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DEA Drugs and Chemicals of Concern: Kratom

The Drug Enforcement Administration (DEA) maintains a list of Drugs and Chemicals of Concern on their web site (Click here to view).

The substances listed represent chemicals that are being considered for possible evaluation or scheduling under the Controlled Substances Act of 1970 (CSA) and its subsequent amendments. Most of the entries are already Schedule I or II substances under the CSA, and most have been on the list for several years but it is interesting to access the list from time to time to see if any changes have occurred or if anything new has been added.

In February 2008, I received an inquiry from a colleague in the San Francisco Bay area who was treating a patient for kratom dependence. I had only a distant memory of this substance and; as it turns out a very mistaken one. I was under the impression that kratom leaves are a mild stimulant used in Southeast Asia like betel nut or like khat in the Middle East. Yet, my colleague was treating his patient with Suboxone® for kratom withdrawal symptoms resembling those found in opioid dependence. As I thought about this I recalled a “short communication” article that I had reviewed in 1988 for the Journal of Psychoactive drugs regarding contradictory psychoactive properties of kratom use. (KRL Jansen and CJ Prast, 1988. Psychoactive properties of mitragynine (kratom), J. Psychoactive Drugs, 20(4):455-457). In revisiting this article, I find contradictions in how some researchers describe the effects of kratom as similar to opium, leading to stupor and habitual use while others found its leaves to be a stimulant like cocaine - chewed, swallowed like tea, or occasionally smoked to increase work output and tolerance to intense sunlight.I was unaware of kratom use migrating to the U.S., so on a whim I logged on to the Drugs and Chemicals of Concern web site and was surprised to see that it was, indeed, listed. Although I might have missed its listing on my past visits to the site, I believe that kratom is a fairly recent addition. Kratom, Salvia divinorum and dextromethorphan were the three non-controlled, non-prescription, psychoactive substances of concern listed.

Some claim that kratom (Mitragyna speciosa) has been used by humans for thousands of years in Thailand and Malaysia where it grows indigenously. It is a tree from the same botanical family (Rubianceae) as the coffee tree and grows up to 50 feet tall. Its leaves are used in low doses (2-6 gm) as a stimulant or in high doses (16-25 gm) as a sedative. Other uses include easing pain, treating opiate addiction and diarrhea, and use as a recreational drug. Although over 25 alkaloids have been identified in kratom leaves, the three principal ones are: mitragynine (9-methoxy-corynantheidine), mitraphylline, and 7-hydroxymitragynine. Recent research indicates 7-hydroxymitragynine is the primary active chemical and that it is more powerful than morphine (KM Babu, CR McCurdy and EW Boyer, 2008. Opioid receptors and legal highs: Salvia divinorum and kratom. Clin Toxicol (Phila), 46(2):146-152). Although this alkaloid is structurally more related to yohimbine and other tryptamines, it is a powerful mu and delta opioid brain receptor agonist like buprenorphine (found in Suboxone®). Suboxone® is one of the major medications used in the treatment of heroin and other opioid addictions. It is fascinating that both Mitragyna speciosa and Salvia divinorum contain chemicals that stimulate the brain’s opioid receptors though neither is botanically or chemically related to the opioids. Salvinorin A, the non-alkaloid psychoactive chemical of Salvia divinorum is the primarily chemical responsible for most of its psychedelic effects. Salvinorin A has been found to be a powerful kappa opioid receptor agonist. (KM Babu, CR McCurdy and EW Boyer, 2008, Opioid receptors and legal highs: Salvia divinorum and kratom. Clin Toxicol (Phila), 46(2):146-152)

Stimulant effects from chewing 2 to 6 gm of kratom leaves occur within 5 to 10 minutes. If it is ingested as a tea, mixed with fruit juice, or made into a cola mixture the onset of action is delayed from 20 to 40 minutes. This dosage is described as making the mind more alert, while at the same time increasing both physical and sexual energy in the user. Users describe themselves as more sociable, friendly and talkative though also a bit edgy. Laborers chew kratom leaves to sustain them during hard monotonous physical tasks. Effects last for 2 to 5 hours.

