Kratom: Medicine or Menace to Society?

As of recently there has been quite an uproar in the community regarding this plant, native to Southeast Asia, which holds great promise in treating opioid use disorder as well as chronic pain when used properly. But, the cause for the uproar is quite paradoxical: it can cause dependence and is able to be abused itself, which is what leads some to think its best to do away with altogether despite its potential benefits!

I have been using kratom on and off for almost 20 years, and its really not such a terrible thing that it deserves to be banned. Most substances aren't to be totally straightforward. I even say that as someone who had become dependent on it at one point, and I have at times struggled to stay away. However, on should also consider the fact that kratom is probably the only reason I was able to stay away from drugs like fentanyl despite the fact that I have an opioid use disorder when forming an opinion on the matter. I have used the raw leaf, 7-HO-Mitragynine, and Mitragynine Pseudoindoxyl. Each have their own benefits as well as drawbacks, and all can lead to dependency issues. I, myself, found it a safe way to eliminate my cravings for the more dangerous opioids like oxycodone, hydrocodone, heroin, morphine, and even opium itself. Without it, I would never have even fathomed seeking treatment in a traditional way for opioid use disorder due to the stigma involved. But, after having spent a few years dependent on it, I realized I was essentially using it in the same manner that Suboxone is used. This is when I decided to transition over to Suboxone as it is a regulated drug, and there would be no risk of an outright ban as is being proposed for kratom at present. Even now though, as someone who is being treated for OUD, I sometimes wish I would have never gone this route because it will forever be on my medical record now.

It is a shame that I have to worry that I may not be able to get proper medication for pain should something major ever happen in my life requiring it such as surgery or injury, or even if my fibromyalgia gets so bad that I require it. I've been prescribed opioids in the past, and I have always taken LESS than prescribed, and I have never abused the medications given. I know that some people choose to abuse the system thus the reason doctors hesitate to prescribe opioids these days (especially to those who have OUD on their medical record), but as someone who has never abused the system I don't feel that my choosing to have my OUD treated with Suboxone should affect my quality of care. And, what is worse, is the fact that it doesn't just affect my care in terms of pain management. Having OUD on ones record can affect the person even just generally speaking as many doctors, even in this day and age, pass judgement on those who have or have had substance use disorders. And, this is why many turn to kratom; its about as effective as Suboxone in reducing opioid related cravings and withdrawal symptoms, and one does not end up with OUD on their medical record if they choose to use it to get off of street drugs such as fentanyl, nitazenes, or heroin. Some may also simply not believe in using pharmaceuticals to treat such things, and for them this is a viable alternative. In my case, it was a mix of both factors.

Now, let's consider the fact that kratom can be abused too of course. It can be used as a way to get "high" for some, but its not nearly as dangerous as drugs like fentanyl or oxycodone. Kratom's "alkaloids" (the things in the plant that cause the effect), similarly to buprenorphine (the active ingredient in Suboxone), is a "partial agonist". Partial agonists, in this case, attach to the body's mu opioid receptors to elicit an effect similar to "full agonists", but because they do not activate the receptor all the way they do not have near the same risk profile. Partial agonists can essentially be considered weaker forms of opioids. Another partial agonist you may be familiar with is tramadol, which is often prescribed for moderate-severe pain. It is more readily prescribed than things like oxycodone because of the fact that it doesn't have near the same habit forming effect, and it doesn't tend to result in deadly overdose either. Kratom, much the same, would require one to eat their entire body weight in plant matter and then some for the person to even come close to dying. That being said, the leaf itself is pretty benign in spite of the misinformation being spread in the media. Often times one will read about the deaths "caused" by kratom and related products, but in actuality the deaths were a result of poly drug abuse rather than kratom itself. There is not one single documented case of overdose or death caused by kratom or its various alkaloids.

The newer forms of this plant are 7-OH-Mitragynine and Mitragynine Pseudoindoxyl. 7-OH-Mitragynine is very potent, but is still a partial agonist of the mu opioid receptor. Mitragynine Pseduoindoxyl is even more potent yet, but still a partial agonist. And, these are the drugs the FDA is looking to control more so than the plant's leaves (however, the city of Toledo is trying to do away with it all). These are the drugs that people are forming severe dependencies on which are much worse than that produced by raw leaf. They are created semi-synthetically in labs (though 7-OH-Mitragynine exists in trace amounts in the leaf, and Mitragynine Pseudoindoxyl is a metabolite of the alkaloids found in the leaf), and they create a much more powerful "buzz" than raw leaf. So, then, are these substances so terrible that we should outlaw them?

