The substance kratom has been making waves in the media lately. Relatively new to the United States, it’s quickly becoming popular as a legal, herbal painkiller, but it’s still unclear whether kratom can do what its supporters claim. Users report everything from feelings of euphoria to terror, energy to lethargy.

Kratom is a tree in the same family as the coffee tree, native to Southeast Asia.

Kratom has been used for centuries as a pain reliever and anti-diarrheal. It’s also touted to be able to improve sexual performance. Although illegal in Thailand, Malaysia, Australia, and Burma, kratom is new enough in the United States that it’s not yet regulated at all.

Because kratom is legal and unregulated in the United States, it’s unclear how many people use the substance. It is clear, however, that it’s gaining popularity. Kratom is readily available on websites, in smoke shops, and even in some gas stations. In 2005, just two incidents related to kratom were reported by poison control centers nationwide. In 2011, the Banner Good Samaritan Poison and Drug Information Center in Phoenix, Arizona, reported six kratom-related emergencies.

There are several different ways to use kratom.

Fresh kratom leaves can be chewed after the removal of the stringy central vein. While it’s possible to chew dried kratom leaves, too, they’re rather tough. For this reason, dried kratom leaves are often crushed or powdered, instead of chewed whole. Powdered kratom can be mixed with water, fruit juice, or apple sauce. It can also be put into capsules and taken as a pill.

Alternatively, dried kratom leaves might be used to make tea. If the water is evaporated from the tea, a paste-like extract can be made. This paste can be stored and later dissolved in hot water to produce tea again, or the paste can be made into pellets and swallowed.

According to the website SageWisdom.com, the above methods of kratom use are the most common and the safest. However, kratom users have also reportedly snorted, smoked, and even injected kratom; these methods are not recommended.

When used as directed, kratom claims two distinct sets of results, one from using a small dose and one from using a large dose. The definition of small and large dosages varies depending on the potency being used.

A small dose of kratom is believed to have a stimulant-like effect.

The kratom tree is related to the coffee tree, so it seems sensible that it should produce a similar effect. At smaller dosages, kratom may cause the user to feel more mentally alert. He or she might also have more energy, have a greater perception of strength or stamina, or be more sociable or talkative. Smaller doses of kratom may also increase sexual energy.

While some people may utilize kratom for its stimulant-like effects, others may find it unpleasant. The experience can be “edgy” or upsetting.

A larger dose of kratom is believed to produce a sedative-like effect.

In larger dosages, kratom may reduce physical and emotional pain. It may induce a feeling of calmness or dreaminess. It may also produce a euphoric-like feeling or even act as an antidepressant. Users might also undergo a waking-dream type experience, similar to that produced by some opioids.

This dosage of kratom might also have some negative effects. Itching, sweating, and nausea are all possible. Some sources also suggest that severe vomiting or constipation are possible.

Because kratom shares certain similarities with opioids, it’s possible that it may help with opioid withdrawal symptoms.

Not only can kratom produce feelings of euphoria, pain relief, or dreaminess like opioids, but it actually works in a similar way. Certain compounds in kratom bind to the same receptors as opioids, thereby explaining the similarities in perceived experiences.

However, while it is believed that kratom is potentially addictive, it doesn’t seem to be as addictive as opioids. In fact, in a transcript from a Scientific American article, Edward Boyer, professor of emergency medicine and director of medical toxicology at the University of Massachusetts Medical School, described a patient he saw. The patient had been so addicted to opioids that he was injecting himself with large amounts of Dilaudid. After the patient’s wife found out and demanded that he stop, he switched to kratom.

After eventually mixing kratom with multiple other drugs, the individual seized and was admitted to the hospital. Dr. Boyer describes what happened to the patient after his discharge from the hospital, stating:

“After his stay at Mass General, he went off kratom cold turkey. The fascinating thing is that his only withdrawal symptom was a runny nose. As for his opioid withdrawal, we learned that kratom blunts that process awfully, awfully well.”

Dr. Boyer also notes that in preliminary studies, kratom doesn’t seem to produce the same symptoms of respiratory distress as opioids. While it does seem to hold the potential for abuse and addiction, it may eventually be possible to develop pharmaceutical drugs from kratom. These drugs might provide a safer painkiller alternative to opioids, as well as something to help ease withdrawals from opioid addiction.

Just as the potential benefits of kratom are not yet understood, its risks are not fully understood, either.

It seems clear that kratom can be potentially addictive. Even websites that promote its use, such as SageWisdom.com, warn against using too often. It’s suggested that kratom be used no more often that twice a week at most, although once a month or less is preferable.

Because kratom is unregulated, different qualities, potencies, preparations, and methods of use are rampant. When added to the fact that it can affect different people in different ways, it’s not so surprising that individual responses to kratom use can vary widely.

In an article on Vocativ.com, the authors describe their findings after looking through hundreds of user-posted kratom reviews. It seems that for each review, an opposing review was posted, as well. One person will report an increase in libido, while another will report the opposite; one will report lethargy, while another describes a burst of energy. If you decide to peruse the article, though, be aware that there are obscenities in the compiled list of reviews.

It’s possible that this is because differing effects from different dosages, but the extreme results – either wonderful or terrible, with nothing in the middle – are concerning. It may be that kratom is a alternative treatment option, but until it is more closely studied and regulated, it cannot be recommended as a safe pain relief method.

What have you heard about kratom?

Image by Marco Arment via Flickr

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