We’ll start our story with a story. There are two sides to Kratom and two distinct views of it in the public’s mind. Kratom users see the drug as a lifesaver. Some of them consume it for pain, others, as a means to wean themselves off opioids. The medical profession tends to be suspect of the drug and for good reason.
It hasn’t been tested, at least not in meaningful ways that would allow traditional medicine to give it the green light. Additionally, current pressure in the public sphere from groups of Kratom supporters reeks of ulterior motives and their strategies look remarkably similar to those used by the anti-vaccination campaigners.
So what is the truth? Is the drug a godsend, as users would have you believe? Is it a dangerous narcotic that needs to be banned, or is it perhaps something more important? A medicine, waiting to be formally recognized. I asked a few users from within the Kratom community to share their stories. I’ve received many but wanted to share the two below as they highlight the two different benefits of the drug claimed by its supporters, namely pain relief and release from opioid addiction.
To be clear, I am not an advocate for Kratom, not as it currently distributed. I do however believe the drug offers a real window of hope to many suffering from chronic pain and it is my firm belief that action needs to be taken to both protect users and to ensure. availability of a clean and safe, clinically trialed product. I’ll discuss the routes to this below.
Let’s hear from Keith first, a Kratom fan and potentially, a life long devotee. He has been using the product for a while and his story is reflective of many Kratom users. Here. unedited, is his response to my request for information.
Hi Robert. I am a 48 year old Catholic School Teacher in NYC the last 24 years. Had terrible DDD and didn’t want to use any Rx drugs. Found Kratom in 2011. Got my pain down so much I put a full gym in my house. Down 120lbs. Healthiest I’ve ever been. Kratom has been a God send. I saw what opioids did to my dad and swore never to take them. Found it in a simple Google search and now I’ve been on network news 3x (NBC, CBS, PIX11) and have contributed to many interviews and podcasts. I have to say, your statement that it’s deadly is misleading. Sure, theres some bad apples out there, but I am getting pure, lab tested, cGMP Kratom. Never abused it. I drink 2 cups of tea a day with a few grams of it in each. My entire family (wife is a Doctor. Mom an RN) support Kratom after seeing the amazing results. Energy, focus, motivation…All fantastic. Zero side effects. Zero WD. Have to have a good honest source with labs. I look forward to a productive conversation\debate.
Next up is Kendell. Kendell was addicted to opioids and experienced life threatening symptoms from Tramadol use. This is his experience with Kratom, verbatim from his response.
I’m responding to your request for kratom input. I can’t speak to other advocates, but me personally, I use kratom for 3 things. TO manage chronic pain from scoliosis, to keep me away from medications of the opioid class, specifically tramadol, and to manage the mild depression that goes along with my tramadol withdrawal. I’ve been using it for a total of a year this december, so I’m new compared to most other kratom users. One of your reporters wrote a very negative article on kratom claiming it to be a legal narcotic that people can buy at gas statations, he’s right, it can be bought at gas stations, but it’s no more a narcotic than coffee is. Others will probably send you good scientific proof of this, so all I can do is share my own personal kratom story. Read here at kratomherald.com/real-life-kr…. We don’t ordinarily respond so passionate to reporters but this article was particularly unpleasant, with a host of assumptions, mainly that all kratom users are drug addicts looking for a legal high or to get around the regulations on opioid pain meds. Kratom is a partial bias gProtein agonist at the mu opioid receptor, so yes it does bind at the same site as opioids, but it binds differently. Most opioids are full agonists, and cause a huge release of dopamine into the nucleus acumbuns, leading to addiction. Kratom’s alkaloids don’t affect this area of the brain, and one of them, mitragynine, reverses the downregulation of opioid receptors caused by chronic opioid use, and also reduces the upregulation of cAmp, cyclic adenasine monophosphate, which happens when you use opioids for a long time. We fight for kratom’s legality because we don’t see any other choice, but we aren’t ordinarily so harsh with reporters unless they treat kratom advocates rather badly, as this one did.
In case you’re wondering about that nasty reporter, guilty as charged. You can read the article he is referring to here.
That feedback was not what I had expected, given the drug’s bad reputation and FDA advice. It wasn’t the end of it though. My DM’s on Twitter soon filled with similar stories and this has led me to a few conclusions I will share below. First off though, let’s have a closer look at some of those ingredients Kendell was referring to. It’s important, as these alkaloids are at the very heart of the Kratom controversy.