The answer isn't quite so simple. The semi-synthetic forms of kratom are sometimes viewed as a more accurate way to measure ones dose which can be useful for someone trying to monitor their intake and/or taper off of the drug once they have transitioned from more dangerous drugs like fentanyl for example. But, if abused, they have a much higher potential for addiction. However, they also are practically impossible to overdose on just like kratom itself which is something worth noting too. So, while not inherently bad, they should be respected due to their potency and addictive potential. And, let's be real here, a lot of people don't respect these substances which is what has led us to where we are today with the FDA seeking to outright ban 7-OH-Mitragynine. Mitragynine Pseudoindoxyl isn't even on their radar yet, but you can bet that once 7-OH-Mitragynine is banned that it will go next.

Interestingly, the pharmaceutical companies are looking at semi-synthetic drugs designed after 7-OH-Mitragynine (as well as kratom's other major alkaloid, Mitragynine) for use in the treatment of chronic pain. And, there are talks about such drugs being used to treat opioid use disorder. Both 7-OH-Mitragynine and Mitragynine Pseudoindoxyl hold great promise because they are relatively non-toxic and yet are capable of alleviating cravings and withdrawal symptoms as well as pain. Something worth noting with Mitragynine Pseudoindoxyl too is the fact that users of it seem to report that it doesn't even cause a tolerance like other drugs which means the same dose can be effective for years unlike with other opioid drugs which require higher and higher doses the longer one takes them. This quality makes it ideal for those with chronic pain who end up having to take pain medicine for extended periods of time. But, getting back to the legal debate at hand, 7-OH-Mitragynine's proposed ban is on the premise that it holds no medicinal value whatsoever, and thus is the reason it is going to be placed into Schedule I (the most restrictive drug class according to the DEA; right alongside heroin). So, how does that make sense if what I am telling you is true? If it doesn't hold medicinal value, then why are the pharmaceutical companies designing and patenting other semi-synthetic drugs (such as MGM-15) designed to mimic it therapeutic? This, my friends, is where the "conspiracy" comes into play. Ever since 2016, when the first proposed kratom ban went public, the conspiracy theorists have claimed that the government's FDA advisor's ties to big pharma are what's driving these things more so than anything. And, honestly, it is a plausible theory! But, we can't prove that this is the case of course, so a theory it will remain.

The withdrawal from all forms of kratom is quite unpleasant, but none of them are deadly. I, like many others, feel the withdrawal is much nastier than that of opiates. However, many others claim they have no major withdrawal from it. So, it seems it is quite varied in terms of how it affects people. And, this is why its important to know your mind and body before you put anything into it. One should know the risk they are taking as well. This is why I have provided some links below for additional insights into these substances, as well as some links to give additional insights into the politics behind what is going on at present. The misinformation that is ever-present in the media is designed to sway people's opinion in favor of a ban, and the reason is because of the fact that the media profits more by creating headlines that demand attention. An article about a "deadly drug" that is "13x the potency of morphine" which is readily available on store shelves commands greater attention than one that explains honestly the truth of the matter. But, there are some media outlets that do better than others with regard to remaining truthful. One such instance I have made sure to list below so that readers can stay informed about the truth of the matter rather than feed into the hype. Question everything, even me! If you aren't sure about something, always do your own research. I have provided the links below for convenience, but if one so chooses to do some fact checking then so be it. You will ultimately find the same truth as self-evident upon doing so, and form this truth you may draw your own opinion on how the matter should best be handled. My personal stance is that people should be free to make their own decisions regarding what they put into their bodies as well as be properly informed as to the potential repercussions. Perhaps some additional regulations should be put into place regarding the more potent forms of kratom, but an outright ban is most likely just going to drive more people to the illicit drug markets based on statistical analysis of drug use patterns when other substances have become restricted which is entirely counterproductive in terms of harm reduction.

So, there you have it, this is what we have going on today. I hope that I have helped shed some light on the gist of it, but if you have any questions feel free to reach out as always!

The Truth About 7-OH, Kratom, and the Politics of Prohibition (LA Downtown News article exposing misinformation about 7-OH)
"Pharmaceutical Kratom" - Real Reason for Kratom Ban?
Keep Kratom Legal in Toledo - Change.org Petition
Residents, Toledo City Council Debate Potential Ban on Kratom Sales
Erowid Kratom Vault - Information about Kratom and its Use
Psyhconaut Wiki Entry on Kratom - In Depth Look at Kratom as a Drug