A drug called kratom is being sold legally in bars in Florida and other states, where some people are reportedly using it to wean themselves off their heroin addiction.
But as a recent New York Times story reports, the drug may be addictive itself, and could lead to a relapse with heroin, which is cheaper and more potent.
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Kratom is a psychoactive drug derived from the leaves of the kratom plant (Mitragyna speciosa) that has been widely used in Southeast Asia — especially Thailand, where it is now banned — as a recreational drug. But it has recently become popular in the West for its supposed medicinal purposes. The drug is known for its sedative effects, but in low doses, it also acts as a stimulant.
Reports of kratom's effects vary, but some users report feelings of stimulation, euphoria, sedation, pain relief, and a lasting "glow." At higher doses, some people report dizziness, nausea, and vomiting.
And because it's believed to work on the brain similarly to heroin, some people have been self-administering it as a treatment for heroin addiction.
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The Times reports that a growing number of bars in South Florida have started selling the drug as a tea in containers that resemble juice bottles. Powdered forms of the leaf are also available at shops that sell drug paraphernalia and at convenience stores, as well as online. Kratom is also sold in Colorado, New York, and North Carolina.
According to the Times, the drug has been banned by several states, including Indiana, Tennessee, Vermont and Wyoming; meanwhile, Florida and New Jersey are waiting to pass bills until more is known about it.
How Kratom affects the brain
Like heroin, kratom belongs to a class of pain-relieving drugs called opioids, which are found naturally in the opium poppy plant and act on opioid systems in the brain. These systems play key roles in modulating how we respond to pain.
Kratom's main psychoactive ingredient is a compound in its leaves called mitragynine, which is thought to act on these receptors in a way that is similar to the powerful pain reliever morphine, Oliver Grundmann, an associate professor at the University of Florida's College of Pharmacy, told Business Insider.
"We don't know directly the potency of metraginin," Grundmann said, but "it's supposed to be less potent than morphine."
While there haven't been any reported fatalities directly linked to kratom use, there was the case of a young man in South Florida who was reportedly addicted to the drug when he died of a car crash.
Grundmann and other experts warned of the drug's addictive qualities, and don't recommend it as a treatment for opioid addiction.
Treating opioid addiction with opioids
Opioid addiction is commonly treated using other opioids — for example, the drug methadone, an opioid used to treat pain, is sometimes used to treat heroin addiction. But these drugs are of pharmaceutical quality, and have been approved for clinical use.
Kratom, on the other hand, has not been approved for treating opioid addiction. And like all opioids, kratom is potentially addictive itself.
Though we don't have as much experience with kratom, it's probably not as addictive as heroin or prescription opioids like morphine, Nelson said. An opioid's effects depend on how quickly it builds up in the brain, as well as how strongly it binds to and stimulates opioid receptors, and kratom takes a far higher dosage to reach the same level of euphoria as something like heroin, he said.
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But given that we don't know the dosage or fully understand its effects, "it's probably not an appropriate therapy [for heroin addiction] at this point," Lewis Nelson, head of toxicology at NYU Langone Medical Center, told Business Insider.
However, some say we shouldn't rule out the drug's medical use.
Marc Swogger, an assistant professor of psychiatry at the University of Rochester Medical Center, told Business Insider in an email that we should consider its therapeutic potential instead of waging war on it like many other drugs. But he wouldn't recommend using it yet, because its effects haven't been studied in a controlled and thorough way, with medical supervision.
For now, people trying to recover from addiction should probably stick to traditional treatments, said Nelson.
"If anybody does think they have a problem with opioids, they should seek proper therapy," Nelson said. Self-medicating with kratom "is not a safe thing to do, nor is it probably effective."