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Kratom

What is kratom?

Kratom, also known as Mitragyna Speciosa is a tropical tree that originates in Southeast Asia, and was first discovered by the Dutch botanist Pieter Willem Korthals. The harvested leaves of the kratom tree are used fresh or dried as both an intoxicant and as a medicine. Kratom leaves have opiate like properties that have long been recognized in various regions of Southeast Asia but have only recently became known in west. The psychoactive substances mitragynine and 7-hydroxymitragynine are the main alkaloids of the Kratom leaves. In Southeast Asia, fresh leaves are usually chewed (most often on an ongoing basis) by workers in order to achieve a stimulating effect and lessen fatigue. In other places, dried leaves are often brewed as tea or extracted with water, which is then evaporated into a resin suitable for consumption.

There are three different types of kratom: white, red and green leaf veins. The different varieties contain a different composition of alkaloids. While varieties with green leaf veins, such as Horned Leaf Kratom are more likely to have an activating effect, the varieties with red leaf veins, such as Maeng Da Kratom, are said to have a rather sedating effect. Since there are many different varieties of kratom trees in nature, the content of alkaloids also depends on various location factors and climatic influences, so these three types can only be regarded as general classifications.

Where is kratom grown?

Kratom grows naturally in several regions of Southeast Asia, specifically: Thailand, Malaysia, Indonesia (on the islands of Kalimantan and Sumatra), the Philippines (Luzon, Mindanao, Mindoro), Papua New Guinea and in the Indochina territory of Vietnam. It grows mostly in lowland forests and in swampy areas. Most of the kratom used for commercial sale is grown in Indonesia.

What does kratom do?

Pharmacologically, kratom acts in a similar way to substances such as opioids and caffeine. The effects are however less pronounced. Kratom consumption reportedly produces analgesic, euphoric and stimulating feelings among its users.

The active substances in kratom, 7-hydroxymitragynine and mitragynine, which are contained in kratom, are thought to act as an agonist at the mu- and delta-opioid receptors as well as alpha-2 adrenergic and 5-HT2A receptors in the brain to create a strong analgesic effect. These are the same receptors impacted by opioids and some other drugs.

The pure alkaloid mitragynine increases the excitability of the craniosacral and sympathetic parts of the autonomic nervous system, as well as increasing the excitability of the medulla oblongata and motor centers of the CNS. A strong dose of kratom (more than 10 grams of dry leaves per serving) can create a pronounced analgesic (pain relieving) and sedating effect, however if the required dosage is exceeded, then blurring of vision, nausea and vomiting are also possible. A weaker dose (about 1-3 grams) has slightly stimulating properties that resemble caffeine without certain effects such as rapid heartbeat. Reportedly, it relieves light pain, helps focus and increases physical endurance.

How is kratom used?

Most people take kratom as a pill, capsule, or extract. Some people chew kratom leaves or brew the dried or powdered leaves as a tea. Sometimes the leaves are smoked or eaten in food.

How long does kratom last? How long before kratom kicks in?

The effects of kratom takes about 30 minutes to an hour to kick in. The duration of the analgesic action is about 4-5 hours, and the stimulating effect is 2-5 hours. Kratom’s peak of action happens with an hour or two of intake.

What are the side effects of kratom?

The most common side effects that can occur at low doses are itching, dry mouth, nausea and vomiting, and in some cases anxiety and agitation.

At higher doses, side effects may include increased heart rate, constipation, light headedness, low blood pressure and sweating. Another high dose side effect of kratom known among its users as the “kratom wobbles” is an eye condition commonly known as nystagmus. Kratom eye wobbles affect the muscles responsible for controlling the eyes, causing them to contract involuntarily and making the eyes move or wobble in different directions.

Kratom causes constipation by binding to opioid receptor sites in the gastrointestinal system, this creates a wide range of side effects. It impedes gastric emptying and slows down movement of food throughout the intestines as well as increases the involuntary muscle tension of the anal sphincter, making it more difficult to excrete stool. It also reduces water and electrolyte release inside the intestinal passage making stool much harder and bulkier, intensifying the bowel movement problems caused by kratom constipation. These side effects are also caused by opioids and are called , or more generally Opioid-induced constipation (OIC).