Stimulant-like effects or euphoric-sedative-analgesic effects are attributed to medium dosages of 7 to 15 gm of kratom leaves while opioid-like euphoric-sedative-analgesic effects that last about 6 hours occur at dosages of 16 to 25 gm. Users say they are less sensitive to pain, sedated, euphoric (comfortable pleasure), and experience a dreamy reverie with greater appreciation of music. Negative effects at this higher dosage are very similar to those from opioids: sweating, itchiness, pupil constriction, constipation, nausea and potential hangover. Advocates of kratom use are quick to point out that the dosage schedule delineated for use does not apply to the recent rash of extract products currently found on the Internet. These extracts are alleged to be 8, 15 or even 35 times as potent as kratom leaves. Those who promote kratom use also warn that the natural leaves may vary in potency and some individuals may be more sensitive to its effects. It should not taken with other drugs, it should not be used if pregnant, while driving, or prior to a potentially hazardous situation that requires focus or alertness. (D Siebert, The Kratom User’s Guide, http://www.sagewisdom.org/kratomguide.html accessed 3/6/08)

The major drawback to kratom abuse is its ability to induce opioid-like tissue dependence with a significant withdrawal syndrome when it is used at high doses on a daily and chronic basis. Long-term use of kratom has been shown to produced anorexia, weight loss, insomnia, skin darkening, dry mouth, frequent urination, and constipation. The kratom withdrawal syndrome consists of symptoms of hostility, aggression, emotional labilitly, wet nose, achy muscles and bones, and jerky movement of the limbs. Some kratom addicts also exhibited psychotic symptoms that included hallucinations, delusion and confusion. (http://www.deadiversion.usdoj.gov/drugs_concern/kratom.htm, accessed 3/6/08)

Since kratom dependence appears to be related to its agonist effects at the opioid mu receptor, I look forward to my San Francisco colleague’s report on the effectiveness of using buprenorphine (Suboxone®) to treat kratom addiction. Similarly, various internet sites claim that kratom has been used effectively to treat other opioid drug dependencies including buprenorphine dependence (EW Boyer, KM Babu, GE Macalino, 2007, Self-treatment of opioid withdrawal with a dietary supplement, Kratom. Am J Addict, 16(5):352-356).

At least 4,000 plants and fungi have been found to produce interesting psychoactive chemicals. The vast majority of these plants or the psychoactive chemicals they contain have never made it to the DEA’s list of Drugs and Chemicals of Concern. I have forgotten how fascinating these natural psychoactive substances can be and can’t help but believe that researching them will ultimately lead science to new and even more enthralling neurotransmitters in our brains. Such discoveries have great potential to either provide us with a better understanding or further baffle our understanding of the human mind.

Darryl S. Inaba, PharmD., CADC III

4 Responses to DEA Drugs and Chemicals of Concern: Kratom

  • Rane

    As a decade long opiate addict, now "sober" on Suboxone for 6 months I am happy to say I have undergone a complete paradigm shift and want to be sober for real, as in no suboxone.

    Kratom has been a lifesaver to make that transition.

    You are probably aware of not only the severity of opiate withdrawal but with drugs like Methadone (which I once spent 2 months dope sick when I stopped) and Suboxone, they are so difficult to come off.

    The extreme length of time is what was killing me. So thanks to Kratom it has eased the transition. Heroin and the like, you are better after 7 days tops, but when it comes to the longer acting ones, coming off is PAIN and FRUSTRATION like nothing else.

    Suboxone may have been a miracle drug for me when I needed it but then it became harmful (basically your personality is operating at 25% of who you really are). I felt that I was unable to grow as a person, that it was holding me back. I am glad I went off of it.

    I am 10 days off Suboxone, after a rapid decrease (32mg>16>8>4>2>0 over a 3 month period) and when it gets unbearable I have a cup of kratom tea. Every day I feel better and I am sure that a week from now I wont need any tea.

