Kratom and Opiate Withdrawal
There has been little scientific research done on the Mitragyna Speciosa plant commonly referred to as kratom. Kratom has been used for centuries in Southeast Asia where natives there chew the leaves to relieve pain, increase energy, appetite, and sexual desire. Using kratom and opiate withdrawal has been seen recently with the opioid epidemic in our country. Though the plant has been used since “time immemorial” in these countries the plant is relatively new to the United States. There has been widespread debate over the plant, its legal status and medicinal properties. Though little actual scientific research has been done, many consider kratom to be a much more natural and effective tool for opiate withdrawal than some of its prescription alternatives.
The Science of Kratom
The part of the Mitragyna Speciosa tree which is consumed is it’s leaves. Kratom leaves contain over 40 separate compounds. Meaning the plant grows a multitude of strains that produce similar but slightly different effects. Two of the most abundant compounds are mitragynine and 7-hydroxymitragynine (also known as 7-HMG). These are both alkaloids, along with about 25 of those 40 other compounds. Alkaloids are a large category of compounds that include a wide variety of drugs. We know that mitragynine and 7-hydroxymitragynine (kratom compounds) are both agonists that bind to the mu opioid receptors. This is the same receptor that morphine binds to. Agonist like the ones found in kratom bind to receptors and causes a reaction, while an antagonist blocks a reaction. Antagonists like naloxone and naltrexone bind to a person’s opiate receptors but do not actually activate the receptors. These drugs effectively blocks the receptor, preventing the body from responding to opioids and endorphins. Kratom binds to mu opioid receptors which is what produces the opiate like effect. In animal studies, the antinociceptive and cough-suppressant effects of mitragynine were comparable to those of codeine. In mice, 7-hydroxymitragynine (less common alkaloid in kratom) was several times more potent analgesic than morphine even upon oral administration. “Kratom is slightly toxic to animals. Mice chronically treated with 7-hydroxymitragynine developed tolerance, cross-tolerance to morphine and withdrawal signs that could be precipitated by naloxone administration.”
Again there has been little scientific study on the kratom plant and although there is a decent understanding of its effects, some of the mechanisms of action still remain a mystery.
Using Kratom for Opiate Withdrawal
People started using kratom for opiate withdrawal for a few main reasons. It is an herbal supplement, some feel its safer alternative and it can be more affordable than going to a hospital or detox center. The common symptoms of withdrawal that kratom helps quell are restless legs and diarrhea. Kratom can help ease bone and body aches as well as combat fatigue and irritability. Variables that will affect the efficiency of kratom on opiate withdrawal are tolerance, duration of usage and personal chemistry. A person using larger quantities of opiates for prolonged periods of time typically will not feel the same relief as someone who has used less opiates for shorter amounts of time with the same dosage of kratom. There are dosing charts available online and we will dive into that in a later post. Since there are so many variations of kratom and different potencies like leaf versus extract it’s impossible to give well educated advice on dosage across the board but starting slow is always a good idea.Since there is such little scientific research the best approach would be to do as much research as one can on kratom and others who share tolerance, duration, and similar drug addictions. Since heroin, pain medication, methadone and suboxone differ so greatly detoxification wise it’s a good idea to search forums for people most similar in situation and read about their journey and testimony.
While kratom can be used to ease withdrawal symptoms from opiates, if used frequently enough it can cause its own withdrawal symptoms. Although it may be a safer substitute it’s not exactly a cure for drug/opiate addiction.
One data point from the European Medical Center for Drugs and Drug Addiction (EMCDDA) cites: “Regular prolonged kratom use may produce dependence. The withdrawal symptoms in humans are relatively mild and typically subside within a week. Craving, weakness and lethargy, anxiety, restlessness, nausea, sweating, muscle pain, restless legs, tremor as well as sleep disturbances and hallucination may occur. Treatment, if needed, may include dihydrocodeine-lofexidine combination, non-steroidal antiinflammatory agents, antidepressants and/or anxiolytics.”
Another data point shows it may be safer in regards to respiratory depression. “While mitragynine acts on the same receptor as other opiates, in animal studies at very high doses, mitragynine caused respiratory depression, but less than morphine or codeine. Respiratory depression is the main cause of death in opiate overdoses, so this is a very important metric for drug safety.” However, reduced risk does not mean no risk. There have been a few hundred hospitalizations in the US, and kratom has been linked to one death. In this case, it was interacting with other drugs. Some drugs that have been used with kratom that caused adverse reactions that have been reported are interactions involving kratom tea taken with carisoprodol, modafinil, propylhexedrine or Datura stramonium. A fatal case in the United States involved a blend of kratom, fentanyl, diphenhydramine, caffeine and morphine sold as a herbal drug. If one is buying kratom online always check to make sure of the site and product legitimacy. Tips on how to spot illegitimate kratom and red flags can found at the above address.
Also in 2010 nine young men died after taking “Krypton Kratom”. This wasn’t an average or legitimate kratom product. This product was “a specially-formulated kratom product that contained the kratom alkaloid mitragynine as well as a powerful mu-receptor agonist known as O-Desmethyltramadol.” On the record, it was the high blood concentrations of O-Desmethyltramadol, an active metabolite of the prescription painkiller Tramadol, that was responsible for each of the nine deaths.
To note that even though Kratom has been used traditionally for centuries in places like Thailand, Borneo, Indonesia, Malaysia, Myanmar, and Papua New Guinea – the study of its medicinal purposes has just begun by most academics studying Western medicine. We look forward to their findings as many people have already begun using an herb to treat an array of illnesses out of fear and distrust of pharmaceutical companies and their products. In the united states 15,000 plus people die each year from NSAIDs like aspirin and 120 people die a day from opioid related overdose. If there is an herb out there that has the potential to make even a dent in this crippling opioid epidemic kratom is definitely at the top of the list.
Written by Allie Severino