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Substance Profile: Kratom

kratom-athletesHistorically, agricultural workers in southeast Asia chewed Kratom leaves to increase work output and offset fatigue. Since those days, Kratom – known scientifically as Mitragynine speciosa – has also been used as a substitute for opium, and as a way to manage the symptoms of opioid withdrawal.

 


What is Kratom?

Kratom is a plant that produces mitragynine and 7-hydroxymitragynine, both of which have opioid-like effects. At low doses, mitragynine has stimulant effects similar to cocaine, but at higher dosages it has an effect more like morphine.

 

Is Kratom prohibited in sport?

No, Kratom is not prohibited. For several years it was on the WADA Monitoring program, but as of 2018, it will no longer be monitored by WADA.

While Kratom is not currently prohibited, athletes are advised to steer clear of Kratom for health reasons, many of which are discussed below.

 

What are the health risks associated with Kratom?

As you can see in the table below, there are a number of dangerous side effects associated with Kratom. The DEA is aware of at least 15 deaths associated with the use of Kratom between 2014 and 2016, and poison control centers received over 600 calls related to Kratom between 2010 and 2015[1].

The FDA also issued a public health advisory on November 14, 2017, stating, “evidence shows that kratom has similar effects to narcotics like opioids, and carries similar risks of abuse, addiction and in some cases, death.”

 

 

Adverse/Toxicological Effects of Kratom
from Cinosi et al (2015) [8]

Short term use side effects Nausea, constipation, sleep problems, temporary erectile dysfunction, itching, or sweating
Long term use side effects Anorexia, dry mouth, problems in diuresis, darker skin, and hair loss
Withdrawal symptoms Hostility, aggression, aching of muscles and bones, jerky movements of the limbs, anorexia and weight loss, and insomnia
Infrequent effects Seizures (individuals using high doses of kratom, either alone or combined with other drugs), intrahepatic cholestasis, psychotic symptoms, Adult Respiratory Distress Syndrome, and hypothyroidism
Fatalities Kratom mixed with other substances: O-desmethyltramadol; propylhexedrine; over-the-counter cold medications and benzodiazepines; venlafaxine, diphenhydramine, and mirtazapine; zopiclone, citalopram, and lamotrigine

 

Is Kratom legal outside of sport?

Kratom is not currently on the Controlled Substances Act so it is not illegal in the way that heroin and cocaine are illegal. In August of 2016, the DEA announced its intention to add Kratom to the Controlled Substances Act, but there was not enough public support to justify making it a scheduled drug. However, U.S. health agencies are continuing to monitor the hazard that Kratom poses to public health.

It’s also important for athletes to remember that Kratom is NOT legal in dietary supplements. Dietary supplements and bulk dietary ingredients that contain Kratom are considered adulterated under the law because they contain a new dietary ingredient for which there is not enough information to support safety[2].

As such, it is not legal to sell or market dietary supplements that contain Kratom. Unfortunately, Kratom is readily available on the internet and is often inaccurately marketed as a “legal high,” so athletes should avoid any supplement that contains Kratom.

 

Resources

[1] DEA Announces Intent to Schedule Kratom. August 30, 2016. https://www.dea.gov/divisions/hq/2016/hq083016.shtml

[2] Import Alert 54-15. December 20, 2016. https://www.accessdata.fda.gov/cms_ia/importalert_1137.html

[3] E. Cinosi, G. Martinotti, P. Simonato, D. Singh, Z. Demetrovics, A. Roman-Urrestarazu, F. S. Bersani, B. Vicknasingam, G. Piazzon, J. H. Li, W. J. Yu, M. Kapitany-Foveny, J. Farkas, M. Di Giannantonio, O. Corazza. Following “the Roots” of Kratom (Mitragyna speciosa): The Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries. Biomed Res Int. 2015, 2015, 968786.

[4] DrugFacts: Kratom (2016). National Institute on Drug Abuse. Available at: https://www.drugabuse.gov/publications/drugfacts/kratom [Accessed on Oct 25 2016].

[5] A. Varadi, G. F. Marrone, T. C. Palmer, A. Narayan, M. R. Szabo, V. Le Rouzic, S. G. Grinnell, J. J. Subrath, E. Warner, S. Kalra, A. Hunkele, J. Pagirsky, S. O. Eans, J. M. Medina, J. Xu, Y. X. Pan, A. Borics, G. W. Pasternak, J. P. McLaughlin, S. Majumdar. Mitragynine/Corynantheidine Pseudoindoxyls As Opioid Analgesics with Mu Agonism and Delta Antagonism, Which Do Not Recruit beta-Arrestin-2. J Med Chem. 2016, 59, 8381-97.

[6] N. Harun, Z. Hassan, V. Navaratnam, S. M. Mansor, M. Shoaib. Discriminative stimulus properties of mitragynine (kratom) in rats. Psychopharmacology (Berl). 2015, 232, 2227-38.

[7] W. C. Prozialeck, J. K. Jivan, S. V. Andurkar. Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc. 2012, 112, 792-9.

[8] S. Guddat, C. Gorgens, V. Steinhart, W. Schanzer, M. Thevis. Mitragynine (Kratom) – monitoring in sports drug testing. Drug Test Anal. 2016,

[9] C. Ingraham. The DEA is withdrawing a proposal to ban another plant after the Internet got really mad. Washington Post, 2016. https://www.washingtonpost.com/news/wonk/wp/2016/10/12/the-dea-is-reversing-its-insane-decision-to-ban-the-opiate-like-plant-kratom-for-now/ [Accessed on Oct 14 2016].

[10] Import Alert: DETENTION WITHOUT PHYSICAL EXAMINATION OF DIETARY SUPPLEMENTS AND BULK DIETARY INGREDIENTS THAT ARE OR CONTAIN MITRAGYNA SPECIOSA OR KRATOM. FDA.gov, 2014. http://www.accessdata.fda.gov/cms_ia/importalert_1137.html [Accessed on Oct 17, 2016].

[11] C. Ingraham. The DEA is withdrawing a proposal to ban another plant after the Internet got really mad. Washington Post, 2016. https://www.washingtonpost.com/news/wonk/wp/2016/10/12/the-dea-is-reversing-its-insane-decision-to-ban-the-opiate-like-plant-kratom-for-now/ [Accessed on Oct 14 2016].

[12] Kratom seized in California by US Marshals Service. FDA.gov, 2016. [Accessed on Oct 17, 2016].

 

 

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