HERBAL DRUG UPDATE: KRATOM <a href="http://www.usdoj.gov/dea/programs/forensicsci/microgram/mg0705/mg0705.html" target="_blank"> From the NDIC Narcotics Digest Weekly 2005;4(16):4 </a> Some epidemiologists have reported that kratom--an herbal drug derived from a tropical tree native to Southeast Asia--has significant abuse potential in the United States, where it currently is legal. Kratom leaves (fresh and dried) and plants are widely available on the Internet and probably are sold at some "head shops" in the United States. Dried kratom leaves are relatively inexpensive, often selling for $10 to $40 per ounce. Kratom users typically chew fresh leaves or make a tea from dried leaves, but some users smoke the dried leaves. Because kratom abuse has been recognized in several regions of Asia, the herb has been made illegal in Australia, Burma, Malaysia, and Thailand. The primary active alkaloid in kratom is mitragynine; however, other alkaloids are present and account for a variety of effects, which are dose-dependent. Low doses usually produce stimulant effects; higher doses usually produce sedative and euphoric effects. Some users report “lucid dreaming.” Effects typically begin within 5 to 10 minutes after ingestion and last approximately 6 hours. Individuals who chronically use kratom become thin, their skin darkens (particularly on the cheeks), and they experience dry mouth, constipation, and frequent urination. Withdrawal symptoms can include muscle and joint pain, hostility, aggression, eye-watering, and spastic limb movements. Users who combine kratom with nervous system depressants may experience respiratory depression, which may cause them to stop breathing. NDIC Comment: Kratom's wide availability on the Internet suggests that demand is extensive; however, kratom abuse is not monitored by any national drug abuse survey, and NDIC has not yet received law enforcement reports regarding kratom abuse in the United States. Newspaper reports regarding kratom abuse recently were published in Malaysia, similar reports have surfaced in Great Britain, and several web sites - some based in the United States - frequented by recreational drug abusers contain extensive information about kratom. It is likely that kratom abuse is unrecognized in areas where it is occurring because the crushed, dried leaves resemble other plant-based drugs, and the effects mimic effects of other drugs. One potential user population for kratom is opiate addicts who may attempt to self-treat if they do not have access to methadone programs or if they are reluctant to seek professional treatment. Some medical researchers have speculated that kratom may be useful as a substitute for methadone in treating opiate dependency, although more research is needed.