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Mitragyna speciosa
Active Principles: A variety of indole and oxyindole alkaloids, most notably mitragynine.

History

The Kratom tree is native to Thailand, and its leaves have been used by peasants there since time out of mind. These people primarily use kratom because it motivates them and makes long hours of tedious work in the fields seem worthwhile and interesting. Scientific studies regarding the use of kratom by these villagers and peasants tend to contradict each other, so it is hard to be sure of the nature of their relationship with kratom; some studies claim that the majority of the users are addicted, while others claim to have found no significant risk of addiction.

At any rate, the users of kratom are much more motivated to work than those who do not use it. Interestingly, the average kratom user is older, with studies indicating that most users start using kratom in their 30's or 40's. This would indicate that the users are probably looking for something to replace the faded energy of their youth, and one can hardly condemn them for finding a replacement that works for them.

But condemn them is exactly what the Thai government did, passing the Kratom Act 2486 in 1943. With the passing of this law, it became illegal to plant kratom trees, and existing trees were to be cut down. However, since the kratom tree is native to Thailand, this law was not very effective. Today, the Thai government considers kratom to be in the same class as cocaine and heroin. The possesion of an ounce of extract is punishable by death. As a result, kratom use and research has migrated out of Thailand, and it can now be purchased readily over the internet.

Modern Use

Modern users of kratom come from all over the world, and cover pretty much every major demographic. There are three main effects which may be sought by users of kratom:

Motivation/Stimulation: This is the effect which is sought traditionally by Thai eaters of the plant. It is achieved by consuming a relatively small amount of pant matter and seems to occur more frequently when the leaves are either smoked or chewed. The state of energetic motivation has been compared to methamphetamine, although there seems to be no debilitating crash associated with kratom.

Opiate-like Effects: The most common contemporary use of kratom is to drink a tea made from 3 to 12 grams of leaf as a means of achieving effects very simlar to the classic opiate experience. Some users mix red poppy, blue lotus, or sinicuichi into the tea to enhance the experience. In this way, some people have been able to achieve an opiate-like waking dream experience, in which they see dream images while they reamin awake.

Opiate Addiction Treatment: Ironically, although it is used by some as an opium substitute, kratom is one of the most effective cures for opiate addiction know to man. This is probably because the primary active principle, mitragynine, acts on many of the same receptors that opiates do. One has to be careful when using kratom for this purpose, however, as too large a dose of kratom will cause crossover to the mu receptor, which will perpetuate the addiction rather than allay it.

Methods of Consumption

Kratom can be ingested in a variety of ways:

Teas and liquid ethanolic extracts: Anywhere from 3 to 12 grams of leaf can be brewed into a tea. Usually the leaves are steeped in a pot of boiling water, then the resulting liquid is boiled down until there is only about a cup of liquid remaining, and this is drunk. This method is very simple, but since mitragynine is only slightly soluble in water, some people have begun steeping the leaves overnight in an mixture of water and alcohol, then boiling this down (at a low temperature so as not to ignite the alcohol), and drinking it. Red poppy or sinicuichi are often added to the tea or drunk seperately to mellow the experience, making it less manic and more euphoric.

Smoking: A pinch or two of kratom smoked in a tobacco pipe has effects similar to a kratom tea, although it tends more towards the energetic and motivated experience. Some people utilize the energy for a while, and the drink a cup of red poppy tea when they are ready for the experience ot become more mellow and opiate-like.

Chewing or Quidding: This is the manner in which Thai natives consumed the plant. Dosage for quidding is about the same as for making a tea. Due to concerns over the cleanliness of leaves imported from eastern Asia, as well as the possibility of bacteria, most people who use this method prefer to first boil a tea from the leaves before chewing them. This serves not only to sanitze the leaves, but also make them more palatable by extracting some of the flavor.

Resin eating: The least common method of kratom consumption is to extract the resin from the leaves and eat it. This method is mostly for those who cannot stomach the taste of kratom tea. To extract the resin, begin as though you were making a tea (preferably using a solution of water and alcohol), but rather than boiling the liquid down until only a cup remains, keep boiling it until there is just a sticky blackish residue. This can be scraped up, rolled into a ball, and eaten. To make it easier on youself, you may want to boil the liquid down in a pyrex dish.

Notes on Responsible Use

First and foremost, because there is the potential for addiction, one has to be careful in the use of this plant. If you plan on using larger doses, require yourself to allow at least two days between uses. With smaller doses there is no chance of physical habituation, but this does not necessarily mean that you should use kratom on a daily basis. Be aware of your personal potential for psychological addiction, and most importantly, use common sense. As with all psychoactives, do not drive or operate heavy machinery under the influence of kratom.

