Kratom therapy: Exploring the medicinal potential of a gray market botanical

28 Aug 2019 --- Kratom (Mitragyna speciosa) is a Southeast Asian tree with a long history of use in traditional medicine. In the region, the plant’s leaves are widely consumed for pain relief, opioid addiction treatment and other therapeutic uses. While clinical research outlining its efficacy and safety is lacking, kratom use has spread to the US and Europe. NutritionInsight sheds light on the plant’s therapeutic potential through expert insights.

Currently, kratom is legal and available in the US and some parts of Europe as a gray-market product with an uncertain regulatory future. In Southeast Asia (Indonesia, Thailand and Malaysia), however, the plant has been used for centuries to relieve fatigue, anxiety, chronic pain, cough and diarrhea and, more recently, as an aid in opioid withdrawal. 

Currently, most of the kratom commercially available is exported from Indonesia, explains Oliver Grundmann, Ph.D., Clinical Associate Professor at the University of Florida. “The leaves can either be used fresh and then chewed to provide a brief stimulatory effect, or dried and ground into a powder to provide a stimulatory or a relaxing and analgesic effect depending on the dose.”

 Illicit opiate users commonly use kratom to reduce opiate withdrawal symptoms.“When consumed freshly in the form of a decoction [brewed tea], kratom tea is safer than its powdered form,” notes Darshan Singh, Ph.D., at the Centre for Drug Research in Malaysia. “Currently, in the West, most of the reported adverse events associated with kratom use stemmed from kratom powder. Possibly due to being stored for prolonged periods, kratom powder can turn toxic. In traditional settings, users prefer using freshly brewed kratom tea than kratom powder.”

In terms of effects, kratom acts as a stimulant, which through chronic use can induce a slight sedative effect. “The subjective experiences of kratom users differ widely depending on the doses that are being consumed,” highlights Dr. Grundmann. “In low doses, the effects appear to be primarily increasing energy and focus for some. Meanwhile, higher doses relieve acute and chronic pain and reduce sleep irregularities and even emotional or mental burdens such as depressive and anxiety disorders.”

“Users felt energetic, active, happy and strong after drinking kratom. Illicit opiate users commonly used kratom to reduce their dependence on opiates. Kratom helps to reduce unpleasant opiate withdrawal symptoms during cessation from opiate use,” says Dr. Singh.

“So far, based on my personal observation, no one has developed any adverse effects or side-effects from kratom use,” adds Dr. Singh. “Kratom is used for various medicinal benefits among rural populations, but its therapeutic effects or medicinal relevance have not been thoroughly documented.”

Data gaps in kratom research
While some animal studies have provided preliminary data on kratom’s therapeutic potential, there is a pronounced lack of controlled human clinical trials.  

“It is difficult to perceive the number of individuals who are ingesting this product in the US and it is near impossible to get a clinical trial initiated,” says Christopher McCurdy, Ph.D., Director of Translational Drug Development Core at the University of Florida. 

“This is mainly due to the fact that there is little traceable raw material that can be utilized. Much of the kratom that is available in the US lacks a reliable chain of custody and therefore it is difficult to know what the plant was exposed to, with regards to pesticides, fertilizers or other chemicals. This includes post-harvest processing of the material in drying, storage, grinding [most likely source of heavy metal contamination], transportation, shipping and more. All of this implicates the safety of the final product,” says Dr. McCurdy.

Dr. McCurdy further underscores the prevalence of “natural” kratom products with adulterated compositions that may pose a health hazard. With this in mind, he emphasizes that there is difficulty in defining what “pure” kratom is in the Western market. 

“No matter the vendor product in the Western world, they are all different from the way kratom is utilized in a traditional setting. We are extremely interested in studying the traditional preparation and how it is different from any product that is available in the Western world,” he says.

General misconceptions of kratomMany reports of kratom fatalities cannot be attributed to kratom use alone, but the interaction of multiple substances.
The experts outline discrepancies in commonly cited kratom research, which have highlighted the drug in cases of adverse reactions or even fatalities. “Despite a number of reported deaths that are claimed by some regulatory agencies to have been caused by kratom, almost all fatalities involved either the exposure to multiple substances such as prescription medication, over-the-counter medication, alcohol, or illicit drugs, or were even were the result of a homicide or suicide,” explains Dr. Grundmann.

“There are plenty of misconceptions surrounding kratom use,” underscores Dr. Singh. “Regulatory and healthcare providers believed kratom is an opioid, thus its use could be more harmful than opioids. The increasing number of case-studies from the West showed kratom causes toxicity and mortality incidents. All these reports are poorly described and the cause leading to this uneventful reporting are largely attributed by many factors such as adulterated kratom products or underlying unresolved medical problems. At times, healthcare providers give wrong information regarding kratom to patients.”

An evolving market for kratom
Although a growing demand for kratom has raised its value for Southeast Asian exporters, it remains in the crosshairs of US federal regulation. “The future of kratom is hard to predict. Several countries have banned kratom with the justification that it is a drug of abuse similar to opioids,” highlights Dr. Grundmann.

Several US states have taken a path to implement legislation to require kratom supplements to follow label requirements and Good Manufacturing Practice (GMP) standards, he adds. “This would usually fall under the Food and Drug Administration (FDA) jurisdiction on the federal level. If kratom was regulated as a dietary supplement and labeled accordingly to adhere to regulatory standards consumers and patients as well as healthcare providers would be better informed. At this point, manufacturers have no obligation to do so.”

“I do hope that the kratom market will eventually evolve in this direction and avoid unsubstantiated health claims. They should also limit dosing ranges, as well as include potential adverse effects that require consultation with a healthcare provider prior to taking kratom products. That would certainly serve both the kratom industry and consumers best, and is the responsible step to take,” concludes Dr. Grundmann.

By Benjamin Ferrer