibogaine as well.

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Works Cited

  1. Veltri, C. & Grundmann, O. Current perspectives on the impact of Kratom use. Subst. Abuse Rehabil. 10, 23–31 (2019).
  2. Hassan, Z. et al. From Kratom to mitragynine and its derivatives: physiological and behavioural effects related to use, abuse, and addiction. Neurosci. Biobehav. Rev. 37, 138–151 (2013).
  3. Meireles, V. et al. Mitragyna speciosa: Clinical, Toxicological Aspects and Analysis in Biological and Non-Biological Samples. Medicines 6, (2019).
  4. Váradi, A. et al. Mitragynine/Corynantheidine Pseudoindoxyls As Opioid Analgesics with Mu Agonism and Delta Antagonism, Which Do Not Recruit β-Arrestin-2. J. Med. Chem. 59, 8381–8397 (2016).
  5. Kruegel, A. C. et al. Synthetic and Receptor Signaling Explorations of the Mitragyna Alkaloids: Mitragynine as an Atypical Molecular Framework for Opioid Receptor Modulators. J. Am. Chem. Soc. 138, 6754–6764 (2016).
  6. White, J. M. & Irvine, R. J. Mechanisms of fatal opioid overdose. Addict. Abingdon Engl. 94, 961–972 (1999).
  7. Olsen, E. O., O’Donnell, J., Mattson, C. L., Schier, J. G. & Wilson, N. Notes from the Field: Unintentional Drug Overdose Deaths with Kratom Detected — 27 States, July 2016–December 2017. Morb. Mortal. Wkly. Rep. 68, 326–327 (2019).
  8. Gianoulakis, C. Influence of the endogenous opioid system on high alcohol consumption and genetic predisposition to alcoholism. J. Psychiatry Neurosci. 26, 304–318 (2001).

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