Kratom

Kratom (Thai: กระท่อม), Mitragyna speciosa, is a medicinal leaf harvested from a large tree in the Rubiaceae family native to Southeast Asia in the Indochina and Malesia floristic regions. The plant has been traditionally used for its medicinal properties. It was first formally documented by the Dutch colonial botanist Pieter Korthals. The genus was given its Mitragyna name by Korthals because the stigmas in the first species he examined resembled the shape of a bishop's mitre. It is botanically related to the Corynanthe, Cinchona and Uncaria genera and shares some similar biochemistry.

Description
Mitragyna speciosa, kratom trees, usually grow to a height of 12 - 30 ft tall and 15 ft wide, although under the right conditions, certain species can reach up to 40 ft–100 ft in height. The stem is erect and branching. The leaves of the kratom tree are a dark green colour and can grow to over 7 in long and 4 in wide., ovate-acuminate in shape, and opposite in growth pattern.

The flowers are yellow and grow in clusters. This genus is characterized by a globular flowering head, bearing up to 120 florets each. During the flower bud stage, the developing florets are surrounded and completely covered by numerous overlapping bracteoles.

Kratom leaves are constantly being shed and being replaced, but there is some quasi-seasonal leaf shedding due to environmental conditions. During the dry season of the year leaf fall is more abundant, and new growth is more plentiful during the rainy season.

When grown outside their natural tropical habitat, leaf fall occurs with colder temperatures, around 4 degrees Celsius. The kratom tree grows best in wet, humid, fertile soil, with medium to full sun exposure, and an area protected from strong winds.

Alkaloids
Kratom contains many alkaloids including mitragynine (once thought to be the primary active constituent), mitraphylline, and 7-hydroxymitragynine (which is currently the most likely candidate for the primary active chemical in the plant). Although 7-hydroxymitragynine and mitragynine are structurally related to yohimbine and other tryptamines, their pharmacology is quite different, acting primarily as mu-opioid receptor agonists. Other active chemicals in kratom include raubasine (best known from Rauwolfia serpentina) and some yohimbe alkaloids such as corynantheidine.

Effects
Kratom's primary pharmacology is mediated by the alkaloids 7-hydroxymitragynine and mitragynine. While these molecules share structural similarities to the psychedelics, there is no psychedelic activity or similarities in effects to such substances. Instead these alkaloids primarily interact with the opioid receptors. Accordingly, kratom is known to prevent or delay withdrawal symptoms in an opiate dependent individual, and it is often used for this purpose. It can also be used for other medicinal purposes and is sometimes used recreationally.

Kratom has been traditionally used in regions such as Malaysia, Thailand, and Indonesia, but was discovered by Western civilization during the 19th century. Besides kratom (or krathom), in Southeast Asia and the Pacific Islands it also goes by the names ithang, biak biak, ketum, kakuam, and in southern regions, thom. In these areas kratom has a history of use by laborers and in folk medicine for opium dependence and diarrhea.

Of the two main active constituents, mitragynine has been studied more thoroughly than 7-hydroxymitragynine. At lower doses, Mitragynine exhibits a yohimbine-like binding to alpha-adrenergic receptors, as well as some binding to the delta opioid receptors. As doses increase, binding to delta receptors increases, and in yet higher doses, crossover to mu receptors occurs.

7-hydroxymitragynine was only recently understood to be the main active ingredient. Limited animal research suggests it is a potent opiate agonist, but with a ceiling effect that limits the potential for respiratory depression and euphoria. No fatal overdose of kratom is known to have occurred.

While one study of Thai users reported that kratom has sedative effects in low doses, changing over to stimulation in higher doses, this seems to be incorrect. Most other sources say that it is a stimulant in lower doses, becoming sedative in higher doses, which is consistent with mitragynine's receptor binding profile. However, recent publications indicate that different alkaloids may be at work to achieve stimulation versus sedation: whereas higher concentrations of mitragynine are attributed to act as a stimulant, 7-hydroxymitragynine is the most significant alkaloid for sedation with more potent analgesic activity than that of morphine. Effects come on within five to ten minutes after use, and last for several hours. The feeling has been described as happy, strong, and active, with a strong desire to do work. The mind is described as calm.

Side effects, although rare, may include dry mouth, increased or decreased urination, loss of appetite, and nausea or vomiting. Heavy use can result in a prolonged sleep. Possible side effects from long term use include anorexia and weight loss, insomnia, and dependence. Comprehensive scientific and clinical studies have yet to be conducted to establish the potential health risks associated with consistent long term consumption of kratom.



Kratom has recently become more known and used in Europe and North America where it has been prized for its applications to many conditions and ailments, primarily pain, depression, anxiety, and opiate withdrawal.