    Consumers should not always have to rely on modern addiction medicine - which is obviously failing us. My doc says "this is what we got" but that is unacceptable. We, the people that are effected, need to be able to find our own solutions when our docs cannot.

    About the guy using bup to get off Kratom- it's a catch 22. i am essentially doing the exact opposite. But it wont matter what any individual or institution does if there is not a huge paradigm shift in the medical community and with personal responsibility.

    So my point in writing this diatribe is that I no longer want to visit the "sickness industry" and I hope this substance that I found helpful will not become restricted to people that need it.

    Personal responsibility is the answer folks. AA wont help you, leaving people places and things wont help you; only you, your thoughts, words, and actions will help you.

    Please do post what happens with the guy using Bup to get off Kratom. And, if you are able, whether he goes on maintenance or just uses bup for detox.

  • an_apple_a_day
    an_apple_a_day on February 4, 2009 at 6:17 pm said:

    Congrats on being sober.

    I use kratom for different reasons... pain management. I have arthritis and not only does kratom help with the pain, it seems to manage the atacks. I'll be very miffed in the DEA bans kratom and I cant buy it anymore.

    I've done a lot of research into becoming addicted to Kratom and from what I've read, it's rare and you dont have trouble quiting you just get some mile withdrawl symptoms... nothing too bad.

    Here are some good sites I've found:

    http://kratom-world.com/
    http://kratom.nl/en/
    http://en.wikipedia.org/wiki/Kratom

  • yurps

    I am going thru the same as this blog posts describes. I have tried most drugs and that includes various opioids. I nearly got put into jail so I started looking for legal highs, at first this was alcohol, but the hangover was so terrible. So I found GHB better until it was made illegal where I live in 2003, then I used phenibut, I sort of got addicted to each of these but stopping came down to not sleeping but not physical discomfort. Then I found Kratom, at first I thought it was a miracle too, and to be honest I went a long time using it without much problem. At first only once a week, then a few times a week, but soon once a night. Even at once a night, when I ran out it was one bad night usually, and I would have some hard liquor and codeine/iboprophen tablets to get thru. Next day I would go to a float tank and get some excercise, at that point I would have mild withdrawal and an alcohol hangover. However then I lost my job during the financial crash and I was at my house during the day, somehow my job gave me structure, got me going in the morning and kept me off the kratom. The job was also alot of stress, and partially the reason I started taking Kratom in the evenings to relax after the day. Anyhow being around the house all day meant I started taking Kratom more often, even first thing upon waking up with coffee. This continued, now when I run out I get very anxious and the full range of symptoms discribed by traditional withdrawals from opioids. I am considering Suboxone, however I don't know if the addiction specialist will know much about Kratom, and any specifics on switching from Kratom to Suboxone. They say wait an 24 hours for heroin addicts, but I think Kratom might even have a shorter half-life than heroin so perhaps it is ok to switch to Suboxone after even a shorter period. I have yet to try Suboxone but it seems like it is easier to taper than Kratom. I have successfully tapered down on Kratom myself, but it was up to my own discipline and it was hard when you have a large stash to resist the urge not to use more and get a high, especially if you have a bad day or something. With Suboxone you don't get high, you just don' t have the w/d's. I hope my specialist will listen to me about this Kratom, if they don't accept it I will have to lie and say I am addicted to codeine or hydrocodone so I can get the treatment, this is part of the problem with being addicted to a legal drug. So I have to find what a equivilent dose of hydrocodone or vicodin compared to Kratom. Anyhow glad I found this webpage, will print it and bring it with me to the specialist.

  • bikegirl76
    bikegirl76 on September 27, 2010 at 2:52 pm said:

    Kratom is an extremely effective OTC remedy for all kinda of complaints - depression, AD/HD, anxiety, pain (esp. migraine and fibromyalgia). I don't view it as a "Hey, dude, let's get high, this is fun.. heh heh heh.." sort of thing, but rather as a legitimate herbal supplement/medication to be taken at specific doses for specific ailments. I'd be thrilled if it were available at FDA-regulated health food stores, etc. in standardized doses in gel caps, with very clear instructions and warnings printed on the package. Education is key.

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