Licit Uses: There is no legitimate medical use for kratom in the U.S.

Chemistry and Pharmacology: Over 25 alkaloids have been isolated from kratom; mitragynine is the primary active alkaloid in the plant. Pharmacology studies show that mitragynine has opioid-like activity in animals. It inhibits electrically stimulated ileum and vas deferens smooth muscle contraction. Through actions on centrally located opioid receptor, it inhibits gastric secretion and reduces pain response. Kratom has been described as producing both stimulant and sedative effects. At low doses, it produces stimulant effects, with users reporting increased alertness, physical energy, talkativeness and sociable behavior. At high doses, opiate effects are produced, in addition to sedative and euphoric effects. Effects occur within 5 to 10 minutes after ingestion and last for 2 to 5 hours. Acute side effects include nausea, itching, sweating, dry mouth, constipation, increased urination, and loss of appetite. Kratom consumption can lead to addiction. In a study of Thai kratom addicts, it was observed that some addicts chewed kratom daily for 3 to 30 years (mean of 18.6 years). Long-term use of kratom produced anorexia, weight loss, insomnia, skin darkening, dry mouth, frequent urination, and constipation. A withdrawal syndrome was observed, consisting of symptoms of hostility, aggression, emotional lability, wet nose, achy muscles and bones, and jerky movement of the limbs. Furthermore, several cases of kratom psychosis were observed, where kratom addicts exhibited psychotic symptoms that included hallucinations, delusion and confusion.

Illicit Uses: Information on the illicit use of kratom in the U.S. is anecdotal. Based on information posted on the Internet, kratom is mainly being abused orally as a tea. Chewing kratom leaves is another method of consumption. Doses of 2 to 10 grams are recommended to achieve the desired effects. Users report that the dominant effects are similar to those of psychostimulant drugs. Other countries are reporting emerging new trends in the use of kratom. In the United Kingdom, kratom is promoted as an “herbal speedball.” In Malaysia, kratom (known as ketum) juice preparations are illegally available.

User Population: Information on user population in the U.S. is limited. Kratom abuse is not monitored by any national drug abuse surveys.

Illicit Distribution: The System to Retrieve Information from Drug Evidence (STRIDE), a federal database for the seized drugs analyzed by DEA forensic laboratories, and the National Forensic Laboratory Information System (NFLIS), which collects drug analysis information from state and local forensic laboratories, indicate that there was one drug report of mitragynine, the primary active alkaloid in kratom, in 2010, 44 reports in 2011, and 81 reports in the first six months of 2012. Kratom is widely available on the Internet. There are numerous vendors within and outside of the U.S. selling kratom. Forms of kratom available through the Internet include leaves (whole or crushed), powder, extract, encapsulated powder, and extract resin “pies” (40g pellets made from reduced extract). Seeds and whole trees are also available from some vendors through the Internet, suggesting the possibility of domestic cultivation.

Control Status: Kratom is not scheduled under the Controlled Substances Act.