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52-457: Mitragyna speciosa is a tropical evergreen tree of the Rubiaceae family (coffee family) native to Southeast Asia . It is indigenous to Cambodia , Thailand , Indonesia , Malaysia , Myanmar , and Papua New Guinea , where its leaves, known as "kratom" have been used in herbal medicine since at least the 19th century. They have also historically been consumed via chewing, smoking, and as
104-497: A cold or dry/wet season. Evergreen trees also lose leaves, but each tree loses its leaves gradually and not all at once. Most tropical rainforest plants are considered to be evergreens, replacing their leaves gradually throughout the year as the leaves age and fall, whereas species growing in seasonally arid climates may be either evergreen or deciduous. Most warm temperate climate plants are also evergreen. In cool temperate climates, fewer plants are evergreen. In such climates, there
156-786: A critical review of it. The committee, however, recommended kratom be kept "under surveillance." As of 2013, kratom was listed by ASEAN in its annex of products that cannot be included in traditional medicines and health supplements that are traded across ASEAN nations. As of January 2015, kratom was controlled as a narcotic in Australia and under Medicines Regulations 1985 (Amended August 6, 2015) in New Zealand. As of October 2020, Health Canada disallowed marketing of kratom for any use by ingestion and has taken action against companies marketing it for such purposes. Kratom can be marketed for other uses, such as incense. As of 2011,
208-471: A few are practical sources of sufficiently concentrated flavor extract, such as from lemons, oranges, and vanilla beans. The majority of concentrated fruit flavors, such as banana, cherry, peach, pineapple, raspberry, and strawberry, are produced by combining a variety of esters with special oils. Suitable coloring is generally obtained by the use of dyes . Among the esters most generally employed are ethyl acetate and ethyl butyrate . The chief factors in
260-731: A higher soil acidity and lower soil nitrogen content. This is the case with Mediterranean evergreen seedlings, which have unique C and N storages that allow stored resources to determine fast growth within the species, limiting competition and bolstering survival. These conditions favor the growth of more evergreens and make it more difficult for deciduous plants to persist. In addition, the shelter provided by existing evergreen plants can make it easier for younger evergreen plants to survive cold and/or drought. Evergreen plants can have decorative as well as functional uses. In months where most other plants are dormant, evergreens with their sturdy structure, and vibrant foliage are popular choices to beautify
312-532: A landscape. Additionally, evergreens can serve as a windbreak , stopping heat loss from buildings during cold months when placed on the northwest side of a structure. Extract An extract (essence) is a substance made by extracting a part of a raw material , often by using a solvent such as ethanol , oil or water . Extracts may be sold as tinctures , absolutes or in powder form. The aromatic principles of many spices, nuts, herbs, fruits, etc., and some flowers, are marketed as extracts, among
364-420: A larger volume of parenchyma and air spaces per unit leaf area. They have larger leaf biomass per unit leaf area, and hence a lower specific leaf area . Construction costs do not differ between the groups. Evergreens have generally a larger fraction of total plant biomass present as leaves (LMF), but they often have a lower rate of photosynthesis. Deciduous trees shed their leaves usually as an adaptation to
416-490: A local anesthetic. Extracts and leaves have been used to treat coughs, diarrhea, and intestinal infections. They are also used as intestinal deworming agents in Thailand. Kratom is often used by workers in laborious or monotonous occupations to stave off exhaustion and as a mood-enhancer and painkiller. In Thailand, kratom was "used as a snack to receive guests and was part of the ritual worship of ancestors and gods". The herb
468-729: A model has been proposed. Kratom overdose is a subject of concern in many countries because of the associated rising number of hospitalizations and deaths in which chronic kratom use is a contributing factor. According to clinical reviews, a kratom overdose can cause liver toxicity , seizures , coma , and death, especially in combination with excessive alcohol use. Between 2011 and 2017, 44 U.S. deaths were kratom-related. However, many cases could not be fully assessed, due to limited information. People who die from kratom use typically have taken it in combination with other substances, or have underlying health conditions. Over 18 months in 2016 and 2017, 152 overdose deaths involving kratom were reported in
520-458: A non-competitive NMDA receptor antagonist . Mitragynine is metabolized in humans via phase I and phase II mechanisms with the resulting metabolites excreted in urine . In in vitro experiments, kratom extracts inhibited CYP3A4 , CYP2D6 , and CYP1A2 enzymes , which results in significant potential for drug interactions . Many of the key psychoactive compounds in M. speciosa are indole alkaloids related to mitragynine , which
572-411: A possible threat to public health from kratom use. In some jurisdictions its sale and importation have been restricted, and several public health authorities have raised alerts. Mitragyna speciosa is an evergreen tree in the genus Mitragyna that can grow to a height of 25 m (82 ft). Its trunk may grow to a 0.9 m (3 ft) diameter. The trunk is generally straight, and the outer bark
