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What is kratom?
Kratom is a tree native to Southeast Asia (Thailand, Malaysia, Myanmar [Burma], and elsewhere). Its botanical name is Mitragyna speciosa. Kratom is in the same family as the coffee tree (Rubiaceae). The leaves of kratom have been used as an herbal drug from time immemorial by peoples of Southeast Asia. It is used in folk medicine as a stimulant (at low doses), sedative (at high doses), recreational drug, pain killer, medicine for diarrhea, and treatment for opiate addiction.

How is it taken?
In Thailand, kratom leaves are often chewed fresh (usually after removing the stringy central vein). Dried leaves can also be chewed, but since they are a bit tough, most people prefer to crush them up or powder them so that they can be swallowed. Powdered kratom is sometimes mixed with fruit juice or apple sauce. This partially masks the taste and allows it to be quickly swallowed. Dried kratom leaves are often made into a tea that is strained and then drunk (this is the most frequently used method in the West). Kratom can be smoked, but doing so has no advantage over chewing or making a tea from it. The amount of leaf that constitutes a typical dose is too much to be smoked easily. A paste-like extract can be prepared by lengthy boiling of fresh or dried leaves. This can be stored for later use. Small pellets of this extract can be swallowed, or it can be dissolved in hot water and consumed as a tea. Some people like to mix kratom tea with ordinary black tea, or other herbal teas, before it is consumed. This is done to make it more palatable.

What are the effects?
Kratom is a rather unique drug in that a low to moderate dose will usually (but not always) be stimulating, while a high dose is almost always quite sedating. This is apparently because the active alkaloids have both stimulant and sedative effects. Which predominates probably depends both on blood level and individual differences between users.

The stimulant level: At the stimulant level the mind is more alert, physical energy and sometimes sexual energy is increased, ability to do hard monotonous physical work may be improved, one is more talkative, friendly, and sociable. Some people find this level edgy rather than pleasant.

The sedative-euphoric-analgesic level: At this dosage you will be less sensitive to physical or emotional pain, feel and look calm, have a general feeling of comfortable pleasure, and may enter a pleasant dreamy reverie. You may experience some itching or sweating. Your pupils may be constricted (small). It is possible you may feel nauseated, but if you lie down and relax the nausea should quickly cease. You may find your appreciation of music is increased. It will be very pleasant to lie down on your back in a semi-darkened room, with eyes closed, and just listen to your favorite music. If you do this you may be fortunate enough to enter the delightful mixed-state of ‘waking-dreaming’ where you have one foot in dreamland and the other foot in the real world. This state was much prized by the 19th century Romantic writers, who, lacking knowledge of kratom, resorted to the much more habit-forming narcotic, opium, to achieve it. The effects of kratom usually last about six hours. The higher the dose, the stronger the effects, and the longer they last. Many people report a positive ‘afterglow’ the next day.

What are the risks? How safe is it?
When kratom is taken by itself (without mixing it with other drugs), the greatest risk is falling asleep while engaged in hazardous activities. NEVER drive while under the influence of kratom, even if you feel stimulated, rather than sleepy, for sleepiness may come on you without warning. Use common sense. Do not use power tools or climb ladders while under the influence of kratom. Be careful not to leave a pot on a lit stove and then fall asleep.

Pregnant women should not take any drug or medication except on medical advice. Since there have been no studies of the risks of kratom use by pregnant women, it is not known whether it could cause birth defects or fetal death. We strongly recommend that any woman who could possibly be pregnant NOT use kratom.

Is kratom habit forming?
Although a small number of people have become dependent on kratom (primarily in Thailand), kratom is not habit forming when it is used responsibly. If used occasionally as a recreational drug, rather than daily, there is virtually no risk of becoming dependent on it. But it is very important not to get into the habit of using it every day. For kratom, like many drugs [e.g. alcohol, coffee, tobacco, etc.] if used on a daily basis for a prolonged period of time, could become a habit hard to break. IT IS IMPORTANT NOT TO USE KRATOM EVERY DAY. Before starting to experiment with it set yourself usage guidelines. If you EVER find it is hard to stay within your usage guidelines immediately quit using kratom.

Are there any reported health problems?
Health problems are unlikely unless one is consuming large quantities of kratom every day. In Thailand, where there are some people who use kratom every day, those dependent on it can develop weight loss, dark pigmentation of the face, and have physical withdrawal symptoms if they quit abruptly. The withdrawal symptoms may include muscle aches, irritability, crying, runny nose, diarrhea, and muscle jerking. Health problems are unlikely to occur in occasional kratom users. Like any drug or medicine, people's reactions vary and some people could possibly have an allergic or other unusual reaction to kratom, even if they used it responsibly.

What is kratom's legal status?
Kratom is illegal in Australia, Malaysia, Myanmar (Burma), and Thailand (these countries impose sever penalties for possession of the herb). It is legal in most other countries, including the United States and all of Europe. Laws can and do change, so be sure that kratom is legal where you live before using it.

