Kratom or Mitragyna speciosa is a native plant to Southeast Asia regions such as Thailand, Indonesia, Myanmar, and Malaysia. Harizal, S. N., Mansor, S. M., Hasnan, J., Tharakan, J. K. J., and Abdullah, J. (2010), ‘Acute toxicity study of the standardized methanolic extract of Mitragyna speciosa Korth in rodent', Journal of Ethnopharmacology, Volume 131, pp. 404-409. The main psychoactive components in the leaves are mitragynine and 7-hydroxymitragynine, both found only in Mitragyna speciosa.

Philipp AA, Wissenbach DK, Weber AA, Zapp J, Maurer HH. Metabolism studies of the Kratom alkaloids mitraciliatine and isopaynantheine, diastereomers of the main alkaloids mitragynine and paynantheine, in rat and human urine using liquid chromatography-linear ion trap-mass spectrometry.

Figure 1. Chemical structures of mitragyna alkaloids, morphine, and amino acid sequence of β-endorphin. Chan KB, Pakiam C, Rahim RA. Psychoactive plant abuse: the identification of mitragynine in ketum and in ketum preparations. Psychoactive effects are caused by its alkaloids, among which is mesembrine, a serotonin 5-HT reuptake inhibitor.

Kratom has a unique pharmacological (see Table 1 ) and toxicological (see Table 2 ) profile and is commonly used for its anxiolytic and antidepressant effects ( 5 ). For chronic users, withdrawal symptoms are consistent with that of opioids such as morphine ( Table 2 ) ( 6 ). According to the National Institute on Drug Abuse, the number of deaths from heroin has increased 6-fold from 2001 to 2014 ( 7 ). While kratom has been associated with several deaths in combination with other substances, there is no solid evidence that it was the sole contributor to an individual's death ( Table 2 ) ( 6 ). In 2010, only one case of kratom use was reported in U.S. drug data bases.

Philipp AA, Wissenbach DK, Weber AA, et al. Use of liquid chromatography coupled to low- and high-resolution linear ion trap mass spectrometry for studying the metabolism of paynantheine, an alkaloid of the herbal drug Kratom in rat and human urine. When the leaves of the Kratom tree are boiled in water and reduced to a concentrate, they form a very glossy, thick dark green extract.

Nelsen, J. L., Lapoint, J., Hodgman, M. J., and Aldous, K. M. (2010), ‘Seizure and coma following kratom (Mitragyna speciosa) exposure', Journal of Medical Toxicology, Volume 6, pp. 424-426. Like any drug or medicine, people's reactions vary and some people could possibly have an allergic or other unusual reaction to kratom, even if they used it responsibly.

Arndt T, Claussen U, Gussregen B, et al. Kratom alkaloids and -desmethyltramadol in urine of a "Krypton" herbal mixture consumer. Kratom appeared on the global drug market only recently, thus there is no information on the extent of its use outside South East Asia.
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