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Medicinal Herb Kratom Classified by US FDA as an Opioid

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Mitragyna speciosa or kratom is a tropical evergreen tree native in Southeast Asia and has been used in traditional medicine since the 19th century. However, the US Food and Drug Administration announced that the kratom plant has opioid properties and is unsafe for medical use.

People in certain regions, such as Thailand and Indonesia, define the plant as a medicinal herb used for chronic pain management, treatment of opioid withdrawal symptoms, and recreational activities. However, pharmaceutical experts classify it as an opioid because of its chemical components and warn people of the potential danger the plant can cause in human health.

The US FDA conducted a scientific analysis using a computational model to determine the compound in kratom. The computational model is called Public Health Assessment via Structural Evaluation or PHASE methodology. It is a tool that simulates the chemical components of a substance at the molecular level using 3D technology. It can also be used to determine how the chemicals interact with the brain and how it behaves inside the body.

With PHASE, the researchers were able to analyze the chemical structures of the 25 most prevalent compounds in the plant. They concluded that all 25 compounds have structures similar to controlled opioid analgesics or morphine derivatives, drugs that act on the nervous system to relieve pain but can induce drug dependence and withdrawal symptoms if abused.

Then, they analyzed the 25 compounds to a specific software. The analysis revealed 22 of the 25 compounds, including mitragynine, can bind to mu-opioid receptors in the body. The analysis also confirmed that two of the top five most prevalent compounds, including mitragynine, are opioid agonists, chemicals that act on opioid receptors.

According to the Centers for Disease Control and Prevention, an opioid is any natural or synthetic chemical that interacts with opioid receptors of the body. That definition classifies kratom as opioid because of its chemical components. Mitragynine is a primary active alkaloid in the plant that produces stimulant effects in low doses. However, it produces euphoric and sedative effects in high doses. In short, the compound has psychoactive properties.

"Even though it's not a direct descendant of the opium plant, it still has direct effects on the opioid receptors. It's not like you need an opium poppy to have opioid effects,” said Wes Hunter, the director of the pharmacy at UCHealth Yampa Valley Medical Center.

Opioids fall in a spectrum based on their effects on the body. According to Hunter, both fentanyl and loperamide are opioids, but fentanyl is a very strong painkiller which is up to 100 times more potent than morphine, which can cause drug dependence. Loperamide does not cause euphoric effects unless taken in extra large doses. In kratom-related deaths, experts cannot precisely determine if the herb alone caused it because the people took something else after kratom consumption.

“Cases of mixing kratom, other opioids, and other types of medication is extremely troubling because the activity of kratom at opioid receptors indicates there may be similar risks of combining kratom with certain drugs, just as there are with FDA-approved opioids,” said Dr. Scott Gottlieb, Commissioner of the US FDA.

People who are taking kratom may experience one or more adverse effects such as nervousness, nausea and vomiting, sweating, itching, lethargy, and aggressive behavior. Chronic users exhibit severe adverse effects including thinness of the body, darkened skin, dryness of the mouth, constipation, and frequent urination. Abrupt cessation of kratom use or stopping cold turkey can cause withdrawal symptoms like joint and muscle pain, hostile behavior, watering of the eyes, and spastic limb movements. Kratom drug dependence can be treated in several ways including detoxification and cognitive behavioral therapy.

The US Food and Drug Administration also mentioned in the announcement that kratom should not be used in treating any kind of medical conditions. It is also not an alternative to any prescription opioid painkiller. Any individuals who are addicted to the plant are urged to seek help from a healthcare provider. The medications that can help treat addiction and drug dependency on kratom are buprenorphine, methadone, and naltrexone.

1. Buprenorphine is a partial opioid agonist that has fewer effects compared to full opioid agonists, such as heroin and methadone. It is used to prevent withdrawal symptoms caused by other opioids.

2. Methadone is a full opioid agonist that reduces the cravings and effects of the withdrawal symptoms caused by heroin or other opioids, without giving a euphoric effect.

3. Naltrexone is an opioid antagonist that blocks the effects of other opioids, such as heroin, and reduces the cravings for alcohol.

About 3 to 5 million people in the United States use kratom which they can purchase in head shops and gas stations, sold in powders, pills, capsules or energy drinks, according to the American Kratom Association.

[메디컬리포트=Ralph Chen 기자]

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