Kratom

Related Terms

7-Hydroxymitragynine, 9-O-demethyl paynantheine, 9-O-demethyl-16-carboxy paynantheine, 9-O-demethyl-17-carboxy-16,17-dihydro paynantheine, 9,17-O-bisdemethyl paynantheine, 9,17-O-bisdemethyl-16,17-dihydro paynantheine, 16-carboxy paynantheine, 17-O-demethyl paynantheine, 17-O-demethyl-16,17-dihydro paynantheine, 17-carboxy-16,17-dihydro paynantheine, biak, biak biak, isopaynantheine, ithang, kakuam, ketum, krathom, kratom, krypton, Mitragyna speciosa, Mitragyna speciosa Korth., mitraciliatine, mitragynine, mitraphylline, paynantheine, Rubiaceae (family), speciociliatine, speciogynine, thang, thom.
Combination product examples: Krypton (kratom, O-desmethyltramadol).
Note: The cultivation, sale, and possession of Mitragyna speciosa are illegal in some countries. Unintentional death has occurred following ingestion of krypton, a combination preparation containing Mitragyna speciosa and O-desmethyltramadol.

Background

Mitragyna speciosa is a tree found in Southeast Asia. It acts on the central nervous system, affects brain function, is known to have pain-relieving, mood-enhancing, and cough-reducing effects, and has been used as an opium substitute.
It is also called kratom and has been identified as an herb of recreational drug abuse. People who use it over the long term may develop an addiction and symptoms of withdrawal when they stop using it. Many countries and states have passed laws to make Mitragyna speciosa illegal, but people may still easily obtain it over the Internet. Unintentional death has occurred following use of krypton, a combination product containing Mitragyna speciosa and O-desmethyltramadol.
There is not enough evidence to support the medical use of Mitragyna speciosa.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (18 years and older)
Mitragyna speciosa is currently used as an herbal drug of abuse. The leaves of Mitragyna speciosa have been chewed, smoked, or made into a tea.
Growing, selling, and owning Mitragyna speciosa is illegal in some countries. Unintentional death has occurred after taking a combination preparation containing Mitragyna speciosa and O-desmethyltramadol.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs
Mitragyna speciosa may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions. People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Mitragyna speciosa may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan?) or diazepam (Valium?), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.
Mitragyna speciosa may also interact with agents that may affect the nervous system, agents that may affect the liver, agents that may promote urination, agents that may treat stomach disorders, caffeine-containing agents, cocaine, monoamine oxidase inhibitors (MAOIs), opioids, pain relievers, stimulants, thyroid hormones, weight loss agents, and yohimbine.

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Adkins, JE, Boyer, EW, and McCurdy, CR. Mitragyna speciosa, a psychoactive tree from Southeast Asia with opioid activity. Curr.Top.Med.Chem. 2011;11(9):1165-1175.
Arndt, T, Claussen, U, Gussregen, B, et al. Kratom alkaloids and O-desmethyltramadol in urine of a "Krypton" herbal mixture consumer. Forensic Sci.Int. 5-20-2011;208(1-3):47-52.
Holler, JM, Vorce, SP, McDonough-Bender, PC, et al. A drug toxicity death involving propylhexedrine and mitragynine. J.Anal.Toxicol. 2011;35(1):54-59.
Kapp, FG, Maurer, HH, Auwarter, V, et al. Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa). J.Med.Toxicol. 2011;7(3):227-231.
Kong, WM, Chik, Z, Ramachandra, M, et al. Evaluation of the effects of Mitragyna speciosa alkaloid extract on cytochrome P450 enzymes using a high throughput assay. Molecules. 2011;16(9):7344-7356.
Kronstrand, R, Roman, M, Thelander, G, et al. Unintentional fatal intoxications with mitragynine and O-desmethyltramadol from the herbal blend Krypton. J.Anal.Toxicol. 2011;35(4):242-247.
McWhirter, L and Morris, S. A case report of inpatient detoxification after kratom (Mitragyna speciosa) dependence. Eur.Addict.Res. 2010;16(4):229-231.
Philipp, AA, Meyer, MR, Wissenbach, DK, et al. Monitoring of kratom or Krypton intake in urine using GC-MS in clinical and forensic toxicology. Anal.Bioanal.Chem. 2011;400(1):127-135.
Philipp, AA, Wissenbach, DK, Weber, AA, et al. Metabolism studies of the Kratom alkaloids mitraciliatine and isopaynantheine, diastereomers of the main alkaloids mitragynine and paynantheine, in rat and human urine using liquid chromatography-linear ion trap-mass spectrometry. J.Chromatogr.B Analyt.Technol.Biomed.Life Sci. 5-1-2011;879(15-16):1049-1055.
Philipp, AA, Wissenbach, DK, Weber, AA, et al. Metabolism studies of the Kratom alkaloid speciociliatine, a diastereomer of the main alkaloid mitragynine, in rat and human urine using liquid chromatography-linear ion trap mass spectrometry. Anal.Bioanal.Chem. 2011;399(8):2747-2753.
Rosenbaum, CD, Carreiro, SP, and Babu, KM. Here today, gone tomorrow...and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J.Med.Toxicol. 2012;8(1):15-32.
Schmidt, MM, Sharma, A, Schifano, F, et al. "Legal highs" on the net-Evaluation of UK-based Websites, products and product information. Forensic Sci.Int. 3-20-2011;206(1-3):92-97.
Sheleg, SV and Collins, GB. A coincidence of addiction to "Kratom" and severe primary hypothyroidism. J.Addict.Med. 2011;5(4):300-301.
Vicknasingam, B, Narayanan, S, Beng, GT, et al. The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy. Int.J.Drug Policy 2010;21(4):283-288.
Ward, J, Rosenbaum, C, Hernon, C, et al. Herbal medicines for the management of opioid addiction: safe and effective alternatives to conventional pharmacotherapy? CNS.Drugs 12-1-2011;25(12):999-1007.