The two primary alkaloids of Kratom that are in contention are Mitragynine and 7-Hydroxymitragynine. We’ll start by examining each of these ingredients individually.
According to a ScienceDirect article (reproduced in part below), Kratom is a psychoactive compound (drug) found in the leaves of M. speciosa. It can be consumed in fresh, dried (leaf or powder), or concentrated liquid extract form. The use of M. speciosa as a narcotic is not new; however, the extraction and refinement of the alkaloids from the plant into Kratom is relatively neoteric (new).
This is an important point and lies at the heart of regulation. There is a world of difference between chewing on a leaf and extracting and refining the active ingredients. It is very likely that this practice has led directly to regulation and bans imposed globally (see countries listed below).
A common route of administration is by chewing the fresh leaves at a dosage of normally 10 to 30 leaves per day. Kratom can be ingested as crushed dried leaves by taking the powder, drinking as a tea, or by smoking the leaves or the extract. Mitragynine is the major alkaloid (up to 66% in the extract) in kratom and is the principal compound responsible for analgesic activity due to its potent opioid agonist property
Recently, 7-hydroxymitragynine, a minor constituent (2%) of M. speciosa, was isolated and demonstrated potent antinociceptive activity in mice. It is now considered to be a major contributory factor for the analgesic properties of M. speciosa due to its selectivity for μ- and κ-opioid receptors. The presence of an hydroxyl group at C-7 increases the potency of 7-hydroxymitragynine to be 13- and 46-fold higher than morphine and mitragynine, respectively. This clearly indicates that this is one of the main pharmacological markers of kratom products’ quality and potency.
In addition to analgesic activity, mitragynine is also a key component for the anti-inflammatory properties of kratom by suppressing prostaglandin E2 (PGE-2) production in the cyclooxygenase 2 (COX-2) pathway .
This all sounds very promising but is there a downside, According to the research documents, yes.
Mitragynine has been shown to demonstrate a wide range of adverse effects. Opioid-like adverse effects have been observed and include constipation, dry mouth, and loss of appetite. There have also been reports of patients suffering from intrahepatic cholestasis after two weeks of kratom use and seizure and coma which might result from opioid agonist action of the major components in kratom.
Studies in mice showing serious conditions after administration, for example, elevated blood pressure and hepatic enzymes after a single dose, impaired cognition and behavior from long-term use, and acute lethally hepatotoxic and mild nephrotoxic effects after high dose administration. Kratom extracts and mitragynine have also been shown to possess cytotoxicity to some human cancer cell lines namely SH-SY5Y cells (neuronal cells).
In conclusion, the author cites the following;
A study looking at ‘kratom dependence syndrome’ has suggested that as it is a short-acting μ-opioid receptor agonist, therapeutic agents such as dihydrocodeine and lofexidine are effective in aiding detoxification. Further studies on kratom toxicology and other natural NPS are crucial to understanding the harms associated with this material due to their increasing popularity.
7-Hydroxymitragynine is a potent opioid analgesic alkaloid isolated from the Thai medicinal herb Mitragyna speciosa. The following is again courtesy of ScienceDirect and the link will take you to the article, parts of which I have highlighted below.
In clinical studies conducted on mice, Subcutaneous (s.c.) administration of 7-hydroxymitragynine produced a potent antinociceptive effect mainly through activation of μ-opioid receptors. Tolerance to the antinociceptive effect of 7-hydroxymitragynine developed as occurs to morphine. Cross-tolerance to morphine was evident in mice rendered tolerant to 7-hydroxymitragynine and vice versa. Naloxone-induced withdrawal signs were elicited equally in mice chronically treated with 7-hydroxymitragynine or morphine.
7-Hydroxymitragynine exhibited a potent antinociceptive effect based on activation of μ-opioid receptors and its morphine-like pharmacological character, but 7-hydroxymitragynine is structurally different from morphine. These interesting characters of 7-hydroxymitragynine promote further investigation of it as a novel lead compound for opioid studies.
Important research by a mouse does not a man maketh. How these ingredients react in humans still needs to be established and clinical trials are already underway, but are very limited and have no doubt been affected by the Covid pandemic.
The Alkaloid Takeaway
Clearly, we are dealing with two very promising and potentially lethal (If abused) compounds here, a fact which has no doubt prompted the countries listed below to act against Kratom. Remember the extract comment earlier. We aren’t simply dealing with a leaf you chew anymore. We’ve now extracted the useful bits in concentrations that are untried and untested. These are potent concentrates in quantities previously not available through simply chewing a leaf.
