Kratom: Is It a Safe and Legal Substance?

Introduction

Kratom is a tree indigenous to South East Asia, with leaves containing the psychoactive alkaloids mitragynine and 7-Hydroxymitrogynine.
It has a long tradition of use by farmers and other manual workers in its native region, who claim it increases productivity.
In recent years, the leaves of this plant (usually prepared as a tea) have been gaining popularity internationally, especially in the US.
Whilst not under international control (as is often the case with ethnobotanical psychoactives) its legality varies between regions and countries.
Little is known about extent of use in Europe, particularly in countries where it is illegal such as the UK, having been controlled under the Psychoactive Substances Act since 2016.

What is Kratom?

Mitragyna speciosa (commonly known as kratom, an herbal leaf from a tree of the Rubiaceae family) is a tropical evergreen tree in the coffee family native to Southeast Asia.
It is indigenous to Thailand, Indonesia, Malaysia, Myanmar, and Papua New Guinea, where it has been used in herbal medicine since at least the 19th century.
It has also historically been used for chewing, smoking, and tea.
Kratom has opiate properties and some stimulant-like effects.
There several types of Kratom, characterised by different colour ‘veins’ in the leaves and sometimes different growing regions, which are said to have impact the plant’s primary indications.
Differences in preference for particular types of kratom are not yet well understood.
Laboratory analysis has so far detected no significant difference in the major alkaloids in the resulting plant matter, and the plants which produce the different colour veins are not separate ‘strains’ of kratom in the true botanical sense.
It is possible that asides from these two well-known alkaloids, there are other compounds within the plant which also produce an effect, either alone or in combination, which may account for these subjective differences.
Street names for kratom include ‘thang’, ‘kakuam’, ‘thom’, ‘ketum’ and ‘biak’.
Kratom is consumed orally.
It is usually sold as a dried greenish powder, which can be swallowed neat, chewed, or prepared as a tea or cold beverage.
Less frequently, it is sold in capsule or concentrated extract form.
A detailed outline of Kratom, its chemistry, physical form, pharmacology, origin, and mode of use etc. can be found on the European Monitoring Centre for Drugs and Drug Addiction website.

How Does Kratom Affect the Body and Brain?

Kratom contains over 40 different alkaloids, plus a number of other compounds.
The two which attract the most attention are mitragynine and 7-hydroxymitragynine; alkaloids which act as partial agonists on the opioid receptors, meaning they produce somewhat similar, but milder, effects to opioid-based medications.
This is partly due to the low concentrations of psychoactive compounds within the plant matter (usually 1-1.5%) meaning relatively large amounts of kratom needs to be consumed before a noticeable psychoactive effect occurs.
Bodily effects maybe noticeable at slightly lower doses; some users report the principle (or only) effect as being an absence of fatigue or pain.
Interestingly, mitragynine also has a broad affinity with many other receptors in the body, potentially explaining its complex effect on energy and mood.

What are the Effects of Kratom?

There is evidence that in smaller quantities, kratom can produce a mild stimulatory effect, hence its traditional use as a aid with hard, physical labour.
These stimulatory effects are not generally considered intense enough to attract the interest of those who use ‘party’ or ‘club’ drugs such as amphetamines.
In larger doses, it may have an analgesic quality, and also possess sedating and muscle-relaxing effects.

As Kratom is sold in unregulated and varied mixtures with other phytochemicals, uncertainty remains on its effects and noxious levels. Difficulty testing for its use poses additional challenges in managing treatment. It makes it a potential drug of choice for people on court ordered urine drug tests. Case reports of overdose and deaths highlight the risk this 100% Organic product poses to life and wellbeing. (Dr. Cosmina Cross & Dr. Nicola Herod, 2023).

Does Kratom Have Any Medical Uses?

Kratom is not widely used for recreational purposes, it is more commonly used for self-medication.
Emerging data suggests that outside of its traditional context, kratom is more frequently used in an attempt to address chronic pain, sleeplessness, and/or to support opioid addiction withdrawal and recovery.
More research is needed to scientifically assess its potential therapeutic applications, but the anecdotal evidence for these effects is strong.

Who Uses Kratom?

An estimated 1.7 million Americans aged 12 and older used kratom in 2021, according to the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health.

What are the Risks of Taking Kratom?

