Is Kratom an Opioid?

Plant-based compounds have been used throughout human history, whether for pain relief or as part of religious ceremonies. Emerging from the shadows of the current opioid epidemic is kratom, a plant leaf extract used to manage chronic pain and fatigue in Southeast Asian countries for centuries and is believed to have a similar mechanism of action to opioids. 

Kratom’s use has garnered considerable attention in the U.S., and it’s now listed as a “medication of concern” by the U.S. Drug Enforcement Administration (DEA). Although kratom is allowed at the federal level, it’s prohibited in certain states. Additionally, the U.S. Food and Drug Administration (FDA) has imposed several restrictions on kratom, including import restrictions. Yet certain people who take kratom seem to highly recommend it, claiming that it has helped them manage their pain and opioid withdrawal. 

Natural plant compounds will undoubtedly continue to play an important role as sources of therapeutic agents. However, as of 2021, federal regulation will stay on hold as the debate over kratom continues. In addition, the FDA has issued warnings to companies that sell kratom in the United States or illegally market kratom as a herbal supplement to treat addiction, anxiety, pain, and other health conditions, as only FDA-approved medications are allowed to make such claims. As such, the future legal status of kratom is yet to be seen.

So is kratom an opioid? While kratom and opioids are two different substances, the FDA classifies kratom as an opioid. Before we go into the reasoning behind this classification, let’s take a closer look at kratom.

What Is Kratom?

Kratom is a tropical tree indigenous to Southeast Asia and certain parts of Africa, with a long history of medical and ceremonial use. Traditionally kratom was consumed in its natural form to reduce fatigue. However, various forms can now be found, including dried or crushed leaves, capsules, tablets, liquids, and resin. Kratom leaves induce stimulating effects at low doses and sedative effects at high doses.

In the United States, kratom is most typically sold as a dietary or nutritional supplement or under the radar in tobacco or head shops. And it is a substance that is fast becoming a popular alternative therapy and the substance of choice on the recreational market in the U.S.

How Does Kratom Work?

The two main compounds in kratom leaves (mitragynine and 7-α-hydroxy mitragynine) interact with opioid receptors in the brain. As a result, these chemicals generate sedative effects when consumed in large doses and stimulating effects in lower doses. Doctors believe that kratom binds to the same regions of the nerve cell as opioid medicines, thus causing similar effects in the brain. However, there are still insufficient clinical trials and studies to understand the long-term health implications and precise function of kratom. 

According to the National Center for Biotechnology Information (NCBI), the compound 7-hydroxy mitragynine is about 13 times stronger than morphine. As a result, these compounds cross the blood-brain barrier at a much faster rate. There are currently 25 compounds identified in kratom, and one such compound contributes to the psychoactive effects of kratom. 

Kratom Effects  

Kratom in low doses can induce increased energy, sociability, and alertness. However, according to the National Institute on Drug Abuse (NIDA), kratom can also cause uncomfortable mental and physical health effects such as:

• Constipation 
• Itching 
• Sweating 
• Dry mouth
• Nausea 
• Increased urination
• Loss of appetite
• Seizures 
• Hallucinations 

Additionally, kratom can also cause “intoxication,” similar to the effects of opioid misuse. The interaction of kratom with opioid receptors in the brain is compared to how morphine interacts with the brain. Opioid medications attach to opioid receptors, causing a rush of neurotransmitters, or chemical messengers, in the brain, which helps regulate mood and influence decision-making. When the levels of these neurotransmitters in the brain are elevated, it helps improve mood. 

The symptoms of kratom misuse are comparable to opioid misuse. In addition, kratom misuse can also result in psychosis (a mental disorder in which one’s thoughts and emotions are so out of control that one loses touch with reality).

The Legality of Kratom in the United States 

In August 2016, the DEA attempted to designate kratom as a Schedule I medication (a medication or substance with a high potential for misuse or addiction with no FDA-approved medicinal purpose). This attempt was due to the adverse side effects and dependence caused by kratom. However, due to public backlash; it remains legal in America except for the following states:

• Arkansas
• Alabama
• Indiana
• Rhode Island
• Wisconsin
• Vermont 
• The District of Columbia

Although kratom isn’t illegal, there are restrictions imposed. At the moment, kratom cannot be lawfully advertised as an effective treatment for any medical condition.

In recent years, there has been substantial debate in the U.S. concerning the safety of kratom use. Although it’s not currently categorized as a controlled substance under the Controlled Substances Act, the DEA categorizes kratom as a “medication of concern.”

Is Kratom a Safe Substitute For Opioids?

Kratom is essentially a medicinal plant with opioid properties. Although kratom is not chemically identical to opioids, the two chemicals of kratom (mitragynine and 7-α-hydroxy mitragynine) interact with opioid receptors in the brain. This interaction is the reasoning as to why the FDA classified kratom as an opioid. While kratom generates opioid-like effects such as pain relief, drowsiness, and intoxication, it also possesses the risk of tolerance, dependence, and addiction. 

There is currently insufficient evidence to verify or disprove that kratom use is safe. However, there are indications that kratom products are highly likely to be tainted with other substances that aren’t safe in and of themselves. In addition, product information like recommended dose is, at best, somewhat hazy. While it’s clear that low dosages have a stimulant effect on the user and high doses have a sedative impact, long-term use can cause withdrawal symptoms and side effects similar to opioids.

As with most opioids and recreational substances, it’s possible to overdose on kratom. The treatment for kratom overdose is the same as that of opioid overdose with similar complications. And more clinical trials are required to better define its benefits, if any, as a therapeutic medication. Therefore, individuals who self-medicate with kratom should be aware of the risks associated with its consumption. Especially those who have developed a tolerance to opioids or kratom, as they are more prone to experience an accidental overdose. 

However, kratom does show some potential as a medication for opioid use disorder (MOUD), like methadone or buprenorphine. But since it has not been studied thoroughly, this claim is not clinically confirmed. 

Why Is Kratom Popular

At present, methadone, buprenorphine, and naltrexone are the only FDA-approved medications for treating opioid use disorder. Even though the FDA has outlawed the use of kratom as a dietary supplement, it’s still freely available and far cheaper than buprenorphine. However, it’s vital to note that there is no evidence to demonstrate kratom as a safe alternative for opioid use disorder at this time.

The first indications of kratom being used to treat OUD date back to 1836. Reported benefits include analgesic, anti-inflammatory, and antipyretic effects. Recreational use of kratom has grown extensively across Europe and the United States because of easy access via the internet and because kratom’s main alkaloid component, “mitragynine,” is not yet classified as a controlled substance (unlike its derivative 7-α-hydroxy mitragynine, which is a controlled substance in several countries outside the United States).

Given the widespread kratom use and its popularity on social media, practitioners must be educated and contribute to clinical evidence. At the same time, health care providers and consumers are encouraged to report any adverse outcomes to the FDA MedWatch program while the FDA continues to examine the potential for misuse and effects of kratom. 

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