Kratom’s rise in popularity is concerning.

Kratom is an extract from the tropical tree Mitragyna speciosa, a relative of the coffee plant.

Historically, manual laborers in Southeast Asia have used the compound — either chewing the leaves or making them into tea — to soothe aches and pains and boost energy levels.

As it stands, kratom is not illegal in the United States, and people can easily purchase it online.

It is most commonly available in the form of a green powdered supplement. Although manufacturers market kratom extract as safe and natural, it is far from inert.

Scientists have carried out limited studies on its effects, but it appears to act as a stimulant at lower doses and has a sedative effect at higher doses. Over recent years, usage in the U.S. has increased sharply.

Who uses kratom?

Some people with mood disorders or chronic pain use kratom to self-medicate, whereas others use it recreationally. Some individuals with opioid use disorder use the drug because the active component of kratom — mitragynine — acts on opioid receptors.

Although there is no medical evidence to support this use, some people who are dealing with an opioid addiction consider kratom to be a godsend. Relative to opioid-replacement medications, such as buprenorphine, it is much cheaper and easier to obtain.

After witnessing firsthand an increase in patients experiencing either the toxic effects of kratom or symptoms of withdrawal, Prof. William Eggleston from the State University of New York at Binghamton decided to investigate.

Prof. Eggleston and his team took data from the National Poison Data System (NPDS) and a County Medical Examiner’s Office in New York State. They recently published a brief report in the journal Pharmacotherapy.

A startling increase

The researchers took data from between January 1, 2011, and July 31, 2018. In total, they identified 2,312 reports that mentioned kratom exposure.

The data describe a worrying trend: In the whole of 2011, there were 18 exposures, but, in just the first 7 months of 2018, there were 357 exposures.

More than half of the events (56.5%) involved taking kratom as a powder, capsule, or tablet, with 86.2% of users taking kratom orally.

Many of these events involved multiple substances, so the scientists focused their analysis on the 935 cases that only involved kratom. The most common adverse events were:

• agitation: 18.6%
• tachycardia: 16.9%
• drowsiness: 13.6%
• vomiting: 11.2%
• confusion: 8.1%
• seizure: 6.1%
• withdrawal: 6.1%
• hallucinations: 4.8%
• respiratory depression: 2.8%
• coma: 2.3%
• cardiac or respiratory arrest: 0.6%

Additionally, they identified four cases of neonatal abstinence syndrome, in which an infant experiences withdrawal from a drug due to exposure during gestation.

In four cases, the reports listed kratom as either a contributing factor or a cause of death. In two of these cases, the reports identified kratom alone; in the other two cases, additional compounds played a role.

Although kratom is less potent than other opioids, it can still have significant negative effects on the body.

“In larger doses, it can cause slowed breathing and sedation, meaning that patients can develop the same toxicity they would if using another opioid product. It is also reported to cause seizures and liver toxicity.”

Lead author Prof. William Eggleston

More work necessary

It is clear that kratom can produce negative effects, but that does not mean that the authorities should ban it entirely. As Prof. Eggleston explains, “Kratom may have a role in treating pain and opioid use disorder, but more research is needed on its safety and efficacy.”

Importantly, though, he hopes that regulations will become tighter. “Our results suggest it should not be available as an herbal supplement,” he says.

The authors note that reporting drug events to the NPDS is voluntary, so the findings are likely to significantly underestimate the true number of adverse events relating to kratom.

Although these findings add to our understanding, there are still questions around who uses kratom, why they use it, and how it interacts with other substances. Prof. Eggleston plans to follow up this work with a deeper dive into kratom and those who use the drug in the U.S.

As the opioid crisis continues, the number of people using kratom is likely to increase. Understanding kratom and its impact is more important than ever. The authors end the article with a call to action:

“[K]ratom’s rapid rise in popularity in the [U.S.] highlights the urgent need to expand access to evidence-based medication-assisted treatment for patients with [opioid use disorder] and to address the complex symptoms of chronic pain.”