Kratom is less likely to cause harm to health than many other illicit drugs and prescription medications, particularly those from the opioid family, of which it mimics some effects.
None the less, there some side-effects of kratom. Similar to opioids, it can produce agitation, tachycardia, constipation, vomiting and nausea.
It does not, however, appear produce the respiratory depression which is characteristic of opioid overdoses.
There have been a small number (this varies according to the source consulted) of fatalities internationally where kratom was implicated.
This was usually because kratom was detected on post-mortem toxicology.
However, in almost all cases, a number of different drugs were detected, which may contributed to, or been responsible for, the death. According to the US Centre for Disease Control (CDC) ‘Postmortem toxicology testing detected multiple substances for almost all decedents…Fentanyl and fentanyl analogs were the most frequently identified co-occurring substances.’
It also needs to be considered that as the vast majority of regular kratom users report experiencing chronic pain, or are in recovery from addiction to another substance, they are already at increased risk of death in any given year.
Interestingly, no deaths attributed to kratom have been reported in Asia.
Over 18 months in 2016 and 2017, 152 overdose deaths involving kratom were reported in the US, with kratom as the primary overdose agent in 91 of the deaths, and 7 with kratom being the only agent detected.
Nine deaths occurred in Sweden during 2010-2011 relating to use of Krypton, a mixture of kratom, caffeine and O-desmethyltramadol, a metabolite of the opioid analgesic tramadol.

Are There Health Conditions That Make Kratom More Dangerous?

People who have impaired liver function, or who are taking prescription medications which may be changed by the liver, may be more at risk of harm, as kratom is believed to temporarily slow down functioning of this organ.

Can Kratom be used with Other Drugs?

Taking more than one psychoactive drug at a time is always riskier than taking a single substance.
Consuming Kratom alongside other opioids (whether illicit drugs or prescribed medications) may be very dangerous, as this likely to potentiate the effects, and the risks of each substance increase.
Using alcohol will also raise the likelihood of experiencing negative effects.
Little is known about this combination, but in general, central nervous system depressants such as alcohol pose even more risk when combined with either stimulants or sedatives.

Is Kratom Addictive?

There is some evidence that kratom may cause dependence, if taken in sufficient quantities for an extended period of time.
Some people report difficulty in stopping or reducing daily use.
Withdrawal symptoms are likely to be much milder than those associated with opioids, bearing in mind one of the most common uses of Kratom is to lessen the effects of opioid withdrawal in those with existing issues with addiction.
As previously mentioned, the most common mode of use is oral ingestion, which does not lend itself as easily as to addiction, as the onset of effect is longer and milder due to the metabolisation process which accompanies this.

Is there any Harm Reduction Advice for Kratom Users?

Kratom is a comparatively low-risk substance when taken in small doses.
Those who have decided to use kratom are advised to begin with small amounts, as individual tolerance levels will vary.
Taking too much kratom can be unpleasant; nausea vomiting and dizziness are common side effects in such instances.
Concentrated preparations, such as liquids, are best avoided – accurate dosing is difficult as the strength is often unknown.
There may be other ingredients present which pose risks of their own – as with any drug purchased in a non-regulated market, there is always the possibility of adulteration.
As noted above, kratom can produce mild withdrawal symptoms after regular use, so caution is advised with regards to frequency of consumption.

Kratom Myths and Misunderstandings?

The US Food and Drug Administration declared kratom to contain ‘opioid agonists’ in 2018, and The CDC states that Kratom is not an opioid.
Nonetheless, its action on the Mu-opioid receptors means kratom is sometimes erroneously ‘lumped together’ with opioids such as morphine and heroin.
It does not display the same properties, and does not pose the same level of risk of abuse, or in terms of respiratory depression (Opioids such as heroin, suboxone etc can slow breathing down to such an extent that it can cause death – a 2019 review concluded this was not the case with kratom).
In 2016, the US Drug Enforcement Administration (DEA) expressed intent to place both mitragynine and 7-hydroxymitragynine into schedule 1, which would have made possession or sale of kratom illegal across the US.
Protesters organised a march and a petition, which garnered over 120,000 signatures to oppose the ban.
Of the 23,116 comments which were submitted during the public consultation, 99.1% supported kratom, and included positive accounts from a large number of law enforcement officials, heath care professionals and scientists, who overwhelmingly stressed its potential role in addressing the opioid epidemic currently facing the US.

