Mitragyna speciosa is a tropical evergreen tree of the Rubiaceae family native to Southeast Asia. It is indigenous to Cambodia, Thailand, Indonesia, Malaysia, Myanmar, and Papua New Guinea, where its dark green, glossy leaves, known as kratom, have been used in herbal medicine since at least the 19th century. They have also historically been consumed via chewing, smoking, and as a tea. Kratom contains multiple alkaloids (primarily, mitragynine and to a lesser extent, 7-hydroxymitragynine) that bind to opioid receptors, mostly as partial μ-opioid agonists. Kratom can also be subjectively stimulating to some, though this is likely not achieved through typical stimulant mechanisms (such as reuptake inhibition or release of monoamines), nor is this a universal effect. The efficacy and safety of kratom are unclear. In 2019, the United States Food and Drug Administration (FDA) stated that there is no evidence that kratom is safe or effective for treating any condition. Kratom has been used for managing chronic pain, for treating opioid withdrawal symptoms, or for recreational purposes. It is under preliminary research for possible antipsychotic and antidepressant properties. Kratom use has not been shown to positively affect mental health. Anecdotal reports describe increased alertness, physical energy, talkativeness, sociability, sedation, changes in mood, and pain relief following kratom use at various doses. Common side effects include appetite loss, erectile dysfunction, nausea and constipation. More severe side-effects may include respiratory depression (decreased breathing), seizure, psychosis, elevated heart rate and blood pressure, trouble sleeping, and liver injury. Addiction is a possible risk with regular use: when use is stopped, withdrawal symptoms may occur. Serious toxicity is relatively rare and generally appears at high doses or when kratom is used with other substances. A small number of deaths have been connected to the use of kratom, most commonly when mixed with other substances. As of 2018, kratom is a controlled substance in 16 countries. Some countries, like Indonesia and Thailand, have recently moved toward regulated legal production for medical use. There is growing international concern about a possible threat to public health from kratom use. In some jurisdictions its sale and importation have been restricted, and several public health authorities have raised alerts.
Description
Mitragyna speciosa is an evergreen tree in the genus Mitragyna that can grow to a height of 25 m (82 ft). Its trunk may grow to a 0.9 m (3 ft) diameter. The trunk is generally straight, and the outer bark is smooth and grey. The leaves, ovate-acuminate in shape and opposite in growth pattern, are dark green, glossy on their upper surfaces, and can grow to over 14–20 cm (5.5–7.9 in) long and 7–12 cm (2.8–4.7 in) wide. They have 12 to 17 pairs of veins. The spherical inflorescences, which are deep yellow, grow in clusters of three at the ends of the branches. The calyx-tube is 2 mm (0.08 in) long and has five lobes; the corolla-tube is 2.5–3 millimetres (0.098–0.12 in) long. Mitragyna speciosa is indigenous to Thailand, Indonesia, Malaysia, Myanmar, and Papua New Guinea. It was first formally described by the Dutch colonial botanist Pieter Korthals in 1839, who named it Stephegyne speciosa; it was renamed and reclassified several times before George Darby Haviland provided the final name and classification in 1859.
Uses of the leaves
Kratom has been studied in cells and in animals, but no clinical trials have been conducted in the United States. The U.S. Drug Enforcement Administration (DEA) stated in 2013 that there is no legitimate medical use for kratom, and in 2019, the U.S. Food and Drug Administration (FDA) said that there is no evidence that kratom is safe or effective for treating any condition, and that there are no approved clinical uses for kratom. Kratom is commonly ingested by chewing, as a tea, powdered in capsules or pills, or extracted for use in liquids. Kratom is rarely smoked. Different varieties of kratom contain different relative proportions of alkaloids such as mitragynine.
Traditional use In cultures where the plant grows, kratom has been used in traditional medicine. The leaves are chewed to relieve musculoskeletal pain and increase energy, appetite, and sexual desire in ways similar to khat and coca. The leaves, or extracts from them, are used to heal wounds and as a local anesthetic. Extracts and leaves have been used to treat coughs, diarrhea, and intestinal infections. They are also used as intestinal deworming agents in Thailand. Kratom is often used by workers in laborious or monotonous occupations to stave off exhaustion and as a mood-enhancer and painkiller. In Thailand, kratom was "used as a snack to receive guests and was part of the ritual worship of ancestors and gods". The herb is bitter and is generally combined with a sweetener.
Opioid withdrawal Because the withdrawal effects of kratom are often reported to be less severe than those associated with traditional opioids, some people use kratom in the attempt to manage opioid use disorder, though no clinical trials have been done supporting this use. As of 2018, there have been no formal trials to study the efficacy or safety of kratom to treat opioid addiction. Stanciu et al. conducted a review of all literature and found insufficient evidence for any conclusions concerning whether kratom is harmful or whether can serve as harm reduction for those with opioid addiction. While some literature reviews claim that kratom has less potential for dependence or overdose than traditional opioids, other reviews note that kratom withdrawal itself can still be quite severe. Data on how widely it is used worldwide are lacking, as it is not detected by typical drug screening tests. Rates of kratom use appear to be increasing among those who have been self-managing chronic pain with opioids purchased without a prescription and are cycling (but not quitting) their opioid use. In 1836, kratom was reported to have been used as an opium substitute in Malaysia. Kratom was also used as an opium substitute in Thailand in the 19th century.
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