What is kratom (Mitragyna speciose?

Updated: Jun 21, 2018
  • Author: David W Dixon, DO; Chief Editor: Glen L Xiong, MD  more...
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Kratom (Mitragyna speciosa) is a psychoactive plant in the coffee family native to Southeast Asia. [68] Its use in the United States has grown over the past decade and it is estimated that millions of people take it regularly. [69] Controversy exists regarding whether kratom has any acceptable medicinal use and its safety.

The ongoing debate in the United States regarding kratom and its growing use originates from reports of kratom-related deaths, seizures, liver failure, psychosis, and concern of its addictive properties. [70] Proponents of kratom describe the botanical product and its history of being sold as a dietary supplement in Southeast Asia to manage pain, boost energy, and as a method to avoid opioid use and relieve opioid withdrawal symptoms. Recently, recreational use of kratom has been described. [71]

In 2016, the DEA announced its intention to designate kratom as a Schedule 1 controlled substance (ie, a substance with high potential for abuse and no currently accepted medical use). [72] Criticism of the DEA’s announcement came from those using kratom. Researchers also expressed concern regarding expensive and time-consuming regulations required to obtain Schedule I substances. Instead, the DEA withdrew the scheduling, and announced they would gather further scientific evidence. Kratom is currently listed as a "drug of concern" within the DEA’s Drugs of Abuse resource guide 2017 edition. [73]

Studies in rodents suggest alkaloids in kratom bind to opioid receptors and elicit antinociceptive properties, but with less respiratory depression than typical opioids. [74]

FDA scientists analyzed the chemical structures of the 25 most common compounds in kratom utilizing a computational model. Their conclusion was that all of the compounds share structural characteristics with controlled opioid analgesics, such as morphine derivatives. Additionally, the FDA found the compounds in kratom bind strongly to mu-opioid receptors, comparable to opioid drugs. [75]

At the time of this writing, a handful of states (ie, Alabama, Arkansas, Indiana, Tennessee, Vermont, Wisconsin) and several cities (ie, Denver, San Diego, Sarasota, and Washington DC) have banned or limited kratom sales. Legislation is being considered in other states (eg, Illinois). [76]

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