Historically, agricultural workers in southeast Asia chewed Kratom leaves to increase work output and offset fatigue. Since those days, Kratom – known scientifically as Mitragynine speciosa – has also been used as a substitute for opium, and as a way to manage the symptoms of opioid withdrawal. Because of its demonstrated opioid activity, mitragynine is now being evaluated as a new drug for pain relief.
What is Kratom?
Kratom is a plant that produces several compounds that have opioid-like effects, with mitragynine being the active compound in Kratom that’s present in the highest concentrations. At low doses, mitragynine has stimulant effects similar to cocaine, but at higher dosages it has an effect more like morphine.
Is Kratom prohibited in sport?
As of 2017, Kratom is not a prohibited substance on the World Anti-Doping Agency (WADA) Prohibited List, but mitragynine has been on the WADA Monitoring program since 2014 as a narcotic. Given that narcotics are only prohibited in-competition, WADA labs screen samples for the presence of mitragynine only on drug tests that take place in-competition.
With this analysis, WADA can determine if substances that aren’t presently prohibited should be added to the Prohibited List because they are being abused for performance-enhancement in sport. Since it was added to the monitoring program in 2014, mitragynine has been detected in the samples of four strength-sport athletes from countries outside the U.S.
While Kratom is not currently prohibited, athletes are advised to steer clear of Kratom for health reasons.
What are the health risks associated with Kratom?
As you can see in the table below, there are a number of dangerous side effects associated with Kratom. Even worse, the DEA is aware of at least 15 deaths associated with the use of Kratom between 2014 and 2016.
In August 2016, the DEA announced that it planned to place Kratom on Schedule 1 (the most restrictive schedule) under the Controlled Substances Act. At this time, the DEA has temporarily withdrawn its proposal to schedule Kratom until it has conducted more research on the plant and considered all of the comments received from the public.
| Short term use side effects | Nausea, constipation, sleep problems, temporary erectile dysfunction, itching, or sweating |
| Long term use side effects | Anorexia, dry mouth, problems in diuresis, darker skin, and hair loss |
| Withdrawal symptoms | Hostility, aggression, aching of muscles and bones, jerky movements of the limbs, anorexia and weight loss, and insomnia |
| Infrequent effects | Seizures (individuals using high doses of kratom, either alone or combined with other drugs), intrahepatic cholestasis, psychotic symptoms, Adult Respiratory Distress Syndrome, and hypothyroidism |
| Fatalities | Kratom mixed with other substances: O-desmethyltramadol; propylhexedrine; over-the-counter cold medications and benzodiazepines; venlafaxine, diphenhydramine, and mirtazapine; zopiclone, citalopram, and lamotrigine |
Is Kratom legal outside of sport?
Over the last few years, Kratom has been in the news because abuse of this plant by recreational drug users has increased dramatically. In light of the current epidemic of opioid abuse in the United States, the medical community and law enforcement officials are very concerned about the increased use of Kratom.
Unfortunately, Kratom is readily available on the internet and is often marketed as a “legal high,” but such advertising is not completely accurate. It’s true that unlike heroin, Kratom (or mitragynine) is not a scheduled drug under the Controlled Substances Act. However, that does not mean it is entirely legal.
For example, the FDA issued an import alert in February 2014 stating that imported dietary supplements and bulk dietary ingredients that contain Kratom can be seized. As such, a shipment of Kratom was recently seized by US Marshalls in California with the explanation that Kratom products are unapproved and misbranded drugs under the Federal Food, Drug, and Cosmetic Act.
Resources
[1] E. Cinosi, G. Martinotti, P. Simonato, D. Singh, Z. Demetrovics, A. Roman-Urrestarazu, F. S. Bersani, B. Vicknasingam, G. Piazzon, J. H. Li, W. J. Yu, M. Kapitany-Foveny, J. Farkas, M. Di Giannantonio, O. Corazza. Following “the Roots” of Kratom (Mitragyna speciosa): The Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries. Biomed Res Int. 2015, 2015, 968786.
[2] DrugFacts: Kratom (2016). National Institute on Drug Abuse. Available at: https://www.drugabuse.gov/publications/drugfacts/kratom [Accessed on Oct 25 2016].
[3] A. Varadi, G. F. Marrone, T. C. Palmer, A. Narayan, M. R. Szabo, V. Le Rouzic, S. G. Grinnell, J. J. Subrath, E. Warner, S. Kalra, A. Hunkele, J. Pagirsky, S. O. Eans, J. M. Medina, J. Xu, Y. X. Pan, A. Borics, G. W. Pasternak, J. P. McLaughlin, S. Majumdar. Mitragynine/Corynantheidine Pseudoindoxyls As Opioid Analgesics with Mu Agonism and Delta Antagonism, Which Do Not Recruit beta-Arrestin-2. J Med Chem. 2016, 59, 8381-97.
[4] N. Harun, Z. Hassan, V. Navaratnam, S. M. Mansor, M. Shoaib. Discriminative stimulus properties of mitragynine (kratom) in rats. Psychopharmacology (Berl). 2015, 232, 2227-38.
[5] W. C. Prozialeck, J. K. Jivan, S. V. Andurkar. Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc. 2012, 112, 792-9.
[6] S. Guddat, C. Gorgens, V. Steinhart, W. Schanzer, M. Thevis. Mitragynine (Kratom) – monitoring in sports drug testing. Drug Test Anal. 2016,
[7] C. Ingraham. The DEA is withdrawing a proposal to ban another plant after the Internet got really mad. Washington Post, 2016. https://www.washingtonpost.com/news/wonk/wp/2016/10/12/the-dea-is-reversing-its-insane-decision-to-ban-the-opiate-like-plant-kratom-for-now/ [Accessed on Oct 14 2016].
[8] Import Alert: DETENTION WITHOUT PHYSICAL EXAMINATION OF DIETARY SUPPLEMENTS AND BULK DIETARY INGREDIENTS THAT ARE OR CONTAIN MITRAGYNA SPECIOSA OR KRATOM. FDA.gov, 2014. http://www.accessdata.fda.gov/cms_ia/importalert_1137.html [Accessed on Oct 17, 2016].
[9] C. Ingraham. The DEA is withdrawing a proposal to ban another plant after the Internet got really mad. Washington Post, 2016. https://www.washingtonpost.com/news/wonk/wp/2016/10/12/the-dea-is-reversing-its-insane-decision-to-ban-the-opiate-like-plant-kratom-for-now/ [Accessed on Oct 14 2016].
[9] Kratom seized in California by US Marshals Service. FDA.gov, 2016. [Accessed on Oct 17, 2016].
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