Kratom (aka Thom, Thang, and Biakis) is the US name of the drug obtained from the leaves of the Mitragyna speciosa tree, growing up to 50' high in Indonesia, Malaysia, Thailand, and Bali.  In these environments it grows leaves quickly but it can be grown in subtropical climates, although the leaves die if the temperature dips below 50 deg F.  Its leaves contain 25 active alkaloids including the major components mitragynine and 7-hydroxymitragynine.  Other active alkaloids include ajmalicine, mitraphylline, mitragynine pseudoindoxyl, and Rhynchophylline.  The major components are metabolized in the liver to 16-carboxy mitragynine, and 9-O-demethyl mitragynine. (Anal Biochem. 2017 Dec 14;543:146-161).  The compounds mitragynine, 7-hydroxymitragynine, and MGM-9 are active stimulating the mu and kappa opioid receptors (Curr Drug Targets. 2017 Apr 25) and the alpha-2 adrenergic receptors, while inhibiting the 5-HT2A receptors (Pain Physician. 2017 Jan-Feb;20(1):E195-E198).  It is taken orally by chewing the leaves (common in Southeast Asia),crushed dried leaf, capsule, or powder mixed as a slurry in water, drank as tea to make it more palatable, smoked (Front Psychiatry. 2017 Apr 24;8:62), liniment, balm, or tincture (J Ethnopharmacol. 2017 Apr 18;202:302-325). Long term usage of Kratom does not reportedly cause any unusual blood chemistry or hematologies with the exception of elevated HDL and LDL cholesterol. (J Ethnopharmacol. 2018 Mar 25;214:197-206.).  Other species of mitragyna have been used for pain as a topical agent, for anxiety, fever, and infections (J Ethnopharmacol. 2017 Apr 18;202:302-325). 

Kratom is used both for pain in 68% of those taking it, as a mood elevator in 66%, and as a drug to control the withdrawal symptoms from other opioids in 30%.  (Drug Alcohol Depend. 2017 Jul 1;176:63-70), but has been used for centuries as a stimulant in laborers at doses of 1-5 g, as an opioid agonist at 5-10 g dosage (pain control, blunting of withdrawal symptoms, constipation, euphoria, muscle relaxation and treatment of diarrhea), and sedation at high dosage (10-15 g) (Pain Physician:January 2017; 20:E195-E198).  It also creates a "sense of well-being". It is also used as a substitute for opioids in both addiction and pain treatment, and acts to reduce anxiety while increasing generalized well-being (Drug Alcohol Depend. 2017 Dec 7;183:134-140).  The 7-hydroxymitragynine was found to be the most effective substance in kratom for the treatment of pain.  Kratom is unregulated in the US currently and is freely imported, but has no quality control, no assay or analysis for either the content or purity and one study found many commercial products are adulterated (https://www.ncbi.nlm.nih.gov/pubmed/27752985).  It operates on the opioid receptors in the human body, the alpha 2 receptor, and as an anti-inflammatory drug (Am J Health Syst Pharm. 2017 Dec 18). It reportedly has a low abuse potential (Psychopharmacology (Berl). 2017 Dec 23).  Withdrawal from Kratom is usually well tolerated by most but may be severe in a few (Drug Alcohol Depend. 2017 Dec 7;183:134-140).  Kratom does cause constipation that may be significant. At low doses it is well tolerated, producing a stimulant effect, whereas with high doses it produces euphoria and an anesthetic effect. At even higher doses it may produce psychosis, seizures or death. (A A Case Rep. 2017 Oct 26).  A growing number of people are treated in Emergency Departments in the US for overdose symptoms associated with Kratom including nausea, difficulty sleeping, irritability, restlessness, mood swings, diarrhea, running nose, muscle aches, and joint pain. Overdoses on Kratom produce seizures, psychosis, coma,  hallucination, extreme paranoia, severe vomiting, respiratory depression and in the worst scenarios, death (Pain Physician. 2017 Jan-Feb;20(1):E195-E198). 

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Kratom grows in red vein, green vein, and white vein leaves, each reported to have different properties.  For instance, red vein is reported to have more pain killing properties while green is more  "pep".  The usual dosage of Kratom is 1-3g of leaves (yes, some people eat the leaves) or powder or capsules.  The powder and capsules may be cut with other substances and may not be pure.  Kratom is reported to be 13 times as potent as morphine.  The green vein kratom has a mixture of opioid effect and increasing "pep" or stimulation while white vein kratom is primarily a stimulant. 

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Kratom addiction has been shown in chronic users.  More than half of the regular users (>6 month of use) developed severe Kratom dependence problems, while 45% showed a moderate Kratom dependence. Physical withdrawal symptoms commonly experienced include muscle spasms and pain, sleeping difficulty, watery eyes/nose, hot flashes, fever, decreased appetite, and diarrhoea. Psychological withdrawal symptoms commonly reported were restlessness, tension, anger, sadness, and nervousness. The average amount of the psychoactive compound, mitragynine, in a single dose of a Kratom drink was 79mg, suggesting an average daily intake of 276.5mg. Regular users who consumed ≥3 glasses Kratom per day, had higher odds of developing severe Kratom dependence, withdrawal symptoms, and inability to control Kratom craving. (Drug Alcohol Depend. 2014 Jun 1;139:132-7)

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