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While there are no shortage of "vicious lies" in law enforcement and media circles about Mitragyna speciosa, better known as kratom, unfortunately the header is referring to "dangerous rumors" within the kratom community itself. There's a glaring tendency in the online kratom world to focus exclusively on the plant's benefits while downplaying or even lying about its downsides as if it has none. Remind you of anyone? Potheads, perhaps? Lushes? Proponents of vaping, anabolic steroid use... veganism? {Shudders}
I'd like to address why this is a bad--and potentially deadly--idea, both for the well-being of potential new users as well as the continued legality of kratom itself. Gather 'round & lend me your ears, cherubs. It's time to spill the tea on everyone's fave, uhh, tea. 🍵
First, The Good
Yes, kratom is technically related to coffee (both are members of the Rubiaceae family) & has been "used for hundreds of years"--since at least the 1929 and 1934 reports of Marcan to the government of Siam that opined that the kratom habit "did not have the bad reputation associated with opium smoking." It was traditionally used in its native Indonesia & Thailand to increase stamina & relieve pain in exhausted farm workers & also grows naturally in Papua New Guinea, Malaysia & the Philippines where it's never been known to cause outbreaks of addiction or illness. More on this later.
And true, kratom does NOT cause respiratory depression even at high doses, which makes it far safer than any other synthetic opioid or naturally-occurring opiate in terms of overdose risk. Because it's cheap, legal & abundant and for the other reasons listed above, it can be a great option for tapering down from harder drugs or staving off severe withdrawals in addicts waiting for their next fix. Many pain patients & people with mental illnesses like PTSD & depression have found it helpful for managing those conditions as well. Unlike methadone or Suboxone, kratom withdrawals do not generally last months and you do not have to attend a clinic to obtain it which can make it highly convenient in a pinch. Kratom is perhaps the only naturally-occurring opioid agonist/antagonist that both stimulates opioid receptors AND blocks them, making it uniquely useful in treating addiction to more potent, dangerous opioids.
But when it comes to addiction & withdrawal? It's time to get real & stop lying to unwitting users: Kratom is every bit as hard to quit as equipotent opioids for most people.
The Bad: Kratom Addiction & Withdrawal
Kratom is believed to be both an opioid agonist & antagonist comparable to to Suboxone (buprenorphine + naloxone). This gives it both desirable painkilling/euphoric effects as well as some opioid-blocking effects, plus a ceiling on the desirable effects. This "ceiling" means that increasing the dose beyond a certain point does not result in increasingly pleasant effects as it would with morphine, oxycodone or Dilaudid (for instance). It also precludes respiratory depression: something chemists have been searching for since time immemorial. An opioid painkiller that doesn't stop your breathing? Sign us up!
Indeed, kratom is something of a holy grail in the pharmaceutical world for this reason which explains the rush to ban the whole plant & patent its active alkaloids. (I was not aware just how far back in time the patents went or how extensive they were, covering everything from kratom alkaloids to extraction methods & combination products). The financial potential of mitragynine & other kratom alkaloids is as limitless as its possible medical applications, which may include treating alcoholism, opioid addiction, pain, depression & other mental/physical ailments.
Despite this, kratom has no such ceiling in terms of withdrawal potential. Most habitual kratom users find that symptoms are of the same severity & duration as a heavy codeine habit or a moderate hydro- or oxycodone addiction. I can attest to this: in a blind test I wouldn't be able to tell the difference between codeine, kratom or hydro/oxycodone withdrawal. Thankfully I've never been one to vomit or have severe physical withdrawal symptoms regardless of dose or drug, but I'm the exception rather than the rule. Typical kratom withdrawal symptoms include: cold sweats, nausea, diarrhea, joint/muscle pain, nightmares, anxiety/depression, restless legs & runny nose/eyes. These acute symptoms typically last about a week but post-acute withdrawal symptoms like low mood, fatigue, cravings & apathy can drag on for a month or longer in a minority of users.
Tolerance to kratom's positive effects also builds over time, requiring the user to increase the dose to achieve the same effects (and due to the aforementioned "ceiling," higher doses don't necessarily = stronger or better effects even in the short-term). This can get expensive & may cause painful issues like gastritis or ulcers in unlucky users due to the sheer amount of powder ingested.
