Mood enhancing beverages are becoming increasingly popular in wellness communities. These products offer a tincture of herbs and minerals that are noted to improve mood and enhance overall wellness. Kratom is typically the active ingredient in these “wellness drinks”. While companies are being transparent about the drinks ingredients, many individuals are unaware that kratom is a natural opioid. This plant-derived opioid is legal, and has historical uses, but also carries an understudied addiction liability. By spreading information about the ways that kratom works on the brain’s opioid system, individuals can better understand the drug itself.
Kratom “bars” are beginning to pop up in metropolitan areas, leading to more public exposure and accessibility. This substance is misunderstood by much of the public, and carries its own unique neurological abilities and properties. Although, kratom is not a mysterious substance to those in recovery from an opioid use disorder. Since kratom is an opioid itself, it is used to reduce withdrawal, craving, and anxiety-like symptoms associated with abstinence from opioids. In a study of 2,798 kratom consumers, 41% of participants reported drinking kratom to reduce their use of other opioids and maintain abstinence. While kratom acts on opioid receptors, it does not impact the brain in the same way as morphine, heroin, or fentanyl. Kratom can induce relaxation, decrease pain, and increase mood. However, it does not bind to receptors with the same strength as other opioids, leading to very mild effects.
Dependence and withdrawal can occur from kratom use, which is not commonly mentioned as a possible risk. It is estimated that 2.35 million people had consumed kratom in 2022. Just as other opioids, kratom activates Mu opioid receptors, which are the primary receptor for opioid reinforcement. Continuous activation of these receptors by kratom, can lead to craving and potential withdrawal symptoms if use is discontinued. Stopping kratom use can result in opioid withdrawal symptoms, which can be life threatening if symptoms are severe.
Many people have symptoms ranging from tremor, pain, and anxiety, during withdrawal. In 2019, the Center of Disease Control (CDC) reported that less than 1% of opioid overdoses involved kratom, making kratom overdose quite rare. The primary concern with long term kratom use is not overdose, but dependence and withdrawal symptoms if use is discontinued.
Opioid withdrawal from stopping kratom use can be extremely unpleasant. The brain has to begin a process of resetting its chemical balance during the withdrawal period. The Mu opioid receptors are conditioned to be frequently activated, so during withdrawal, receptors are waiting for kratom to bind to them. With no kratom present in the system, these receptors are not firing, leading to muscle aches, craving, and irritability. Stopping kratom use also impacts other neurochemical brain systems, such as dopamine and serotonin activity. Withdrawal symptoms can last anywhere from 24 hours to a week, depending on how frequently kratom was being used. It is important to monitor symptoms of use and withdrawal, and understand that kratom is an opioid that carries a risk for dependence. In the event that the signs of an opioid overdose are present in someone using kratom, naloxone will work to reverse these effects. Naloxone works by removing kratom from the opioid receptors, and inhibiting further binding for the next 30-90 minutes. Through understanding how kratom can induce dependence and withdrawal, we can increase public awareness surrounding this legal opioid.
SOURCES:
Garcia-Romeu, A., Cox, D. J., Smith, K. E., Dunn, K. E., & Griffiths, R. R. (2020). Kratom (Mitragyna speciosa): User demographics, use patterns, and implications for the opioid epidemic. Drug and Alcohol Dependence, 208, 107849. https://doi.org/10.1016/j.drugalcdep.2020.107849
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