Opiate dependence
Inspired by traditional use, H. Ridley reported In 1897 that the leaves of Mitragyna speciosa were a cure for opium dependence. In more recent times, mitragynine has been used in New Zealand for methadone dependence detox. Kratom was smoked whenever the patient experienced withdrawal symptoms, over a 6 week treatment period. Patients reported a visualization effect taking place at night in the form of vivid hypnagogic dreams. While working on plans for ibogaine experiments in the USA, Cures Not Wars activist Dana Beal suggested that mitragynine could be used as an active placebo for comparison in the study. Acting Deputy Director of the NIDA Charles Grudzinskas rejected the proposal, however, saying that even less was known about mitragynine than ibogaine.

Although chemically similar, ibogaine and mitragynine work by different pathways, and have different applications in treatment of drug dependence. While ibogaine is intended as a one time treatment to cure opiate dependence, mitragynine is used to gradually wean the user off opiates. The fact that mitragynine's mu crossover is increased by the presence of opiate drugs may be exploitable in the treatment of drug dependence, because it directs binding to where it is needed, automatically regulating the attachment ratio and modulating it towards the delta receptors over a short time. Within a few days, a person dependent on opiates would stop use of opiates, and the cravings and withdrawal will be moderated by the binding of mitragynine to the delta receptors. Mitragynine could also perhaps be used as a substitution or maintenance drug to manage dependence. In Southern Thailand, many heroin users have been using kratom to break their dependence and to manage painful withdrawal symptoms.

In 1999, Pennapa Sapcharoen, director of the National Institute of Thai Traditional Medicine in Bangkok said that kratom could be prescribed both for opiate dependence and to patients suffering from depression, but stressed that further research is needed. Chulalongkorn University chemists have isolated mitragynine which researchers can obtain for study.

In 1897 Ridley reported the leaves and bark of Mitragyna speciosa as a cure for the opium habit and this was quoted by Hooper (1907) In 1907 Holmes had referred to the leaves and possibly, the leaves of M. parvifolia as well, as an opium substitute. Certainly the leaves of M. speciosa have been chewed for many years under the local name 'kratom' by the native population of Thailand as a stimulant though the practice is now forbidden. As a consequence the leaves of M. javanica are frequently used as a substitute but are not considered to be as effective. The natives will also distinguish between different kratoms, for example, those with red and those with green midribs (Tantivatana, 1965).

Mitragynine was the only constituent isolated from Mitragyna speciosa it was assumed to be the physiologically active constituent having morphine-like properties, Grewel (1932) reported to be a protozoal poison but in 1933 Raymond-Hamet and Millat undertook a more critical examination and reported it to have markedly depressant properties. This was substantiated in 1934 by Masson. More recently Macko, Weisbach and Douglas (1972) reported that mitragynine possesses pain threshold elevating and antitussive properties but no addictive properties.

Recent drug use trends in Thailand indicate that a emerging pattern and profile is emerging in relation to kratom use. Around 2005, young people aged between 13 to 30 years old started boiling kratom leaves (15 to 100 leaves at a time) to produce a tea as a base for a cocktail coined 4x100 (สี่คูณร้อย). The basic 4x100 cocktail includes the kratom tea, cough syrup, Coca-Cola, and ice. The cocktail is generally prepared twice or more per day, depending on availability of leaves and is consumed for recreational purposes.

Although kratom has been shown to help people suffering from opiate addiction and withdrawal symptoms, kratom itself is believed to be similarly addictive if abused. Daily kratom users can develop a dependency similar to that of opiate addiction; however, withdrawals from kratom are said to be substantially less severe and shorter in duration. If used responsibly and on a non-daily basis the chances of developing a kratom dependency are shown to be remote.

Legal status
Kratom is a controlled substance in Thailand, Bhutan, Australia, Finland, Denmark, Poland, Lithuania and Sweden (Mitragynin) as of September, 1, 2011. Malaysia and Myanmar (Burma). In Malaysia, kratom is scheduled under the Poisons Act.

Thailand
The Thai government passed the Kratom Act 2486 which went into effect on August 3, 1943. This law makes planting the tree illegal and requires existing trees to be cut down. This law was not found effective, since the tree is indigenous to the country. Today, kratom is scheduled in category 5 of the Narcotics Acts (1979), in the same category as cannabis and magic mushrooms (the least punitive category). A related species, Mitragyna javanica, is often used as a substitute to get around the law, but it is not considered as effective. The dominant alkaloid in this species is mitrajavine, which has not yet been pharmacologically tested.

United States
Kratom is currently an unscheduled substance.

Canada
Although kratom has not been approved by Health Canada for human consumption, it currently does not fall under the purview of the Controlled Drugs and Substances Act thus, remaining largely unregulated.