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#1732780888573624-649: A range of 10–50 μg/L in persons using the drug recreationally. Detection in body fluids is typically by liquid chromatography-mass spectrometry. As of January 2018, neither the plant nor its alkaloids were listed in any of the Schedules of the United Nations Drug Conventions. In 2021, the World Health Organization 's Executive Committee on Drug Dependency investigated the risks of kratom and declined to recommend
676-656: A severe problem among youth in three provinces along the border of Malaysia and southern Thailand. In the U.S., as of 2015, kratom was available in outlets such as head shops and over the Internet; the prevalence of its U.S. use was unknown at the time. In the United States, kratom use increased rapidly between 2011 and 2017. By 2020, it was estimated that 15 million people in the U.S. use kratom. Mitragyna speciosa may cause many adverse effects, and in November 2017
728-1070: A tea. Kratom has opioid -like properties and some stimulant -like effects. As of 2018, the efficacy and safety of kratom are unclear. In 2019, the United States Food and Drug Administration (FDA) stated that there is no evidence that kratom is safe or effective for treating any condition. Some people take it for managing chronic pain , for treating opioid withdrawal symptoms, or for recreational purposes . The onset of effects typically begins within five to ten minutes and lasts for two to five hours. Anecdotal reports describe increased alertness, physical energy, talkativeness, sociability, sedation, changes in mood, and pain relief following kratom use at various doses. Common side-effects include appetite loss, erectile dysfunction , nausea and constipation . More severe side-effects may include respiratory depression (decreased breathing), seizure , psychosis , elevated heart rate and blood pressure, trouble sleeping, and, rarely, liver toxicity . Addiction
780-518: Is a plant which has foliage that remains green and functional throughout the year. This contrasts with deciduous plants, which lose their foliage completely during the winter or dry season. Consisting of many different species, the unique feature of evergreen plants lends itself to various environments and purposes. There are many different kinds of evergreen plants, including trees , shrubs , and vines. Evergreens include: The Latin binomial term sempervirens , meaning "always green", refers to
832-430: Is a possible risk with regular use: when use is stopped, withdrawal symptoms may occur. A number of deaths have been attributed to the use of kratom, both by itself and mixed with other substances. Serious toxicity is relatively rare and generally appears at high doses or when kratom is used with other substances. As of 2018, kratom is a controlled substance in 16 countries. There is growing international concern about
884-438: Is a predominance of conifers because few evergreen broadleaf plants can tolerate severe cold below about −26 °C (−15 °F). In addition, evergreen foliage experiences significant leaf damage in these cold, dry climates. Root systems are the most vulnerable aspect of many plants. Even though roots are insulated by soil, which tends to be warmer than average air temperatures, soil temperatures that drop too low can kill
936-1059: Is a tetracyclic relative of the pentacyclic indole alkaloids, yohimbine and voacangine . In particular, mitragynine and 7-hydroxymitragynine (7-HMG) compose significant proportions of the natural products isolable from M. speciosa ; e.g., in one study, mitragynine was 12% by weight from Malaysian leaf sources, versus 66% from Thai sources, and 7-hydroxymitragynine constituted ~2% by weight. At least 40 other compounds have been isolated from M. speciosa leaves, including ~25 additional alkaloids , including raubasine/ajmalicine (originally isolated from Rauvolfia serpentina ), corynantheidine (also found in Corynanthe johimbe ), as well as mitraphylline , mitragynine pseudoindoxyl , and rhynchophylline . In addition to alkaloids , M. speciosa produces many other secondary metabolites . These include various saponins , iridoids and other monoterpenoids , triterpenoids such as ursolic acid and oleanic acid , as well as various polyphenols including
988-435: Is bitter and is generally combined with a sweetener. Because the withdrawal effects of kratom are often reported to be less severe than those associated with traditional opioids, some people use kratom in the attempt to manage opioid use disorder , though no clinical trials have been done supporting this use. As of 2018, there have been no formal trials to study the efficacy or safety of kratom to treat opioid addiction. Kratom
1040-490: Is not approved for this or any other medical use. Stanciu et al. conducted a review of all literature and found insufficient evidence for any conclusions concerning whether kratom is harmful or whether can serve as harm reduction for those with opioid addiction. While some literature reviews claim that kratom has less potential for dependence or overdose than traditional opioids, other reviews note that kratom withdrawal itself can still be quite severe. Data on how widely it
1092-416: Is rarely smoked. Different varieties of kratom contain different relative proportions of alkaloids such as mitragynine . In cultures where the plant grows, kratom has been used in traditional medicine . The leaves are chewed to relieve musculoskeletal pain and increase energy, appetite, and sexual desire in ways similar to khat and coca . The leaves, or extracts from them, are used to heal wounds and as