What are kratom's active constituents?
There are many closely-related tryptamine alkaloids in kratom. The most important ones are mitragynine and 7-hydroxymitragynine. These are primarily responsible for kratom’s pain relieving, sedative, euphoric, and stimulating effects. These alkaloids resemble yohimbine in structure, but do not have the same effects.

Mitragyna speciosa

 

Mitragyna speciosa (ketum, kratom or kratum, Thai: กระท่อม) is a tropical deciduous and evergreen tree in the coffee family (Rubiaceae) native to Southeast Asia in the Indochina and Malesia floristic regions. Its leaves are used for medicinal properties. It is psychoactive, and leaves are chewed to uplift mood and to treat health problems. M. speciosa is indigenous to Thailand and, despite growing naturally in the country, has been outlawed for 70 years and was originally banned because it was reducing the Thai government's tax revenue from opium distribution.

Kratom behaves as a μ-opioid receptor agonist like morphine and is used in the management of chronic pain, as well as recreationally. Kratom use is not detected by typical drug screening tests, but its metabolites can be detected by more specialized testing. The pharmacological effects of kratom on humans, including its efficacy and safety, are not well-studied.

Taxonomy and description

Young M. speciosa tree

It was first formally described by the Dutch colonial botanist Pieter Korthals. The genus was named Mitragyna 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 genera Corynanthe and Uncaria and shares some similar biochemistry.

Mitragyna speciosa trees usually grow to a height of 12–30 ft (3.7–9.1 m) tall and 15 ft (4.6 m) wide, although some species can reach 40–100 ft (12–30 m) in height. Mitragyna speciosa can be either evergreen or deciduous depending on the climate and environment in which it is grown. The stem is erect and branching. The leaves of the kratom tree are a dark green color and can grow to over 7 inches (180 mm) long and 4 inches (100 mm) wide, are ovate-acuminate in shape, and opposite in growth pattern. The flowers are yellow and round and tend to grow in clusters at the end of the branches. The leaves of M. speciosa are elliptic and are smaller at the end of the branchlets and are pointed at the tip. The leaves have a round and heart-shape at the base with the petioles between 2 to 4 centimeters long. The flowers are crowded in a round terminal inflorescences which are three to five centimeters long. The calyx-tube is short and cup-shaped, with round lobes. The corolla-tube is five millimeters long with three millimeter long lobes and smooth and revolute in between.

Chemistry

There are 40 compounds in M. speciosa leaves, including many alkaloids such as 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). Other active chemicals in M. speciosa include raubasine (best known from Rauwolfia serpentina) and some yohimbe alkaloids such as corynantheidine.

Mitragyna speciosa also contains at least one alkaloid (rhynchophylline) that is a calcium channel blocker, and reduces NMDA-induced current. The amount of mitragynine within the leaves depends highly on many factors, one major factor is the location of the tree. When trees are grown in Southeast Asia, the levels tend to be higher but when grown elsewhere (even in greenhouses) the levels tend to be low or non-existent. One analysis of products marketed as kratom leaf found, using liquid chromatography-electrospray ionization mass spectrometry (LC-ESI-MS), mitragynine at levels of 1–6% and 7-hydroxymirtrogynine at levels of 0.01–0.04%. The chemical structure of mitragynines incorporate the nucleus of the tryptamine, and these may be responsible for the molecules which are observed in the serotonin and adrenergic systems. In mitragynine, the phenolic methyl ether is considered to be stronger in analgesic paradigms according to some studies. Moreover, studies concerning the pharmacokinetics of M. speciosa in humans has not been well studied and various aspects such as the half-life, protein binding properties and other properties such as the elimination or metabolism is not known.

Use and Safety

Kratom leaves

Kratom has been traditionally chewed, in raw leaf form, by people in Thailand and especially in the southern peninsula. Kratom is also used in neighboring countries in Southeast Asia where it grows naturally. As traditionally used, kratom is not seen as a drug and there is no stigma associated with kratom use or discrimination against kratom eaters. In southern Thailand, kratom has been a part of traditional culture for thousands of years and is common in traditional cultural performances and in agriculture. In southern Thailand, kratom chewers generally start at around the age of 25 and many continue to chew the leaves for the rest of their lives. The average number of leaves consumed is between 10 and 60 leaves consumed daily, but even more than this is common. In southern Thailand, upwards of 70% of the male population uses kratom on a daily basis in some areas. Some users consume M. speciosa along with dextromethorphan-containing cough syrup, amphetamines, or benzodiazepines. Kratom has seen therapeutic use in Thai ethnomedicine as an antidiarrhoeal, as a treatment for opioid dependence, and rarely to increase the duration of coitus.