Further study is definitely warranted, given the initial research and user feedback, but this raises a particularly interesting question, one which should be at the forefront of most people’s minds.
Where is big pharma? Why do they apparently express very little interest in the plant or its compounds? Make no mistake, combatting pain is big money. The only market more lucrative, and arguably one they have created themselves, is dealing with opioid addiction, one of the biggest challenges American healthcare faces in the coming decade. There are two possible answers to this question.
The first is simply this. They may have already evaluated the compounds and not seen the financial viability in further development, given the clinical risk profile associated with (perhaps unfairly so) both ingredients. The second is that they may simply view any opioid-related products as tainted, given their current market saturation and the associated negative press surrounding opioids. Simply put, if the drug works, pharma is all over it.
The conspiratorialist that lives on my shoulder would also like to raise a third possible scenario. Existing treatments for opioid addiction, developed at huge cost and generating massive income for big Pharma may have seriously affected decisions to explore a cheaper alternative. Pharmaceutical companies don’t down-sell. It is simply not in their makeup.
Next, let’s examine global regulation and then look at the nutrition and health sectors’ role in Kratom distribution in the US.
Global Regulation and Bans
This is a definitive list of countries across the globe that have either ruled Kratom to be a regulated medicinal drug (available from your doctor on prescription) or classified it along with other illegal substances, such as heroin and cocaine, meaning possession of the drug is illegal. The information below was sourced from this webpage.
Belarus, Bulgaria, Croatia, Denmark, Estonia, Finland, France, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Moldova, Norway, Poland, Portugal, Romania, Russia, Slovenia, Switzerland, Turkey, United Kingdom,
Ironically, Indonesia. It is the world’s largest producer of Kratom but use and possession are illegal. Shipping it off to users globally is however encouraged. China and Hong Kong, Japan, Malaysia, Myanmar, Singapore, South Korea, Taiwan, Thailand, Vietnam, Middle East (all countries), Israel, Australia, New Zealand, Egypt, and Argentina all regulate Kratom.
Alabama, Arkansas, Indiana, Mississippi, Vermont, and Wisconsin have called for a ban on sales. It’s is freely available in most other States or can be ordered online.
That makes a total of 45 countries (excluding American states) globally that either ban or regulate Kratom as medicine or a controlled substance. Many of these countries have only recently (within the last decade) applied bans or stricter regulation, indicating a growing awareness globally of the dangers of Kratom’s two psychotropic substances in unregulated use. The fact the plant is now sold as an extract has undoubtedly also impacted this decision-making process.
The Business Side of Kratom
In 2016, Kratom exports from the region of West Kalimantan, Indonesia conservatively reached $130 million in annual profits. Most of these exports were to the USA and in the subsequent years till 2020, profits and volumes have risen annually, but not for much longer.
A law was passed in late 2019 in Indonesia banning the further production of Kratom. Farmers have been given a five-year “window of grace” to switch over to another crop, but you can be sure production will be ramped up in that period. Make hay will the sun shines.
The world will soon be facing a Kratom supply problem. This is great news for countries with the right climate and lax legislation. As shrinking demand drives up Kratom prices, the supply chain will be rubbing its hands in glee, in anticipation of the financial windfall to follow. To sell your product though, you require a legal marketplace to peddle your wares, and America’s lax regulatory system allows the perfect climate for exploitation.
To clarify, Kratom is currently sold and marketed by the natural products sector. A sector Medika views as a real danger to public health. These are the same companies and individuals that encourage the sale of Covid cures, bleach-based treatments and that make a plethora of ridiculous claims about the products they sell.
They are unscrupulous, driven by profit, and a complete lack of ethical responsibility to the users who buy their snake oils. They are also largely unregulated.
If anything, every effort should be made to ensure Kratom distances itself from this market. The accompanying reputation of dishonesty and deception the natural products market brings with it will do nothing to further Kratoms case to be recognized as a real medicine with legitimate benefits.
Enter the AKA (American Kratom Association). This not for profit is essentially a group of lobbyists petitioning anyone and everyone for the right to legally choose to use Kratom. Their pitch is essentially this. Fund us and we will ensure that you retain the right to have access to your drug.
