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Your weekly dose of drug facts while dispelling fiction
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You're listening to locally produced programming created in KUNV Studios on Public Radio. KUNV 91.5. Welcome to another episode of The Chemical Collective. The Chemical
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Collective will offer you a weekly dose of drug facts and fiction. Today we're talking about the traditional medicine kratom and some of its effects on the
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brain and society. So let's start off at the beginning. What is it used for? Yeah, that's a great question. So, kratom is actually a plant that's native to Southeast Asia, and it's really known for its analgesic or pain-relieving and stimulant qualities. It's from the same family of flowering plants as the coffee plant, and communities use the leaves of the kratom tree as traditional medicine to help minimize and treat pain, gastrointestinal issues and increase energy levels. So kratom is native to countries in Southeast Asia.
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Can you expand on how kratom has been used there historically? Yeah, so the
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kratom tree is indigenous to Thailand, Malaysia, Indonesia, Papua New Guinea and typically it's been used by people who are working hard all day long to combat fatigue. It can be chewed so it's got this sublingual, submucosal kind of application and then kind of for stronger indices people will grind it up into a little powder and then steep it in a tea. I usually used, you know, people working the fields all day long, super long hours, again to kind of relieve maybe possibly both the boredom and then also some of the pain associated with those type of jobs.
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Earlier, you guys mentioned that kratom is an anxiolytic, like it's pain relieving. How has
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kratom been used to treat pain throughout time? Yeah, so not an anxiolytic, it's an analgesic.
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And analgesics are a form of pain relieving compounds. Yeah, and different types of pain
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that kratom can be used to treat. For example, you can use it topically. So you can apply it onto the surface of your skin for burns and wounds. Anecdotally, it's been used that way for a long time. But there's a body of evidence that mentions that people tend to use kratom to help treat chronic pain. So really intense pain that lasts all day. For this reason and others, kratom is considered to be opiate-like. Okay, what do you mean by opiate-like?
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What is an opioid?
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So, opioids are a whole different class of drugs. So, we can class certain drugs like psychedelics, antipsychotics. Opioids are a class of drugs that really are analgesics. So as we already said, these are things that relieve pain. Probably the most common analgesics related to the opiate family that we talk about are things like heroin and morphine. And so, well, in the news, a lot of these drugs and especially fentanyl with the fentanyl crisis have gotten, you know, a really bad rap. You know, drugs are neither really good nor bad. And so when you have cases of intense pain, since it's seen in, you know, end of stage life, hospice, these can be amazing compounds to relieve that pain.
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So I hear a lot of things about opioids as far as like their side effects being serious. Are they dangerous?
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Yeah, well, opioid use can come with risks and severe adverse effects depending on a variety of different factors, including how long you've been taking the painkiller or opioid and the dose that you need to feel the relief from your pain. Together, I guess you can consider these factors as what makes them dangerous. But kratom is actually an interesting opioid-like substance because it isn't just used for its primary stimulant or pain relieving effects, right? People tend to use it as a substitute for other opioids like morphine to help treat addiction and dependence on these other opioid substances. And there's evidence of this practice in multiple countries including Thailand and Malaysia, but the extent of creative use on addiction is still
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largely unknown. Yeah and back into that point on addiction, you know it's important to think about opioids again, the fentanyl crisis, we see a lot of people getting addicted. But remember you know there's a lot of studies that came out of the Vietnam War era where we had a lot of soldiers that were highly addicted to morphine and heroin and as soon as they returned stateside, they didn't have any of these addiction problems. Similar to, you can go in for hip surgery and you can be on some sort of opioid for a week or two to relieve that major pain from the surgery, but when you go home you don't have the addiction again. So what's interesting is opioids is exactly like what April said, we don't fully understand them. But more to the point, we don't really fully understand addiction yet.
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Would you guys say that kratom is something that's commonly used in the United States?
