Mitragyna Speciosa - largely referred to as Kratom in English-speaking communities - is a tree grown primarily in Southeast Asia. It may be also known as biak-biak, ketum, kakuam, kraton, ithang, or thom in these indigenous regions.
It is in the coffee family (Rubiaceae) of flowering plants. Reports of medicinal kratom use in Southeast Asia go back as far as 1836 . Some of its traditional applications include treating infection, muscle pain, and the suppression of coughing and diarrhea .
Kratom generally comes in a powdered form. The leaves of the Mitragyna Speciosa trees are harvested, dried, and ground before being distributed and sold. Kratom extracts are also available. The most popular methods of ingestion include "toss-and-washing" (swallowing the powder with water), brewing the powder as a tea, or simply chewing the leaves.
Kratom contains over 25 alkaloids, which are largely responsible for its psychoactive effects . Two of these alkaloids - mitragynine and 7-hydroxyminitragynine - are thought to be agonists of the μ-opioid receptor. Activation of this receptor commonly results in sensations of pain relief, sedation, and euphoria . In animal studies, 7-HMG has been found to be nearly 13 times more potent than morphine .
When kratom is ingested, the outcome of effects may depend on factors such as the quantity, quality, strain, and user. In general, at lower dosages, the effect is thought to be more stimulating than sedating. At higher doses, the effects are thought to be more sedating than stimulating .
Kratom has garnered significant attention from those attempting to wean themselves off of opiates/opioids (or other drugs) because of its opioid-like behavior. In the past, medical researchers have concluded that "the therapeutic potential of Kratom ... deserves further study" . It has a sizeable and diverse user base worldwide, with many using it to treat anxiety, depression, pain, and fatigue.
Despite its efficacy and potential medical utility, kratom is widely misunderstood and under-researched. It remains illegal in many countries. In 2016, the United States Drug Enforcement Administration declared its intention to Schedule I kratom, making it illegal to sell, possess, or own. The DEA cited kratom as being "... an imminent hazard to public safety" and stated that it "... has no currently accepted medical use." However, due to the rallying of American kratom users, the DEA later withdrew this intent.
The usage of kratom is certainly not risk-free. Adverse long-term effects have been identified, and include anorexia, weight loss, hyperpigmentation, psychosis, constipation, insomnia, fatigue, and poor concentration .
However, in the US, all fifteen documented cases of death deemed "kratom-related" by the DEA were uncited and lacked transparent peer review. In the case of nine kratom-related deaths in Sweden, the presence of the kratom-borne alkaloid mitragynine was confirmed alongside O-desmethyltramadol (the active metabolite of tramadol) in autopsy reports . Because of its accessibility, kratom is often utilized as an ingredient to produce harmful street drugs, which are largely responsible for these deaths as well as their misattribution to kratom.
At this time, no evidence suggests that kratom is definitively toxic or lethal to the human body when used in moderation. More research is required to understand both the long-term and short-term risks of use. The medical literature is clear - there are risks, it's just question of understanding them better.