Prolonged use of kratom, especially at high doses, can cause weight loss, seizures, and psychosis, as well as lead to tolerance and dependence similar to that seen with other opioids. Kratom addiction is manifested by symptoms such as pain, nausea, gastro-intestinal disorders, insomnia, hypertension and psychological symptoms such as anxiety and irritability. According to a 2017 study, compared to other opioids, kratom has a fairly low potential for respiratory depression, likely due to its molecular structure which has recently been referred to as a biased agonist.

Rare cases of liver toxicity have been reported after the consumption of plant extracts and were associated with characteristic symptoms such as jaundice and fatigue. Serious toxicity is relatively rare and generally appears at high doses or when kratom is used with other substances.

Where is kratom illegal?

As of July 2019, kratom is illegal in the states of Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin, as well in San Diego California, Sarasota County Florida, Alton and Jerseyville Illinois and multiple counties in Mississippi. It is also banned in the United States Army.

Within the EU, kratom is a legally controlled substance in Denmark, Latvia, Lithuania, Poland, Romania, Sweden, Switzerland, Ireland and the UK.

How addictive is kratom? How long does it take to get addicted to kratom?

The use of kratom is likely to lead to habituation and those who use it consistently may experience withdrawal symptoms when they stop. There are varying reports on the length of daily use required for physical symptoms to manifest. Reports range from one week of daily use to a full month for first signs of physical addiction. Individual biological differences and history of addiction both play a significant role. Some individuals develop mental and physical addiction more quickly than others.

What is kratom withdrawal?

Kratom withdrawal is a set of physical and mental drug discontinuation symptoms that begin to develop and increase in strength with prolonged daily use of kratom. Typical physical withdrawal symptoms include muscle cramps, pain, difficulty sleeping, insomnia, watery eyes and nose, heat attacks, fever, chills, decreased appetite and diarrhea. Typical mental withdrawal symptoms are restlessness, tension, anger, anxiety, agitation and nervousness. The severity of kratom withdrawal symptoms depends heavily on the dosage at the time of discontinuation and the length of time kratom was used on a regular basis.

How long does kratom withdrawal last?

Kratom withdrawal usually starts within 12 hours after discontinuation of its use and hits its peak within 24-36 hours. The length of kratom withdrawal depends on length of usage and daily dose taken. Acute kratom withdrawals can last anywhere from 5 to 7 days, with a possible follow up period of psychological adjustment that can last up to several weeks.

How is kratom withdrawal treated? How can Recovery Centers of America help?

According to the National Institute on Drug Abuse kratom causes effects similar to opioids and may cause physical dependence, which means users may feel significant withdrawal symptoms when they stop taking kratom. Due to the similarity between kratom and classic opioids, kratom addiction can be handled with the same protocols. Recovery Centers of America treats opioid dependence with a range of treatments including medications and behavioral therapies.

We start opiate addiction treatment with a medically monitored detox, during which we monitor the patient around the clock, continually evaluating physiological and psychological symptoms and using medications to control any of the symptoms that begin to manifest themselves. Medications that may be used during this phase of treatment include palliative or “comfort” medications such as Clonodine, Robaxin, Trazadone, Phenobarbital, Bentyl, Librium, and others. Medical aspects of detoxification may last up to 10 days before patients become medically stable. However, psychological symptoms and intermittent cravings can continue for some time and require additional treatment to subside.

After medical detoxification, the next phase of treatment may include small group therapy sessions, individual sessions, educational seminars, and workshops. To assist with calming the body and the mind, classes for mindful meditation, yoga, progressive relaxation, and other therapeutic techniques may be provided during treatment. To ensure a long-term recovery from kratom use, patients are offered wellness seminars and life skills workshops which focus on developing a balanced lifestyle that includes healthy habits, physical exercise, sober recreational activities and building supportive relationships.

Recovery Centers of America also offers Medically-Assisted Treatment options such as bupernorphine to treat opioid addiction and withdrawal. Buprenorphine was shown to be an effective treatment for kratom addiction and withdrawal by a 2018 study published in the Journal of Addiction Medicine.

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