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Well, I'm not really an expert on who's using and who's not. It makes my kind of Reddit threads once in a while. It's largely exported into the United States from other countries. So on its own in that it makes it a little harder to come by versus things that kind of grow locally like some of the cactuses. You can find it in different forms. I've seen online, capsules, etc. But it really has become part of the, you know, alternative pain crowd, people that don't want the heroin, don't want the morphine to treat their pain.
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You've mentioned multiple times now that kratom is an opioid-like substance that acts on opioid receptors to treat pain. But can
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you tell me more about what opioid receptors are? Yeah, opioid receptors are part of a really large and diverse super family of receptors in the brain. And this family of receptors are called the G-protein coupled receptors, or GPCRs. And they're really interesting because they regulate most of our physiological responses to hormones, different neurotransmitters or brain chemicals, and other environmental stimulants. Okay, so how do or how does Kratom interact with these G-protein coupled receptors in the brain to treat pain?
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Great question. Let's go back a step though. So we said that these are G-protein coupled receptors. You know, if we were to broadly class all of the receptors into your brain into two categories, one would be these G-protein couple receptors and the others would be ionotropic receptors. What ionotropic receptors do is they pass ions. This is really fast, so you can imagine like a copper wire passing ions along electricity. As April said, these G- protein receptors really change how the cells are signaling. So now when we look at the brain, the brain has both classes within the same ligand category. What does that mean? It means if you take something like acetylcholine, it has both an inotropic and a metabotropic subset. And the benefit of that is the inotropic signals fast and the metabotropic signals slow. So to kind of answer your question, really these G protein couple receptors are going to help for things not like acute pain necessarily, but more for chronic pain where DNA and other things have been enabled in the system.
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When it comes to the breakdown of like the specific chemical components of kratom,
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can you speak more on that?
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Yeah, so once the kratom leaf itself is ingested, whether you know you're chewing on the leaf or taking it in a tea, it's called, it's metabolized and so this means that all of the chemical constituents or components are breaking down into as many small components as possible. And the specific chemical components are mitragynine, which is an alkaloid, and an alkaloid is a type of compound found in plants that have really profound effects on human physiology. So I'm guessing that there's maybe different kinds of opioid receptors? Is that what I'm hearing? Like, does this mitragynine and these parts of the
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alkaloid that you're referring to, like, do they interact with different types of
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receptors? Let's go back. Let's back up a bit. So when we look at this word alkaloids, let's talk about what that means first. And it's very interesting and easy for us in Southern Nevada to understand this because anytime you go in the desert, we see these salt flats, that white stuff is basically alkaloids. And really when you kind of condense a whole bunch of water, you get an alkaloid substance. Plants are exquisite at using these. And most of the drugs that we get from plants are alkaloid based. And it's this ability really to be solubilized, to be a salt that then affects our cells.
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Okay, that makes a little bit more sense. I was curious about maybe kratom's effect more so on the body. How does it work? Well, I'd like to focus a little bit more on the brain,
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maybe, and how kratom's constituents actually act on the opioid receptors. So there are many different kinds of opioid receptors, these G-protein coupled receptors we mentioned earlier, and some of the subtypes are called the mu, delta, and kappa opioid receptors. And they can differentiate based on the area of the brain, where they're most abundant and enriched, as well as the actual effects or responses that are associated with their activation. And so, Kratom's constituents, mitragynine and 7-hydroxymitragynine, actually bind to delta and mu opioid receptors to mediate that pain-relieving analgesic response.
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And so, one of the things this does is it really creates a state of euphoria or a state of feeling of intense excitement and happiness. Most of those receptors, this is interesting to know, we've been using opioids for thousands if not tens of thousands of years and really only until probably the late 70s and 80s, which is really recently scientifically, have we been able to understand the receptors in the body. And so we call these class of receptors and the drugs and the ligands in your body the endosipenes. And so largely where the endosipenes are is in your spinal cord in your gut. And this kind of makes sense, right? If you're moving a lot all day long, going on a long run or something like that, we want to release these endosipenes to help us not move as much. Further to that, if you look at the plant, the plant isn't trying to give us this feeling of intense excitement or happiness, right? The plant is trying to make us stop moving so we don't need more of it. And so when we look at what Kratom does, you know, it really creates this intense excitement and happiness driven from our PNS, our peripheral nervous system, and then triggering the receptors in our brain, our CNS. How does
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exactly Kratom work on the body?
