The Fight Addiction Now community has been engaging in some very interesting conversations about kratom lately, discussing whether or not it can be used as a substitute for opioids safely, debates on its legality, and stories from people who have found success with kratom. We wanted to continue the conversation on this hot topic, and we feel we need to start by covering some of the most basic, yet pressing questions.
What is Kratom?
Kratom is an herb that is derived from the mitragyna speciosa plant, which is native to Southeast Asia and grows freely in Thailand, Myanmar, New Guinea, Malaysia, and Indonesia. It has gained popularity recently – in the wake of the opioid epidemic – for its opioid and stimulant effects similar to opioids like morphine.
The herb has been used in traditional medicine in Southeast Asia for centuries, with the earliest reported use as an opium substitute coming in 1836.
What Are the Active Ingredients in Kratom?
The alkaloids in kratom are what most consider to be the “active” ingredients, as they are the ingredients that produce the effects that most people ingest kratom for. Kratom contains over 40 different alkaloids that could be considered active ingredients, but “Mitragynine” is what we will focus on, as this alkaloid is responsible for the “desired effects.”
Mitragynine and 7-OH Mitragynine
Alkaloids mitragynine and 7-OH Mitragynine, found in kratom, are opioid-receptor agonists. This means that – much like opioid medications like Vicodin and OxyContin – mitragynine binds to the Mu receptors and causes analgesia and sedation. Chemically, there is nothing different between using an opioid drug like morphine or heroin to bind to receptors and using kratom for the same effect.
Is Kratom Addictive?
If we want to be exact about it, there are two different types of addiction: chemical dependence and psychological addiction. Anything can be addictive including gambling, shopping, compulsive behaviors, and even – as of recently – video games. So, in this sense, yes you can become addicted to the use of kratom.
Can you become chemically dependent on kratom? Yes; chemical dependence is very possible with kratom, as it works exactly like opioid-based drugs – which we know are not only addictive, but one of the most addictive types of drugs.
I am Addicted to Heroin, and Substitute Kratom for Opioids. Do I have to worry about Kratom Addiction?
Many people who have started using kratom recently do so because they are already addicted to dangerous opioid drugs like heroin, morphine, oxycontin, or even opioid replacement drugs like suboxone and methadone. They use kratom because they don’t want to use opioid drugs, but are chemically dependent on them.
Kratom works as a substitute for heroin and opioids because it acts on the Mu opioid receptor in the brain, just like opioid drugs. When you are addicted (chemically dependent) to an opioid, your body has actually just become so used to a certain balance of opioid agonists on these receptors that when the balance is interrupted, the body reacts by producing the opioid withdrawal symptoms. So in this sense, an opioid addict is chemically dependent on all drugs or chemicals that produce this effect in the brain.
Since kratom works on the opioid receptors in the brain in the same way that heroin and other opioids do, an opioid addict is essentially already addicted to alkaloids in kratom, even if they have never ingested it. This works the same with other drugs as well, and is why drugs like buprenorphine and methadone can be used to replace heroin or prescription painkillers in opioid replacement therapy.
Is Kratom Dangerous for Opioid Addicts?
This is hard to give a definite answer on. Much of the dangers that opioid addicts face are attributed to dangerous behaviors and self harm – like accidental overdose. Some opioid addicts choose to replace their heroin addiction with kratom, because of worries that their heroin supply may be tainted or laced with synthetic opioids. These addicts feel that the risk of accidental overdose is lower with kratom, and kratom dosage is easier to monitor than heroin.
Can you Overdose on Kratom?
Technically, yes you can overdose on the opioid agonist alkaloid mitragynine that is found in kratom. This is because opioid overdose happens when too many opioid agonists attach to the opioid receptors. However, kratom and the mitragyna speciose also produce opioid antagonists, which knock excess opioid agonists off the receptors. Much like how suboxone contains an opioid antagonist (Naloxone) alongside an opioid agonist (buprenorphine). The mixture of the two types of chemicals work as a sort of overdose deterrent.
Many manufacturers of kratom products sold in stores and online refine their kratom for strength. This means that they may remove chemicals that act as opioid antagonists, while increasing the amount of agonist chemicals. This creates stronger kratom, but also increases the risk of too many agonists binding to receptors and causing an overdose. However, it is difficult to overdose on kratom. In fact, according to a study done on “Subchronic exposure to mitragynine, the principal alkaloid of Mitragyna speciosa, in rats” , LD-50, or a lethal dosage of the active ingredient mitragynine could not be found in the increased levels of the drug. Once again, this does not mean a lethal dose is not possible, it is just very difficult to get a lethal dose.
The Dangers of Mixing Kratom with Opioids and Other Drugs
Mixing drugs is always a bad idea. When you mix drugs, you are opening yourself up to so many dangers. Mixing kratom with alcohol, mixing kratom with Adderall, mixing kratom with meth or cocaine, all of these are bad ideas that could lead to a host of mental and physical problems. Mixing kratom with other opioid drugs? An even worse idea.
When opioids are incredibly dangerous and addictive drugs, and can cause overdose and death on their own. The danger of mixing opioids with kratom compounds the dangers of opioids, and you will be at increased risk of accidental overdose. There simply is not enough research to say for sure what the dangers of kratom are when mixed with specific drugs.
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