Paula Bronstein/Getty Images
From alleviating social anxiety and inducing a “legal high” to providing a number of medicinal properties which can aid with opiate withdrawal, Kratom, a drug accessible to the public at as young as 18 years of age in some U.S. states, seemingly possesses a variety of uses. Naturally, this has led some to wonder, what’s the catch? In truth, the skepticism surrounding Kratom involves a complex dialogue that spans matters of physiological safety and public concerns over its regulation. To understand this debate, it’s important to understand the biological and societal context surrounding this drug.
Kratom, or Mitragyna speciosa, originated centuries ago as a psychoactive, ethnomedicinal remedy in Southeast Asia that can, depending on its dosage, yield stimulant and sedative-like effects. Though Kratom plant leaves have been consumed to yield medicinal benefits for many years, self-administration of this remedy is rising in Western countries to treat pain, psychiatric illnesses, opioid and other substance use disorders, in addition to rising recreational usage.
However, skepticism has grown with its spike in usage, considering there have been growing claims of this substance yielding opioid-related effects (i.e. sedation, physical dependence/withdrawal, euphoria). Over the past decade, the FDA has kept kratom under a scrutinizing lens due to the obscureness surrounding kratom’s effects and claims of toxicity, barring kratom from medical distribution. Similarly, The DEA has expressed concerns with this drug and has made attempts since 2016 to classify kratom as a Schedule I Drug alongside heroin and ecstasy. Another area of concern is the general deficit in research surrounding the safety and efficacy of Kratom. Much of the current data surrounding these parameters is actually self-acclaimed, sourced from online surveys, drug fora, and case reports. Although there have been a number of review papers to support these findings, further experimental data is needed to draw a causal relationship between kratom and its alleged effects.
The lack of foundation in kratom research might explain why four states have banned kratom usage, while other states have loose regulations, despite the aforementioned concerns. Specifically, kratom is legal in 44 U.S. states, with eighteen states imposing an age limit of just 18 years and roughly twenty states requiring no age limit at all. Even with these legal parameters, kratom use in the U.S. has boomed to nearly 15.6 million Americans over this past decade and continues to rise. Hence, the grey area posed by both the public safety and the potential uses of this drug reveals a complex interplay between the two.
Kratom County’s 2023 report of Kratom legality on state-basis
Despite debate surrounding the potential consequences of kratom, the experimental and review papers that do exist on its effects have provided promising evidence of kratom’s potential in medicine. One notable finding is the fact that kratom’s unique composition gives it dual functionality: alleviating pain and potentially more serious opioid withdrawal symptoms. Specifically, kratom consists of over 40 alkaloids, which are able to interact with and stimulate opioid receptors. Such activity allows kratom and synthetic kratom-derivatives to yield pain relieving effects without as high a risk of addiction, making it both a possible substitute to more addictive pain medications and a candidate for aiding with withdrawal. Numerous emerging studies have also suggested the potential use of kratom to mimic some anxiolytic effects of antidepressants and antipsychotics effects. Additionally, researchers believe kratom can act on the brain's serotonergic system to reduce stress-related hormones, which furthers the list of potential applications of this drug for advancing public health. This research, though new and lacking some experimental grounds, highlights the need to further more research to actually test these hypotheses. Understanding kratom's promising pharmacological profile, however, requires investigating the safety of this drug.
Given the fairly lenient Katom regulations in the United States, critics of kratom underline this clear lack of research surrounding the suspected consequences of the drug. A 2019 review paper, conducted on kratom toxicity, reports on the more concerning side effects of the drug by analyzing the National Poison Data System. These reports depicted a concerning rise in kratom exposure calls. It was reported that out of 2312 kratom exposures, the most common side effects ranged from tachycardia to vomiting to confusion. Although less reported, the more chronic symptoms reported included seizure, withdrawal/dependence, hallucinations, respiratory depression, and even kratom-related death. Therefore, with an increase in exposures highlighting the potential dangers of kratom, current regulations regarding kratom accessibility and self-treatment are a valid area of concern.
National Poison Data System total reported exposure calls to poison centers
However, there does seem to be evidence that questions the severity of some of these suggested side effects. Despite the parallel between kratom’s effects and that of opioids, the chemical structure of kratom is fairly unrelated to that of opioids and even appears to block the delta receptor for opioids. This not only crushes this superstition, but also suggests that kratom might be able to reduce morphine tolerance and withdrawal, which could again possibly aid in opioid withdrawal. Kratom also doesn’t provide as intense of a euphoric high as opioids, which further suggests that the abuse potential of kratom would pale in comparison to opioids. Still, the safety profile of kratom is vastly neglected with a well-designed human abuse potential study yet to be conducted according to the FDA. With only sparse studies regarding withdrawal and dependence on kratom–much of which are conducted on animal models–the discrepancy among experts as to the risk of kratom being a gateway or addictive drug is expected.
Therefore, the true challenge of kratom lies in the lack of regulation of a drug whose safety and proper usage remains obscure. It’s clear that kratom has the potential to benefit public health in a number of ways, yet this is critically undermined by the lack of research surrounding its efficacy and safety. The debate around classifying kratom as a Schedule I drug under the Controlled Substances Act highlights the issue of drug criminalization due to pure lack of information on kratom. Nonetheless, there is still a need for tighter regulation, especially considering the understudied side effects of the drug and the dangers of self-administration of this drug, particularly among younger users. It’s evident that kratom has a long way to go before it is administered for public health benefits, but the prospects of it are worth the research effort. As said by chemist Susruta Majumdar, kratom “might be better than any other pain drug science is currently investigating.” Thus, the urgency to continue research on what kratom is capable of, for better or for worse, is imperative to the health and wellness of the public.