By Mark Winsberg, M.D.
Kratom (mitragyna speciosa) is a tropical tree native to Southeast Asia, where it has been used for centuries as a traditional medicine. In countries like Thailand, Malaysia and Indonesia, kratom leaves were chewed or brewed into tea to increase energy, relieve pain and treat ailments such as diarrhea and cough.
Laborers in rural areas used kratom to help them endure long hours of work, while others used it in social and religious rituals. Although kratom has a long history in Southeast Asia, its recent introduction to the West has created new challenges, particularly in terms of addiction and public health concerns.
Kratom’s introduction to the U.S.
Kratom began gaining popularity in the United States in the early 2000s, marketed as a “natural” way to self-treat conditions such as pain, coughing, diarrhea, anxiety and depression, opioid use disorder and opioid withdrawal. Though not stated on the label, it was and is viewed as a way to get a “natural high.” Because of its perceived benefits and legal status, it quickly became available over the counter in places like New York state, where it is still legal to buy and sell. Smoke shops, online stores and other businesses, except pharmacies, now sell kratom, often alongside other herbal supplements.
However, while kratom is legal in most U.S. states, it is banned in many countries, including Thailand, Malaysia and Australia, due to concerns about its potential for abuse and addiction.
Effects of Kratom
The active compounds in kratom, known as alkaloids, interact with the brain’s opioid receptors, similar to legal opioids like prescription painkillers and illegal drugs like heroin and fentanyl. These compounds, particularly mitragynine and 7-hydroxymitragynine, can produce effects such as euphoria, pain relief and relaxation. Because of these effects, some people use kratom to manage chronic pain or to alleviate symptoms of opioid withdrawal.
However, the same properties that make kratom appealing also make it risky. Like other opioids, kratom can be addictive. Many people start using it innocently, unaware of its addictive potential. Over time, they may find it difficult to stop using kratom because of the withdrawal symptoms, which can include irritability, muscle aches, fatigue and intense cravings — symptoms similar to those experienced by individuals addicted to opioids.
Growing Public Health Concerns
As kratom use has increased in the West, so have the public health concerns surrounding it. Many people are unaware of kratom’s addictive potential and may start using it thinking it is a safe, natural remedy.
However, once they become dependent, they may struggle to quit. This has led to an increase in the number of people seeking help in both outpatient and inpatient drug treatment programs. Treatment for kratom addiction is often similar to that for opioid addiction, involving a gradual tapering of the drug to manage withdrawal symptoms.
Legal and regulatory issues
Kratom’s legal status varies widely. In the U.S., it remains legal in most states, including New York, where it is sold over the counter. However, some states and cities have banned it and its legal status remains a topic of debate. In 2016, the U.S. Drug Enforcement Administration considered classifying kratom as a Schedule I drug, which would place it in the same category as heroin. However, public outcry and advocacy efforts delayed this decision, leaving kratom unregulated at the federal level.
Internationally, kratom is illegal in many countries, including several Southeast Asian nations where it has a long history of use. These bans reflect concerns about kratom’s potential for abuse and its role in public health crises. Despite these concerns, advocates argue that kratom may have legitimate medicinal uses, similar to marijuana, and that more research is needed to fully understand its effects and potential benefits.
Issues with contamination and additives
One of the significant concerns with kratom is the lack of regulation in its production and sale. Because kratom is often marketed as a supplement, it does not undergo the same rigorous testing as prescription medications. This means that the concentration of active compounds can vary widely between products, making it difficult for users to know how much they are consuming.
In addition, kratom products may be contaminated with harmful substances, including heavy metals, synthetic opioids, and bacteria such as salmonella. These contaminants can increase the risk of overdose, illness and other adverse effects.
Conclusion
Kratom addiction is a growing problem in the West, driven by the drug’s availability, lack of regulation and opioid-like effects.
While it has a long history of use in Southeast Asia, kratom’s introduction to the U.S. has raised new challenges for both individuals and public health systems. Many people start using kratom without fully understanding its risks, only to find themselves struggling with addiction and withdrawal. As a result, more people are seeking help in drug treatment programs, where they receive care similar to that for opioid addiction.
Although kratom may have potential medicinal uses, the risks of addiction, contamination and public health concerns highlight the need for more research and regulation to ensure its safe use.
Physician Mark Winsberg is the former medical director of Rochester Regional Health chemical dependency department. He now owns Medical Services, PLLC in Rochester. Contact him at drmark@winsbergmd.com or via text message at 585-565-5220. For more information, visit www.winsbergmd.com.