Is Kratom Legal?

General:
- As of 2018, kratom is a controlled substance in 16 countries.
- As of 2018, there is growing international concern about a possible threat to public health from kratom use, while others have argued that it could be a tool to help the opioid crisis.
- In 2021, the World Health Organisation’s Executive Committee on Drug Dependency investigated the risks of kratom and declined to recommend a ban following a scientific review.
- The committee, however, recommended kratom be kept “under surveillance.”
- In some jurisdictions, its sale and importation have been restricted, and several public health authorities have raised alerts.
- In countries where it is technically legal, it may not be sold as a drug. Instead, it can be part of the so-called gray market, used as a rug but sold as a dye for paint or as incense, for example (a move that allows sellers to circumvent food and pharmaceutical product safety rules).
- Governments can ignore it, ban it, or control/regulate it.
United Nations:
- Neither kratom nor any of its active alkaloids are listed under the 1961 and 1971 United Nations Drug Conventions.
- List of countries where Kratom is illegal: Argentina, Australia, Belarus, Bulgaria (except for a doctor’s prescription), Croatia, Denmark, Estonia, Finland, France, Germany, Ireland, Israel, Japan, Latvia, Lithuania, Myanmar, Malaysia, New Zealand (except for a doctor’s prescription), Poland, Romania, Russia, Singapore, South Korea, Sweden, Switzerland, Thailand, Vietnam, and the UK.
United States:
- Kratom is not controlled under the Controlled Substances Act; however, there are some state regulations and/or prohibitions against the possession and use of kratom.
  - The FDA has not approved Kratom for any medical use.
  - In addition, the DEA has listed kratom as a Drug and Chemical of Concern.
- There are no drug products containing kratom or its two main chemical components that are legally on the market in the US. The Food and Drug Administration (FDA) has not approved any prescription or over-the-counter (OTC) drug products containing kratom or its two main chemical components, mitragynine and 7-hydroxymitragynine (7-OH-mitragynine).
- The FDA has stated that, consistent with its practice with unapproved substances, until FDA scientists can evaluate the safety and effectiveness of kratom (or its components) in the treatment of any medical conditions, the FDA will continue to warn the public against the use of kratom for medical treatment.
- Kratom is not appropriate for use as a dietary conventional supplement.
- The FDA has concluded from available information, including scientific data, that kratom is a new dietary ingredient for which there is inadequate information to provide reasonable assurance that such ingredient does not present a significant or unreasonable risk of illness or injury and, therefore, dietary supplements that are or contain kratom are adulterated under section 402(f)(1)(B) of the FD&C Act.
- Further, the FDA has determined that kratom, when added to food, is an unsafe food additive within the meaning of section 409; food containing an unsafe food additive, such as kratom, is adulterated under section 402(a)(2)(C)(i).
- Based on these determinations by the FDA, kratom is not lawfully marketed as a dietary supplement and cannot be lawfully added to conventional foods.
- Therefore, kratom is not lawfully marketed in the US as a drug product, a dietary supplement, or a food additive in conventional food.
- As of 2021 kratom is illegal in six states: Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin, and it may be outlawed by local ordinance in other states.
- Some states regulate who can use and purchase kratom, while others allow anyone to purchase it without restriction.
- States with restrictions include:
  - Arizona: KCPA passed
  - California: Banned inside San Diego
  - Colorado: Illegal for human consumption in Denver
  - Florida: Banned in Sarasota County
  - Georgia: KCPA passed
  - Illinois: Illegal in the city of Jerseyville; allowed for 18+ in the rest of the state
  - Mississippi: Illegal in Union County
  - Nevada: KCPA passed
  - New Hampshire: Legal for 18+
  - Oregon: Legal for 21+
  - Tennessee: Legal for 21+
  - Utah: KCPA passed
ASEAN:
- As of 2013, kratom was listed by ASEAN in its annex of products that cannot be included in traditional medicines and health supplements that are traded across ASEAN nations.
- Australia and New Zealand:
- As of January 2015, kratom is controlled as a narcotic in Australia and under Medicines Regulations 1985 (amended 06 August 2015) in New Zealand.
- Canada:
- As of October 2020, Health Canada disallowed marketing of kratom for any use by ingestion, and has taken action against companies marketing it for such purposes.