Which brings me to my next point: It's rarely mentioned that Indonesians did not traditionally use kratom the way we do in the West, grinding it into a fine powder and swallowing large quantities in capsules or along with the "tea". This concept is as foreign to them as eating coffee grounds in our morning cup of Joe would be to us. They merely chewed the whole leaves to achieve their buzz. And they CERTAINLY didn't ingest kratom "extracts" or "enhanced blends" like the kind that have been linked to a handful of kratom fatalities in the West. Clearly the way we do it is more extreme & prone to negative outcomes.
The Ugly: Additional Health Risks
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| Severe cholestatic liver injury caused by kratom |
Lying to people about the downsides of any substance can only lead to trouble... and ALL substances from water & chocolate to crack & fentanyl have downsides. It makes no difference that kratom is "natural" or not technically an opiate derived from the poppy--it attaches to mu-opioid receptors throughout the body which means it causes many of the same effects including withdrawal symptoms upon cessation. And because of its unique pharmacology, it comes with some additional risks not seen with classic opiates/opioids. This section will explore some of those.
While not quite as risky as tramadol or Demerol, kratom does have minor serotonergic activity and thus comes with a small risk of Serotonin Syndrome. There have been cases reported in some users of other serotonergic drugs like SNRIs and 5-HTP. Thus, combining it with multiple serotonergic substances like psychedelics, MDMA and other opioids could tip the scales into seizure or Serotonin Syndrome territory in those prone to it. How do you know if you're "prone to it"? You often don't until it happens & by then it's too late. Serotonin Syndrome can range in severity from "uncomfortable/barely perceptible" to "deadly." And it's a terrible way to go.
And then there's Drug-Induced Liver Damage (DILI for short), which has happened seemingly at random to otherwise young, healthy kratom consumers. If you're a heavy alcohol drinker, have liver disease or take Tylenol/other hepatotoxic drugs regularly, your risk is probably higher than average, though we don't know that for sure. In the rare kratom liver damage cases that exist, it wasn't known exactly WHAT triggered the damage, which is a lot like those kava-induced liver failure cases. (Mostly) healthy young people, most of whom had no prior liver issues just developed stabbing abdominal pains & abnormal enzyme levels or other signs of liver trouble that faded upon cessation of kratom. Nobody really knows why.
The lack of quality control & hygiene at the point of harvest/packaging is a concern that can't be overlooked when it comes to liver damage or other general health risks. Salmonella & other pathogens could easily make their way into the final product which is true with any dietary supplement that's not FDA regulated. In fact, a multi-state salmonella outbreak (2018) has been linked to kratom, though it's generally believed the FDA caused undue panic about the risk to justify a pending ban at the time. Still, that doesn't mean such a thing couldn't happen again for REAL & have deadly consequences. If conditions at kratom farms are even 1/10th as bad as they've been described, it's a miracle there hasn't been a massive outbreak of food-borne illness in kratom users. I'll go on record & say I predict that eventually we'll see deadly E. coli or something even worse turn up in commercial kratom products if something drastic doesn't change. We've been very fortunate so far. That's to say nothing of possible cumulative exposures to toxic heavy metals, endocrine disruptors like dioxins & PCBs, pesticides or other dangerous residues in the soil/air where the trees are grown.
The Importance of "Keeping It Real"
Does this mean I support banning kratom or allowing the prohibitionist government to "regulate" (read: schedule) it so pharma companies, doctors & private insurers can get rich prescribing its active components to us? Quite the opposite. I just think KNOW it's harmful to downplay the risks to young people & others seeking honest info about the drug. I know because I've seen it play out so many damn times in my life & we never seem to learn.
What happens when unsuspecting people start using a substance thinking it's no more harmful than pot or wine coolers and get stuck between a rock and a hard place, requiring massive amounts to avoid agonizing withdrawal symptoms? They blame the drug, loudly denounce it and throw the baby out with the bathwater, rallying for its scheduling or prohibition. In worst case scenarios, they combine it with other (much more dangerous) substances, get behind the wheel of a car & crash, leaving only their loved ones behind to go on this crusade. Or they overdose due to the same deadly mix of substances. Or commit suicide.
And sadly, the facts about how they died often follow them to the grave: it doesn't matter that kratom didn't directly or solely cause the death--it's the exotic, legal and "scary" drug in the mix, so the media and parents focus on it to the exclusion of the booze, Rx pills and other drugs present in their system at autopsy. (Not to mention any mental or physical health conditions that might've contributed). Now all parents & concerned citizens are on high alert & have their pitchforks out. This is how unconstitutional bans happen.
