Exploring Kratom: Uses, Controversies, and Cautionary Considerations

Exploring Kratom: Uses, Controversies, and Cautionary Considerations

Published on Friday, July 21, 2023 by Alexander Koch

Curious about Kratom? Let’s find out a little more about what it is.

Kratom is the common name for an herbal supplement made from the dried leaves of the Mitragyna speciosa plant, native to Southeast Asia. Kratom contains two major active ingredients: mitragynine and 7-OH mitragynine, both of which act on receptors in the brain that are termed mu-opioid receptors. 

Acting on mu-opioid receptors is the mechanism behind the effectiveness of many powerful pain medications (think opioids, such as oxycontin), which, while effective for pain relief, also have a dangerously high potential for addiction. While it does activate some of the same receptors, kratom is not technically an opioid, which is why it is not classified as a drug and is available fairly freely (in most US States) as a dietary supplement.

What is it supposed to do?

In traditional medicine, kratom has been touted for multiple uses, including as ergogenic aid, pain reliever, cough suppressant, and a cure for diarrhea. In the modern market, people use kratom primarily for two purposes: 

1) as a harm-reduction tool to wean people from opioid-addiction 

2) as a mood enhancer  

Sadly, there is very little peer-reviewed research on the efficacy of kratom. One systematic review found some promise for Kratom’s use in weaning people from opioid addiction. As far as kratom’s effects on mood, the jury is still out. 

Although there are numerous personal testimonies extolling kratom’s benefit in reducing anxiety and depression, there is a paucity of peer-reviewed data. Chemically, the ingredients in kratom can act on receptors for opioids, dopamine, serotonin, and norepinephrine. This means that kratom may have the potential to work as both an antidepressant and an antipsychotic, at least to some extent.

Cautions about Kratom

Kratom, like all supplements, is not FDA-regulated. This leads to a host of quality-control issues. Kratom is typically available via online purchases or from smoke shops. There are concerns with the easy availability of kratom and the lack of regulation surrounding the substance, such that six US States have prohibited the sale or possession of kratom, including WI, IN, AR, AL, RI, and VT.  

Further, in 2022 the FDA issued a warning for consumers not to use kratom due to its potential risks. Kratom use has been associated with several deaths and acute respiratory distress syndrome

While the potential for addiction to kratom should be lower than true opioids, some individuals report experiencing withdrawal symptoms and an inability to abstain from the products. So for my two cents- I would steer clear of this particular supplement. For resources on treating opioid addiction, the CDC provides good resources to help patients locate treatments with a stronger track record of success.

  1. Centers for Disease Control and Prevention. (2021, September 2). Recovery is possible: Treatment for opioid addiction. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/featured-topics/treatment-recovery.html
  2. Chinnappan, J., Navari, Y., Casini, D., Palanisamy, N., Parikh, N., & Seedahmed, E. (2023). Kratom-Induced Acute Respiratory Distress Syndrome (ARDS). European journal of case reports in internal medicine, 10(4), 003835. https://doi.org/10.12890/2023_003835
  3. Demick, D. S., Lee, T. T., Summers, A. T., & El-Mallakh, R. S. (2020). Kratom: A growing substance of abuse in the United States. Annals of clinical psychiatry: official journal of the American Academy of Clinical Psychiatrists, 32(4), 275–280. https://doi.org/10.12788/acp.0012
  4. Food and Drug Administration. (2023, June 2). FDA and Kratom. U.S. Food and Drug Administration. https://www.fda.gov/news-events/public-health-focus/fda-and-kratom
  5. Johnson, L. E., Balyan, L., Magdalany, A., Saeed, F., Salinas, R., Wallace, S., Veltri, C. A., Swogger, M. T., Walsh, Z., & Grundmann, O. (2020). The Potential for Kratom as an Antidepressant and Antipsychotic. The Yale journal of biology and medicine, 93(2), 283–289.
  6. Prozialeck, W. C., Jivan, J. K., & Andurkar, S. V. (2012). Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic and opioid-like effects. The Journal of the American Osteopathic Association, 112(12), 792–799.Swogger, M. T., & Walsh, Z. (2018). Kratom use and mental health: A systematic review. Drug and alcohol dependence, 183, 134–140. https://doi.org/10.1016/j.drugalcdep.2017.10.012
  7. Swogger, M. T., & Walsh, Z. (2018). Kratom use and mental health: A systematic review. Drug and alcohol dependence, 183, 134–140. https://doi.org/10.1016/j.drugalcdep.2017.10.012  

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