- Kratom could be marketed for other uses, such as incense.
Europe:
- European Union (EU):
  - Kratom is monitored as a new psychoactive substance by the EU Early Warning System under Regulation (EC) No 1920/2006 as amended by Regulation (EU) 2017/2101.
  - Kratom is not controlled at Union level, meaning that it is not included in the definition of ‘drug’ in Council Framework Decision 2004/757/JHA2.
  - The Commission is not planning to propose any changes in this regard.
  - If kratom is placed on the market in the EU as a medicinal product, this should be done in compliance with the rules on packaging established for medicines as well as all other rules applying to medicines as set in Directive 2001/834 and Regulation 726/2004.
- As of 2011, the plant was controlled in Denmark, Latvia, Lithuania, Poland (now illegal), Romania and Sweden.
- Illegal in Slovakia.
- Kratom is a controlled substance in Bulgaria.
- In 2017, kratom was designated a Schedule 1 illegal drug (the highest level) in the Republic of Ireland, under the names 7-hydroxymitragynine and mitragynine.
- Technically legal in Austrai, Spain and Germany.
- France banned it in 2020.
- The sale, import, and export of kratom have been prohibited in the United Kingdom (UK) since 2016 under the Psychoactive Substances Act.
  - The Psychoactive Substances Act received Royal Assent on 28 January 2016.
  - The Act applies across the UK and came into force on 26 May 2016.
  - The Act makes it an offence to produce, supply, offer to supply, possess with intent to supply, possess on custodial premises, import or export psychoactive substances; that is, any substance intended for human consumption that is capable of producing a psychoactive effect.
    - The maximum sentence is 7 years’ imprisonment.
  - The Act excludes legitimate substances, such as food, alcohol, tobacco, nicotine, caffeine and medical products from the scope of the offence, as well as controlled drugs, which continue to be regulated by the Misuse of Drugs Act 1971.
  - The Act provides powers to stop and search persons, vehicles and vessels, enter and search premises in accordance with a warrant, and to seize and destroy psychoactive substances.
  - Two petitions were launched to exempt Kratom from the Act, but only received 1,762 signatures in 2016 and 23 signatures in 2019 (the threshold being 10,000).
  - The National Crime Agency (NCA) works with police forces and the Home Office’s Border Force to prevent the importation, possession (with intent to supply) and sale of Kratom.
Indonesia:
- Kratom is scheduled to become an illegal substance in Indonesia in 2024 once new regulations from the Indonesian National Narcotics Agency (BNN) go into effect.
- This pending ban has been in place since 2019; the date of the ban going into effect was pushed out to 2024 to give Kratom farmers time to switch to other crops.
- Notably, this ban would likely devastate the Kratom supply in the US, since almost all of America’s Kratom is supplied via Indonesian exports.
Malaysia:
- The use of kratom leaves is prohibited to use, import, export, manufacture, compound, mix, dispense, sell, supply, administer or possess in Malaysia under Section 30(3) of the Poisons Act 1952, and will be punished by imprisonment or fine or both.
- Although prohibited by statute, the use of kratom remains widely spread especially in Northern and East Coast region of Malaysia’s Peninsula because the tree grows natively and tea decoctions are readily available in local communities.
- Certain parties have urged the government to penalise the use of kratom under the Dangerous Drugs Act instead of the Poisons Act, which would carry heavier penalties.
Thailand:
- Possession of kratom leaves was illegal in Thailand until 2018.
- The Thai government had passed the Kratom Act 2486, effective 03 August 1943, which made planting the tree illegal, in response to a rise in its use when opium became very expensive in Thailand and the Thai government was attempting to gain control of the opium market.
- In 1979, the Thai government placed kratom, along with marijuana, in Category V of a five category classification of narcotics.
- Kratom accounted for less than two percent of arrests for narcotics between 1987 and 1992.
- The Thai government has considered legalising kratom for recreational use in 2004, 2009, 2013, and 2020.
- In 2018, Thailand became the first Southeast Asian country to legalise kratom for medical purposes.
- In 2021, Thailand fully legalised kratom and removed it from the list of Category V narcotics, and more than 12,000 people who had been convicted for kratom-related offences when it was still considered a narcotic were granted an amnesty.
- You can read more on the background here.