The more that people know about the positive AND negative aspects of a drug before trying it, the better equipped they'll be to make an informed decision about whether and how to use it. As kratom advocates & proponents of sane drug policy, it's our responsibility to be honest about all sides of the plant because we could well be providing the only practical drug education people get. Obviously this is unacceptable in a so-called "free," allegedly "developed" nation, but so it goes with prohibition. Facts are the 1st casualty in any war and the drug war is no exception.
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| From a ridiculous article entitled "My Gas Station, My Drug Dealer" |
The fact that kratom is being sold in weed dispensaries, corner stores & supplement shops gives it an air of harmlessness, and ANYONE regardless of age can buy it due to its current legal status in most states. Even as a kratom advocate & long-term user I cannot condone this. Kratom is not pot--it's a partial opioid agonist with very real addictive potential. Playing up its "herbal" or "natural" qualities & "traditional" use to paint it as a benign medicinal supplement on par with ginseng or Echinacea is incredibly misleading bordering on negligent. Plenty of "natural" plants/herbs will kill your ass or make you wish you were dead, some of which include death cap mushrooms, scopolamine, oleander, opium poppy (Papaver somniferum), black henbane & castor bean, aka the plant that produces ricin. Natural ≠ safe.
While it can be GREAT for addicts and people with severe chronic pain or certain mental illnesses, kratom is not great as a recreational drug for kids or healthy people just looking to unwind or party on a Friday night. Those who use it for that purpose are as likely to end up addicted as if they'd chosen codeine cough syrup, Xanax, Soma or tramadol. Again, we can thank drug prohibition & our bizarre DSHEA supplement laws for this backward policy of allowing drugs like kratom, Spice & bath salts to be openly peddled to kids & others while locking those same users up for attempting to access less risky ones.
And that's why it's so vital that accurate info about drugs is accessible to everyone: nobody's got our back but us.
Here are some tips to keep in mind when discussing drugs like kratom:
- Remember that everyone is not you. Drugs affect people wildly differently--some folks have severe mental/neurological illnesses, some are underage and reckless, some take multiple medications that will interact with recreational drugs poorly. Others simply do not react to substances the way we do or have paradoxical reactions. Universalizing your experience is the biggest rookie mistake you can make in the drug discussion/harm reduction arena, particularly when attempting to downplay the risks of a substance. There are certain drugs I love and have never had a single negative experience with but I always include disclaimers & warnings because it's the responsible thing to do.
- It's ALWAYS better to be cautious than cavalier & to consider worst-case scenarios. If everything goes fine, nothing is lost. But if they have a bad trip and end up dead or addicted, a life has been ruined/lost and your favorite substance is that much closer to being banned. Your little online blurb might be the only piece of advice a kid gets about a drug before trying it, and it'd be a tragedy if they were misled into a long-term addiction or even death by an overly positive report... even if that IS your honest experience. (See previous bulletpoint for why your subjective experience is not necessarily relevant).
- Too many unknown variables. Side effects, interactions & complications are all too real. Factors like dosage, body weight and set/setting all influence the outcome and you have no way of predicting how a drug experience will go based on the tiny amount of info they've posted on an online forum or chat. Also: people LIE and miscalculate things all the time. Assume you don't have all the info & act accordingly.
- Common sense isn't all that common. Humans have a tendency to seek out information that affirms our biases & ignore that which goes against our beliefs, so it becomes extra important to pipe up about any negatives or downsides of drugs when a new user is seeking firsthand advice from veteran psychonauts. This is where you come in, oh wise one.
- Provide credible sources for your claims. While it's ultimately up to the individual to make good choices, harm reduction education is always needed to steer people in the right direction and our government is asleep at the switch. Therefore the more credible links & sources you can provide to back up your claims, the better. What counts as "credible" in this instance? Just as you wouldn't cite a drug rehab center with tons of pharmaceutical ads on their site because they have a vested interest in vilifying kratom, you should be VERY wary of citing the AKA, BEA or other pro-kratom groups for the same reason. Rely instead on sources with no political or financial agenda that focus on the pharmacological effects of the drug. These tend to be dry, boring & use big clinical-sounding words rather than sensational headlines & dramatic photos of addicts screaming into the void with pills scattered all over the floor. Or whatever.
Bottom line: If you care about your fellow human and the future of kratom & other currently legal drugs, you'll be mindful to include both the good and bad when answering questions and discussing these substances. That doesn't mean you should downplay the positives or spread fear-based propaganda, it just means you should strive to be as unbiased as possible so as not to mislead anyone. Consider your audience & save the kratom advocacy for the political arena where it is MUCH needed! ✊🏼🍃
--- Signed,
Responsible Kratom User/Advocate Since 2016
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