Kratom is a rare gem, a psychoactive substance which can be used readily for pleasure or personal growth, but still remains legal throughout the world (with the exception of in Thailand, Myanmar, and Australia). Please help keep it this way.

Sources:
http://www.erowid.org
http://www.entheology.org
http://groups.yahoo.com/group/kratom/
The Merck Index

This has been a nodeshell rescue

"Kratom is a rare gem, a psychoactive substance which can be used readily for pleasure or personal growth, but still remains legal throughout the world (with the exception of in Thailand, Myanmar, and Australia). Please help keep it this way."

Sounds too good to be true, doesn't it? Do you feel a little bit suspicious? Ding ding ding, you win! It's too good to be true!

Ok, hello, so if it works at the opioid receptor as an agonist, then you are NOT surprised that it is 1. sedating 2. acts like an opiate 3. is addictive. 4. causes GI problems and constipation. An agonist is a key that fits in the lock (the opiate receptor) and turns it (has opiate effects). An antagonist fits in the lock and blocks it. Nalaxone is an antagonist. Buprenorphine is a partial agonist/antagonist -- at higher doses it blocks and there is no additional opioid effect.

Now, why aren't there any SE Asian wonderful plants that are being sold that are antagonists? Like narcan or nalaxone. That is, they block the receptor. They could be sold to reverse overdoses and save lives. Somehow I don't think it will sell, do you?

Kratom is currently a 250 billion dollar industry. The DEA made it a schedule one drug in 2016 but the backlash from the American Kratom Association and Congresspeople made the DEA back down after two months. At this point the DEA is seizing kratom and asking for volunteer recalls because of a salmonella outbreak involving 36 states. Kratom is still legal but the DEA came out this year saying that it does work as an opioid. There have been a number of deaths as well as addicted newborns that require a morphine withdrawal schedule. Kratom is sold over the counter and on the internet and unfortunately the amount of opioid effect is variable and not controlled. A gram of kratom is approximately equivalent to 2 grams of morphine.

Kratom is touted on the internet as helpful for pain and for getting off opioids. Unfortunately people are trading one addictive drug for another and for a not well controlled drug. We don't know what the hell it will do long term or side effects or drug interactions. Overdose and death are still risks, especially if combined with other sedating substances: alcohol, soma, barbituates, benzodiazepines, sleep medicines, and illegal drugs.

Go ahead, you've always dreamed of being a guinea pig.

I have one patient who has self weaned from oxycodone to kratom. The person (P) used a jeweler's scale, in grains. We did clinic math to get from grains to grams to morphine dose equivalents. Interestingly P got it right. P's dose of kratom is a bit more than the oxycodone in morphine dose equivalents. It's legal, so I said my concerns are that it may not stay legal, we don't know the side effects or if it's toxic, there's a huge recall going on because it's been contaminated with salmonella and the usual You Could Die. P has gut problems already, so it's guinea pig home science, and I expressed large concern that P would up the dose. Follow up is soon.

Now I am adding kratom to my warning to patients and testing for it more. Another patient (P2) disappeared for a couple months. No show for chronic pain visit for oxycodone, morphine dose equivalent at 75 mg daily. P2 would definitely go through withdrawal. Various emergency room notes filled me in a bit and then I saw P2 with fever and problems. I refused to add oxycodone to it and sent out the urine. P2 did not look like P2 was in withdrawal. I was suspicious and yes, kratom in the send out urine. My clinic dipstick doesn't test for it. Yes, it's legal. BUT that does not mean safe nor can I safely prescribe oxycodone with it. So, I notified the specialist (GI again) and sent P2 a letter (phone often does not work in chronic pain and addiction folks) and now have to revise my chronic pain medicine contract and my opioid overuse contract. No kratom, no spice, no supplements without discussing with me first, I can't prescribe safely if you are on these substances. Damn it. Oh, made by "pure encapsulations" so you KNOW it's safe? Snort. I have had at least five patients taking kratom so that's the tip of the iceberg. Time to send out urines on all chronic pain and all addiction patients on controlled substances. But you say, it's legal. Right. So is alcohol. I do test people and offer them inpatient if they are drinking or using meth or using cocaine or what-the-hell ever with their opioids. Got benzodiazepines from their behavioral health person that I don't know that they are seeing and so the risk of overdose rises by 20 times. First do no harm and I do take that seriously.

Don't be a guinea pig. Warn your kids and friends. Have a nice day.

salmonella outbreak: https://www.fda.gov/food/recallsoutbreaksemergencies/outbreaks/ucm597265.htm
maternal newborn kratom withdrawal: http://www.cfp.ca/content/cfp/64/2/121.full.pdf

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