Views:2 Author:Site Editor Publish Time: 2019-02-26 Origin:https://en.wikipedia.org/wiki/Mitragyna_speciosa
What is Kratom?
Kratom (Mitragyna speciosa) is a tropical evergreen tree from Southeast Asia and is native to Thailand, Malaysia, Indonesia and Papua New Guinea. Kratom, the original name used in Thailand, is a member of the Rubiaceae family. Other members of the Rubiaceae family include coffee and gardenia. The leaves of kratom are consumed either by chewing, or by drying and smoking, putting into capsules, tablets or extract, or by boiling into a tea. The effects are unique in that stimulation occurs at low doses and opioid-like depressant and euphoric effects occur at higher doses. Common uses include treatment of pain, to help prevent withdrawal from opiates (such as prescription narcotics or heroin), and for mild stimulation.
Traditionally, kratom leaves have been used by Thai and Malaysian natives and workers for centuries. The stimulant effect was used by workers in Southeast Asia to increase energy, stamina, and limit fatigue. However, some Southeast Asian countries now outlaw its use.
In the US, this herbal product has been used as an alternative agent for muscle pain relief, diarrhea, and as a treatment for opiate addiction and withdrawal. However, its safety and effectiveness for these conditions has not been clinically determined, and the FDA has raised serious concerns about toxicity and possible death with use of kratom.
What’s the Traditional use of it?
In cultures where the plant grows, kratom has been used in traditional medicine. The leaves are chewed to relieve musculoskeletal pain and increase energy, appetite, and sexual desire in ways similar to khat and coca. The leaves or extracts from them are used to heal wounds and as a local anesthetic. Extracts and leaves have been used to treat coughs, diarrhea, and intestinal infections.They are also used as intestinal deworming agents in Thailand.Kratom is often used by workers in laborious or monotonous professions to stave off exhaustion as well as a mood enhancer and painkiller. In Thailand, kratom was "used as a snack to receive guests and was part of the ritual worship of ancestors and gods". The herb is very bitter and is generally combined with a sweetener.
In 1836, kratom was reported to have been used as an opium substitute in Malaysia. Kratom was also used as an opium substitute in Thailand in the nineteenth century. As of 2016, Kratom is not approved for this or any other medical use.
Data on how often it is used worldwide are lacking, as it is not detected by typical drug-screening tests. Rates of kratom use appear to be increasing among those who have been self-managing chronic pain with opioids purchased without a prescription and are cycling (but not quitting) their use. As of 2018, there have been no formal trials to study the efficacy or safety of kratom to treat opioid addiction.
Starting in the 2010s, a tea-based cocktail known as 4×100 has become popular among some young people across Southeast Asia and especially in Thailand. It is a mix of kratom leaves, cough syrup, Coca-Cola, and ice; as of 2011, people who consumed this were often viewed more negatively than users of traditional kratom, but not as negatively as users of heroin.As of 2012, use of the cocktail was a severe problem among youth in three provinces along the border with Malaysia.
In the US, as of 2015, kratom was available in head shops and over the Internet; the prevalence of its use was unknown as of that time.
What is the Adverse effects of Kratom?
At relatively low doses (1–5 g of raw leaves), at which there are mostly stimulant effects, side effects include contracted pupils and blushing; adverse effects related to stimulation include anxiety and agitation, and opioid-related effects like itching, nausea, loss of appetite, and increased urination begin to appear.At moderate (5 to 15 g of raw leaves) doses and higher, at which opioid effects generally appear, additional adverse effects include tachycardia (increased stimulant effect) as well as the opioid side effects of constipation, dizziness, hypotension, dry mouth, and sweating.Frequent use of high doses of kratom may cause tremors, anorexia, weight loss, seizures, and psychosis. If frequent users try to stop using kratom, they may experience withdrawal symptoms including irritability, feelings of distress, nausea, hypertension, insomnia, a runny nose, muscle and joint pain, and diarrhea.Serious toxicity is relatively rare and generally appears at high doses or when kratom is used with other substances.In July 2016, the Centers for Disease Control issued a report stating that between 2010 and 2015, US poison control centers received 660 reports of exposure to kratom. Medical outcomes associated with kratom exposure were reported as minor (minimal signs or symptoms, which resolved rapidly with no residual disability) for 162 (24.5%) exposures, moderate (non-life-threatening, with no residual disability, but requiring some form of treatment) for 275 (41.7%) exposures, and major (life-threatening signs or symptoms, with some residual disability) for 49 (7.4%) exposures.One death was reported in a person who was exposed to the medications paroxetine (an antidepressant) and lamotrigine (an anticonvulsant and mood stabilizer) in addition to kratom. For 173 (26.2%) exposure calls, no effects were reported, or poison center staff members were unable to follow-up regarding effects.
Overdoses of kratom are managed similarly to opioid overdoses, and naloxone can be considered to treat an overdose that results in a reduced impulse to breathe, despite mixed results for its utility, based on animal models.
From October 2017 to February 2018 in the United States, 28 people in 20 different states were infected with salmonella, an outbreak occurring from the consumption of contaminated pills, powder, tea or unidentified sources of kratom. An analytical method using whole genome sequencing applied to samples from the infected people indicated that the salmonella outbreak likely had a common kratom source.
As published on February 6, 2018, the FDA notes it has no scientific data that would support the use of kratom for medical purposes. In addition, the FDA states that kratom should not be used as an alternative to prescription opioids, even if using it for opioid withdrawal symptoms. As noted by the FDA, effective, FDA-approved prescription medications, including buprenorphine, methadone, and naltrexone, are available from a health care provider, to be used in conjunction with counseling, for opioid withdrawal. Also, they state there are also safer, non-opioid options for the treatment of pain.
On February 20, 2018 the US Centers for Disease Control and Prevention (CDC) reported it was investigating a multistate outbreak of 28 salmonella infections in 20 states linked to kratom use. They noted that 11 people had been hospitalized with salmonella illness linked to kratom, but no deaths were reported. Those who fell ill consumed kratom in pills, powder or tea, but no common distributors has been identified.
Respiratory depression is a major risk with opioids, especially those that have activity at the mu-opioid receptor. This is the leading cause of death from opioid use. In animal studies at very high doses, mitragynine caused respiratory depression, but less than morphine or codeine. The respiratory effects of kratom and its main bioactive components have not been studied in people.
A 2016 CDC report on kratom exposures did not list respiratory depression as a risk of kratom, nor did a 2013 DEA report. In 2016, the Food and Drug Administration listed respiratory depression as one of the concerns.Some literature review articles do not list respiratory depression;however other literature reviews and some medical textbooks do name respiratory depression as a risk.
In rare cases, chronic use of kratom has been linked to acute liver injury with associated symptoms of fatigue, nausea, itching and jaundice.Liver injury is associated with cholestasis and may involve acute renal failure.As of 2016, the mechanism by which kratom causes liver damage in some people was poorly understood.
Kratom overdose is a subject of concern in many countries because of the rising number of hospitalizations and deaths from chronic kratom abuse.According to clinical reviews, a kratom overdose can cause liver toxicity, seizures, coma, and death, especially when in combination with alcohol abuse. Between 2011 and 2017, forty-four deaths were kratom-related. In one autopsy, substantial levels of mitragynine and the psychostimulant, propylhexedrine, were found in the blood sample. Found in an additional autopsy were high levels of mitragynine and signs of opioid toxicity. Nine deaths occurred in Sweden during 2010-11 relating to use of Krypton, a mixture of kratom, caffeine and O-desmethyltramadol, a prescription opioid analgesic.