Kratom:

What is it?
o Group of tree-like plants belonging to Mitragyna genus of Rubiaceae
family
o Coffee also belongs to this family
o Indigenous to Thailand and Southeast Asia

Effects: Generally ingested as leaves or brewed as tea
o Dose dependent
Low-dose- mild stimulant
Moderate to high (5-15g) opioid-like effects
Used in Pain mgmt., Diarrhea, or Opioid withdrawal
Euphoriant
High dose (15g+)
Sedating, can induce stupor
Opioid effects
Few studies have been on psychoactive effects mostly
anecdotal
Combination of stimulant and opioid effects which are
dose-dependent and vary by individual
o Opioid effects- Analgesia, constipation, euphoria,
nausea, itching
o Some have unpleasant anxiety, internal agitation,
and increased aggression
o HD effects: hyperpigmentation of cheecks,
tremor, anorexia, weight loss, psychosis in
individuals with long-term use
o Seizures also reported in the setting of modafinil
use
o One case of intrahepatic cholestasis
o A high potency form known as Krypton from
Sweden has been associated with 9 deaths
thought to be from O-desmethyltramadol
additive unclear of cause
Increasingly popular for pain management and self-management of opioid
withdrawal in the US
o Available as raw leaves, capsules, tablets, and concentrated extracts
from internet suppliers and smoke shops
o Legally regulated as an herbal product by the US food and drug admin
and DEA
Pharmacology
o 20 active compounds known
Mainly mitragynine analogs: Mitragynine and more potent 7-
hydroxymitragynine
Indole ring similar to yohimbime
Responsible for opioid-like effects
Opioid Effects inhibitable by naloxone
No well-controlled studies are published in humans
In animals have been shown to control pain and have
opioid effects on smooth muscle
If compounds were given to animals for 5 days or more,
they would show withdrawal sx similar to that of
opiates -> largely mediated by mu and delta type
receptors
Also has anti-inflammatory effects via inhibition of Cox-
2 and PGE-2 production
Anti-nociceptive effects via activation of NE and 5-HT
pathways in spinal cord
Shown to block 5-HT2a receptors and stimulate post-
synaptic a2-receptors
o Addiction
Anecdotal evidence is conflicting
Numerous reporting high addiction rates whereas
others report less than classic opioids
Tolerance has been reported in South Asia amongst
chronic users, who then seek out and abuse more, with
withdrawal when stopped
o Sx of withdrawal: Irritability, dysphoria, nausea,
diarrhea and arthralgias
Mgmt. successful with dihydrocodeine
and lofexidine
o Caused Kratom to be outlawed
o Screening
Will not show up on most routine drug screenings test ex. Utox
Tests are available but not widely with no defined drug level
cut-off for positive testing