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Okay, well, like we just mentioned, outside of the central nervous system in the periphery, kratom can affect your cardiovascular system. It can increase your heart rate, constrict your blood vessels. It can work on your gastrointestinal systems. It can even increase your appetite. And the specific effects of kratom use can actually vary depending on dose and how you take the substance. And individual differences in the people that take them probably play a major role also. That's a great point, April. And that's one thing we always talk about, right?
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That the details and the devil are in the dose.
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How long do the effects of kratom last?
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Well, kind of tying back into the devils and the dose, it depends on the dose. It also depends on the person, right? So if you have somebody that's in intense pain, that could be very different than, you know, somebody that's not. And so typically, a smaller dose, whatever that means per person, could last anywhere from minutes to hours. And then larger doses can then last several hours. So this is something that again, really depends on several different factors. Dose, also route of administration, right? So we're largely taking this orally, but it's very different if you choose some and keep it in the side of your mouth versus you make a highly concentrated
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tea.
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Can you guys speak maybe a little bit more about who might come across kratom or who would want to use it?
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Well, kratom use isn't restricted or limited to any group of people. Usually the type of person that's seeking kratom use is going to be someone that's looking to seek it for its stimulatory or pain relieving effects. And people have really started to consider it as like an alternative to pain medications.
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Okay, so is that why maybe some people may want to use Kratom in the first place?
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Well, it's like any drug.
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I'm not sure why anyone would want to use a drug at some level, other than it's prescribed condition, right, by a doctor. But, you know, one of the main reasons people use recreational drugs is to escape. And so you can think of here's a cheap way to escape. Also, you know, kind of like coffee, everyone thinks coffee, which by the way, kratom is in the same family as coffee, is a stimulant. It is, but it's also a strong, strong mood enhancer. So you have something that you can escape, makes you feel happy, gives you a little energy boost. I think that's probably one of the main reasons people
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are trying kratom. A little earlier you guys mentioned that kratom is also used to help with withdraw from opioids like morphine. Can you expand on this? Yeah, there's been anecdotal evidence in other countries that kratom can be potentially used to help treat substance use disorders and it can really help individuals overcome opioid addiction and alleviate those very severe and painful opioid withdrawal symptoms, like intense sweating or convulsions, because these are really unpleasant, right? And taking kratom in small amounts can help ease withdrawal in general. In addition, kratom is considered as an alternative due to its ability to elicit euphoric feelings like opioids, and they can be obtained more easily than other drugs that are going to be prescribed for withdrawal.
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Yeah, and so if you look at kratom in the context of, say, something like methadone that's already out there, you have a drug that's not as highly activatable, say as heroin, and has a slower onset. So you're kind of getting that slow, low drive that, again, our reward center of our brain like the basal ganglia can tap into, decrease the need for craving use, it still could be and it looks like there's some evidence for this too, addictive on itself. So we're not saying it's curative or a replacement, but it could be kind of a middle step much like methadone. Methadone can be addictive too.
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Are there any risks that might be associated specifically with kratom use? Yeah, there are a variety of risks that can be associated with it because in general, the effects of kratom on the human body aren't fully understood, right? We know that it interacts with opioid receptors, but it's not necessarily considered an opioid itself. Some things that we mentioned already are its ability to become addictive and develop, people can develop dependence on this. So using kratom over the long term can lead to this physical dependence and addiction. Once you stop taking it, you can develop withdrawal symptoms also, and this craving for kratom. And when you stop using it, just like when you stop using coffee, you can become more irritable, maybe have some feelings of anxiety. There's evidence anecdotally also that consuming very high doses of kratom could be toxic. This also probably relates to individual differences and how you might respond to these different doses. You don't want to be using kratom with other substances, right? You don't know how they interact with each other. Kratom isn't regulated in the United States, so there's the idea that you might not exactly know the quality or purity of the kratom that that someone might be taking. And these are a lot of different risks that could be associated, but again, there needs to be more ongoing research to actually understand how they affect the body long-term.