Kratom and its derivatives have been used as a substitute for opium as well as an aid for the management of opium withdrawal. Data on the incidence and prevalence of its use are lacking, as physicians are generally unfamiliar with it, and its use is not detected by typical drug screening tests. Kratom metabolites can be detected by specialized mass spectrometry tests. Incidence of kratom use appears to be increasing among those who have been self-managing chronic pain with opioids purchased without a prescription and are cycling (but not quitting) their use. As of 2011, there have been no formal clinical trials performed to study the efficacy or safety of kratom to treat opioid addiction.

The pharmacological effects of kratom on humans are not well studied. Its metabolic half-life, protein binding, and elimination characteristics are all unknown. Kratom behaves as a μ-opioid receptor agonist, similar to opiates like morphine, although its effects differ significantly from those of opiates. Kratom does not appear to have significant adverse effects, and in particular appears not to cause the hypoventilation typical of other opioids. Compulsive use has been reported among drug users who inject opioids, and those who use opioids to manage pain without direction from medical professionals.

Side effects associated with chronic kratom use include loss of appetite and weight loss, constipation, and darkening of the skin color of the face. Chronic use has been associated with bowel obstruction. Chronic users have also reported withdrawal symptoms including irritability, runny nose and diarrhea. Withdrawal is generally short-lived and mild, and it may be effectively treated with dihydrocodeine and lofexidine. Three case reports document deaths involving kratom. Other drugs were used in all cases, and in one, kratom was speculated to possibly be the primary cause of death. In 1975, there was an isolated report of serious adverse effects such as psychosis, convulsions, hallucinations, and confusion, among five individuals who had used kratom daily for 10–35 years.

Regulation

Thailand

Prohibition

Possession of kratom leaves is illegal in Thailand, despite the tree being native to the country. The Thai government passed the Kratom Act 2486 which went into effect on August 3, 1943. This law made 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. A large aspect of Thai culture supports kratom, however despite this fact the Thai government had initiated a program of destroying kratom trees by burning forests or chopping large sections of kratom forests down. Eradication campaigns often destroy not only the trees but also other trees and wildlife in these areas, which are often untouched rainforests with sensitive ecosystems. A general consensus exists in southern Thailand, where the use of kratom is endemic, among leaders, public health officials, academics and policymakers that kratom use and dependence causes little, if any, health risks.

Proposed decriminalization

In 2010, the Thai Office of the Narcotics Control Board proposed decriminalizing kratom and affirmed its use as an integral part of Thai culture. The ONCB concluded that decades of unproblematic use, and an absence of health and social harm, make prohibiting the leaf unnecessary and counterproductive. According to the ONCB's report, kratom was in fact banned for economic reasons, not for health or social concerns. In a snippet from a book written by Cassandra Hoffman:

"In Thailand, kratom was first scheduled for control in 1943 under the Kratom Act. At the time, the government was levying taxes from users and shops involved in the opium trade. Because of the increasing opium costs, many users were switching to kratom to manage their withdrawal symptoms. However, the launch of the Greater East Asia War in 1942 and declining revenues from the opium trade pushed the Thai government into action to curb and suppress competition in the opium market by making kratom illegal."

As of October 2, 2013 the justice ministry of Thailand suggested removal of Kratom from the narcotic drug list relating to Category 5 of the Narcotic Drug Law of 1979, though still recommended regulating kratom in other ways due to its effects on the nervous system. This recommendation will be made to the Ministry of Public Health, which can move forward with the removal from the list or not.

Malaysia

The use of kratom leaves (locally known as 'ketum') is prohibited in Malaysia under Section 30 (3) Poisons Act 1952 and the user may be penalized with a maximum compound of MYR 10,000 (USD 3,150) or up to 4 years imprisonment. Certain parties have urged the government to penalize the use of kratom under the Dangerous Drugs Act instead of the Poisons Act which will carry heavier penalties.

United States

Kratom itself is not regulated by the United States federal government. However, the Drug Enforcement Administration once included it in a list titled "Drugs and Chemicals of Concern".

Indiana House of Representatives HB1196, sponsored by Edward DeLaney, Steve Davisson, Terri Austin, Vernon G. Smith, and David Yarde during the 2012 regular session as a response to increasing synthetic drug use, made Indiana the first and only state to ban chemicals in kratom, although indirectly. The text of the bill added kratom's two active alkaloids—mitragynine and 7-hydroxymitragynine—to the state's list of controlled substances, though kratom itself is not synthetic and was not specifically addressed by the authors of the bill. Due to kratom not being on the banned plants list nor being a synthetic, kratom is still legal in Indiana.

Iowa legislators grouped Mitragyna speciosa as a synthetic cannabinoid when a bill was proposed that would reclassify nearly all controlled substances in their state. The Louisiana legislature proposed an age limit of 18 to be able to legally purchase, possess and consume kratom. Violators would have been assessed a penalty of no more than $500, or sentenced to six months in jail, or both. Massachusetts Representative Daniel K. Webster sponsored legislation in 2011 that would have included compounds of Mitragyna speciosa in the state's controlled substance classification list.

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