Again I take issue with the tactics being employed by the AKA. Confusing freedom of choice and the safety of the patient is misleading and a clear effort at diversion. Diversion from what though? Could the AKA simply be a tool of the natural products industry to secure future sales? This is simply my suspicious nature at this point smelling smoke, but further investigation is, in my opinion, warranted. If I am wrong, I’ll be the first to hold up my hands.
There are supposedly over 25 million Americans who currently use Kratom if the figures the AKA give out are to be seen as reliable. This figure is an indicator of the size of the market in America and any product with this potential reach is worth its weight in gold to the retailers selling it.
The looming issue around supply will only serve to drive up prices and poses a further potential risk. The development of synthetic versions of the two key ingredients to ensure availability and dilution of existing formulations to stretch existing stock.
As there is currently a lack of regulation there is little to stop manufacturers from lacing or watering down formulations with a myriad of potentially life-threatening cocktails. That’s 25 million potential fatalities waiting for us, not so far down the road.
The AKA’s efforts to ensure self-regulation and quality control, impossible and unenforceable within the natural health sector, in my opinion, may simply be an attempt to avoid regulation from a higher authority. Yeah, I know. Cynical, but sadly a very real possibility.
I intend to reach out to the AKA to discuss these issues in more depth in a later article.
What’s the Value of the Kratom Industry in the US
Great question, but I am not certain anyone has reliable figures. How could they? Product quality differs wildly as does presentation. Kratom takes the form of anything from vapes to powders, teas, and tablets, and with a user who requires the product on a daily basis in varying strengths, the numbers are huge.
The actual active ingredients or alkaloids in the product are often not measured or represented correctly and as there is no testing of products made available to the public, it’s pretty much a question of going on what the label says. Labels sadly are often misleading. Particularly when you’re dealing with the unregulated natural products industry. Fancy packaging isn’t an indicator of quality or content. No matter what the marketing blurb says.
Protecting current users
If there are in fact 25 million Americans using Kratom then the issue truly is pressing. Finding a way forward that protects both the users and assures them continued access to Kratom matters. Particularly to those individuals that rely on Kratom to combat chronic pain.
Banning the drug is short-sighted and counterproductive to its acceptance as medicine if that is where it truly belongs and mounting evidence suggests that to be the case.
Make a claim, substantiated or not, relating to the use of Kratom and its ability to relieve pain or assist users to kick an opioid addiction and you’ve just moved the product into the realm of medicine. Let’s be completely clear about this point. There is no getting around it. Kratom is a medicine that hasn’t as yet been labeled as such.
You can dress it up any way you like, it will always come back to this one simple fact. What Kratom purports to do and what you claim as users, makes Kratom a medical drug, a medicine.
If it’s to be sold OTC or under the supervision of licensed doctors remains to be seen. My gut feel tells me that it is going to require medical supervision, particularly for patients looking to escape the vicious cycle of opioid addiction.
Dosing and safe levels need to be established. Interactions with other medications need to be listed and monitored. Long-term usage brings its own risks and with it, the need to monitor for symptoms that would indicate problems. For all of the above, you require the hand of a trained medical professional. Not an online Quack with a degree in bullshit and shelves of herbal products waiting to be sold..
These individuals are neither properly trained nor do they have the best interests of the patient at heart. Admittedly, neither does every doctor, and it is the duty of the patient to recognize poor care and seek an alternate care provider.
How do we get Kratom reclassified?
Human trials are an essential part of any medication’s journey to acceptance by the FDA. There aren’t any short cuts. Not unless your name is Covid and you’re threatening the globe. Kratom may be controversial but it’s definitely not in that league so it’s going to be subject to lengthy scrutiny.
What may very well benefit the drug is its widespread usage in the US. We have, in effect, got real live clinical trials underway and some of these subjects have years of exposure to the product in varying degrees.
The whole scope of usage is covered. From the occasional mild dose to daily cocktails that would send an elephant into a coma, we have data at our fingertips. Data that could easily be harvested and would reveal the drug’s true risk profile.
Additionally, testing of users for blood toxicity and related safety concerns centered around the liver and high blood pressure would be easy to determine. As would dependency.
It is our intention, through our MOBILIZE Health platform to enable a start to the collection of this data. We will, over the coming days, reach out to research groups involved currently in assessing Kratom’s alkaloids.
Hopefully, harvesting data, data which current users are all too keen to share, will help this novel drug find a safe path onto the shelves of pharmacies across the country.
In doing so, this will also ensure the safety of current and future generations of Kratom users. Feel free to register a free account and add your comments below to join in the conversation. We value your opinions.