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Yeah, to add to that too, that when you look at the legal status, it's kind of in a gray area here right now, but there's many countries that have banned it just for this reason, right? And part of that is the toxicity on the liver that it can have. And there are people that have reported obviously becoming addicted to it. You know, it's kind of like I know the story about Nicorette that came out for nicotine, right? And there's a lot of people that have been able to kick cigarettes and other tobacco products because of Nicorette. But there's a lot of people that start chewing Nicorette, right, for the, you know, the attention focusing aspects that nicotine offers but then become addicted to nicotine and start smoking. So, you know, again, we really need a better understanding of both addiction and kratom to understand this.
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How does kratom compare to other opioids, opiates, excuse me?
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Well, I think, you know, we've said this a couple of times and it's important to talk about this and, you know, I'm not against plant matter and plant material, but the opiates that we get typically come from a type of poppy and it's highly condensed. And from that, then you can synthesize out the major components and create them, right? You have these alkaloids, depending on where they're growing, how they're growing, you'll have different concentrations. However, typically, it's much less potent than other type of opioids that are out there.
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So being that it's less potent, does that also make it like less addictive than other opioids? Well, I guess that's up for debate. We don't really have the research or other evidence to back that up. Kratom is marketed as a less addictive alternative to opioids in general, but its actual addictive potential isn't well understood, and it's going to continue to be the ongoing subject of debate until the research is done and more evidence is gathered.
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And I think on that point, we always talk about this, you know, in the sciences, what's more important, nature or nurture? And it usually turns out to be a little bit of both. And so we look at the drug and then we look at the addiction, it's kind of that same question, nature versus nurture. And so it's really going to depend on the nature of the addiction being treated with kratom and the kratom itself. And I think as April's a student, we said a couple of times, we probably need a lot more research in this area. I'm actually really curious about
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the scheduling of this substance, kratom. Can you guys speak a little bit to that? Yeah, so the legal status of kratom varies depending on which country you're in, which state and county within a certain country. In the United States, kratom is not a controlled substance under federal law, and it's also not approved by the FDA, so the U.S. Food and Drug Administration, for any purposes.
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Yeah, and I think that's a pretty big tell, right? If this was a medicine that, you know, wasn't dangerous at any way at all, it would have passed very quickly, FDA, but it hasn't been able to, right? Because we do know it is a medicine and needs to be structured.
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Okay.
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How does Kratom compare as far as the scheduling is concerned?
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How does it compare to other countries?
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Yeah.
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So Kratom is actually legal in some other countries outside of the US. There's a lot of regulation and licensing in countries where the plant is actually native. So the Southeast Asian countries that we were referencing earlier. Yeah. Yeah, and interestingly, in some countries in Europe, it's considered a medicine, so you do need a prescription to be able to take kratom. Yeah, interesting idea there too, a bigger concept that I hope we can explore more
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on this show.
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When is something a medicine? When is it recreational? When should it be scheduled? When should it not be scheduled, right? If we look at, you know, cannabis obviously is not fully understood in this country yet. At some levels, in some counties, in some states, it's pseudo-legal but not legal at the federal level, right? And there's been some rescheduling recently of CBD, which is a component of cannabis that was deschedulized, so it's tricky, right? And I think it starts with understanding the plant, its use, its historical use, kind of how we've, you know, set up the segments of the show. But it seems in countries where there's a huge historical use and, you know, dare I say the people are culturally responsible enough to handle it, they're able to use it. In other countries, we kind of worry and we look for legislation.
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Leaping off of that concept, do you think that's why kratom is still so controversial?
