Kratom, or Mitragyna speciosa, is a plant native to Southeast Asia.
Kratom is an opioid painkiller, notable because it is possibly the only opioid that most Western nations do not regulate or ban.
Legality and Availability
There is no federal law against kratom, but a handful of states have enacted restrictions.
Indiana is the only state that explicitly bans kratom. However, the plant is in a legal gray area in Louisiana, Tennessee, Vermont, and Wisconsin. Where no state law exists, kratom is legal.
In 2016, the DEA moved to place kratom on Schedule I of the Controlled Substances Act, the highest level of control in the United States. However, following public outcry, the DEA withdrew the ban and opened a public comment period.
Kratom is legal in Canada, and sold in many headshops.
Kratom is legal and sold in stores in the United Kingdom, France, the Netherlands, and other countries.
It is controlled or banned in Ireland, Finland, Denmark, Romania, and other countries.
Legality is questionable in Germany.
Kratom is not approved for medical use by the FDA and other agencies. It is typically classified as an herbal product, or is simply sold for "research" or "botanical" purposes only.
Recovering opioid addicts have reported that kratom is effective in preventing or reducing withdrawal symptoms. In the US, it is a common form of self-medication for withdrawals, as is the potentially more dangerous drug loperamide.
Kratom has been reported to ease anxiety.
The effects of kratom differ significantly with different "strains", likely due to different levels of various alkaloids.
The active substances in kratom have not been identified and documented. However, kratom appears to possess an effect profile similar to buprenorphine, indicating that it could be a partial agonist of mu-opioid receptors. It is also possible that kratom could be classified as a weak opioid agonist, similar to codeine, dihydrocodeine, ethylmorphine, and tramadol.
Evidence for the partial agonist hypothesis includes:
- Hypoventilation is rare
- No overdose has been conclusively documented, despite widespread use in Southeast Asia
- Kratom carries a dependence risk substantially lower than other opioids
- Kratom is often used by recovering opioid addicts to prevent withdrawal without euphoric effects
It should be noted that the evidence above may largely also apply to the weak opioid hypothesis.