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I think all drugs are controversial. I think there's a class of drugs in my mind that have a huge potential to be explored and kratom would definitely be one of them. But the issue is, right, where do you jump off? They're currently in a gray area, right? So people can kind of get them, kind of not get them. That doesn't really facilitate research, right? If you want anything done, really, you have to stick capitalism at some things at some level as much as you agree or disagree with that. So nobody's going to hire somebody to start a kratom business because it's not legal. Right. So, you know, I think as the medicine becomes more useful, more understood, then we'll feel, see those niche markets kind of fill in.
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So beyond what you guys kind of have already alluded to about maybe there being a potential for addiction, can you guys think of any other reasons why someone might want to stay away from kratom? Yeah, so beyond the potential for abuse like a number of other compounds, there is evidence anecdotally that there are some potential adverse effects after using kratom. These can range from seizures all the way to respiratory depression. These are pretty serious, but again, no one really knows the long-term effects of kratom use, so that's something to be wary of.
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Yeah, and in this, you know, it's really understanding all drugs. Most drugs that work in the brain work at a couple sites. The first site is the synthesis or creation of more of the neurotransmitter, then the ability to release across the synaptic cleft, and then the postsynaptic site. So you have a presynaptic and postsynaptic site, and then you have a way, you know, to kind of get rid of all that spillover at the cleft, which is reuptake. Most drugs in the brain work on reuptake. Everything else is a little dangerous, right, because you're not regulating it. So we don't really even understand for kratom at some level what receptors are the chief receptors. Is it back to those ones in the spinal cord? Is it the ones in the brain? And in order to have a significant dose, right, this is going to be orally, it definitely will affect the liver, right? So yes, as always, I always say the same thing, more research is needed.
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Okay, well it looks like we actually have a little bit of time to answer some questions that we received from students here at UNLV regarding kratom use. Are
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you guys up for it? Always. Okay, does kratom cause hallucinations? Okay, that is
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a good question. It's hard to answer, so let's start off by saying what is a hallucination? Most of the opioids and probably the most classically studied is ketamine. Ketamine, a lot of people think, works on glutamate. It does. It also works on the opioids a lot. It's not a true hallucination. It's more what's called a non-dissociative. So you go to this thing called the K-hole where you don't know who you are, what you are. Not really a hallucination. So Kratom has had some reports of hallucination type stuff going on with it. These aren't, you know, documented journals or anything like that. So my guess is as the science peels out, we're going to find that it's not a true hallucination. It's more like a K-hole that you would see from ketamine. Okay.
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This next one is interesting too. What, excuse me, is Kratom better for certain types of pain? Yeah, that's a really great question. So there is some evidence that someone might want to have kratom for one type of pain versus another, but we're not exactly sure. So some users might want to use kratom for that chronic, long-term pain that's really debilitating in your everyday life. Some examples are chronic pain associated with arthritis, fibromyalgia, and people are considering using it acutely for injuries and following surgery.
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And I always say we're also lucky to be in the field of neuroscience because we know so little and we're going to be in so demand to figure this out. So just like we know very little about addiction, we're really changing our ideas on this. We're really changing our ideas on what pain is. So there's definitely acute and chronic, as April's talked about, but there's also pain that is kind of just sensed and felt, and so at some level, this could be at the heart of things like phantom limb. Looks like these things might be really useful for disorders of fibromyalgia, phantom limb, but again, we need a lot more research to figure that out. Great question.
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All right, it looks like we have one more question, and you guys may have already touched on it a little bit, but it is, why don't we use Kratom more often in the US?
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Well, yeah, we said it's a gray area, and so one of these things is, are we not using it, or we're just not aware of who and when it's being used? That's the first thing. The other thing is, you know, we're in the midst of a fentanyl crisis, which, you know, you can probably find fentanyl in most places, so, and probably for pretty cheap, so, I don't have the answer to that, but, you know, it could be the potential for addiction, depends, could be that other things are out there more available, but, you know, again, we probably need to do some socioeconomic study and figure out who and when and where people are using
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it.
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Okay, it looks like we've reached time for today.
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Thank you guys so much for the great discussion. Yeah, and thanks to those listening for coming to Yeah, and thanks to those listening for coming to The Chemical Collective to get your weekly dose of drug facts and fiction.