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#17327808885731144-448: Is smooth and grey. The leaves, ovate-acuminate in shape and opposite in growth pattern, are dark green, glossy on their upper surfaces, and can grow to over 14–20 cm (5.5–7.9 in) long and 7–12 cm (2.8–4.7 in) wide. They have 12 to 17 pairs of veins. The spherical inflorescences, which are deep yellow, grow in clusters of three at the ends of the branches. The calyx -tube is 2 mm (0.08 in) long and has five lobes;
1196-481: Is used worldwide are lacking, as it is not detected by typical drug screening tests. Rates of kratom use appear to be increasing among those who have been self-managing chronic pain with opioids purchased without a prescription and are cycling (but not quitting) their opioid use. In 1836, kratom was reported to have been used as an opium substitute in Malaysia. Kratom was also used as an opium substitute in Thailand in
1248-699: The Centers for Disease Control issued a report stating that between 2010 and 2015, US poison control centers received 660 reports of exposure to kratom. Medical outcomes associated with kratom exposure were reported as minor (minimal signs or symptoms, which resolved rapidly with no residual disability) for 162 (24.5%) exposures, moderate (non-life-threatening, with no residual disability, but requiring some form of treatment) for 275 (41.7%) exposures, and major (life-threatening signs or symptoms, with some residual disability) for 49 (7.4%) exposures. Overall, 92.6% of outcomes were resolved with no residual disability. One death
1300-520: The flavonoids apigenin and quercetin . Although some of these compounds possess antinociceptive , anti-inflammatory , gastrointestinal , antidepressant , antioxidant , and antibacterial effects in cells and non-human animals, there is no sufficient evidence to support the clinical use of kratom in humans. The plant's active compounds and metabolites are not detected by a typical drug screening test but can be detected by more specialized testing. Blood mitragynine concentrations are expected to be in
1352-418: The 19th century. At low doses, kratom produces euphoric effects comparable to those of coca . At higher doses, kratom produces opioid-like effects. The onset of effects typically begins within five to ten minutes and lasts for two to five hours. Some anecdotal reports describe increased work capacity, alertness, talkativeness, sociability , increased sexual desire , positive mood , and euphoria following
1404-399: The 2010s, a tea-based cocktail known as "4×100" became popular among some young people across Southeast Asia and especially in Thailand. It is a mix of kratom leaves, cough syrup , Coca-Cola and ice. Around 2011, people who consumed the cocktail were often viewed more negatively than users of traditional kratom, but not as negatively as users of heroin . As of 2012, use of the cocktail was
1456-1014: The FDA issued a public health advisory for the drug. The side effects of kratom appear to be dose-dependent and are more common with doses that exceed 8 g. While the incidence of adverse effects in people who use kratom is unknown, a 2019 review of 935 kratom exposures reported to U.S. poison control centers over a seven-year period listed the following signs and symptoms: agitation (18.6%), tachycardia (16.9%), drowsiness (13.6%), vomiting (11.2%), confusion (8.1%), seizures (6.1%), withdrawal symptoms (6.1%), hallucinations (4.8%), respiratory depression (2.8%), coma (2.3%), and cardiac or respiratory arrest (0.6%). The study also reported two deaths and four cases of neonatal abstinence syndrome . A different 2019 review listed as common side effects: decreased appetite , weight loss , erectile dysfunction , insomnia , sweating , hyperpigmentation , hair loss , tremor , and constipation . Kratom products in
1508-472: The Food and Drug Administration listed respiratory depression as a concern. Confusingly, a 2018 review found that the alkaloids in kratom do not induce respiratory depression. In rare cases, though with a dangerous delay, kratom use has been linked to acute liver injury, with symptoms of abdominal discomfort, dark urine, itching and jaundice . Liver injury has been reported with a latency (time from first use to
1560-710: The U.S. are commonly used in doses of 2–6 g of dried leaf, and doses exceeding 8 g are relatively uncommon. Given that kratom products may vary greatly in potency, there is no standard dosing system. At relatively low doses (1–5 g of raw leaves), at which there are mostly stimulant effects, side effects include contracted pupils and blushing; adverse effects related to stimulation include anxiety and agitation, and opioid-related effects such as itching, nausea, loss of appetite, and increased urination begin to appear. At moderate to high doses (5–15 g of raw leaves), at which opioid effects generally appear, additional adverse effects include tachycardia (an increased stimulant effect) as well as
1612-695: The United States, with kratom as the primary overdose agent in 91 of the deaths, and 7 with kratom being the only agent detected. Nine deaths occurred in Sweden during 2010–11 relating to use of Krypton , a mixture of kratom, caffeine and O-desmethyltramadol , a metabolite of the opioid analgesic tramadol . Kratom contains at least 54 alkaloids . These include mitragynine , 7-hydroxymitragynine (7-HMG), speciociliatine , paynantheine, corynantheidine, speciogynine, mitraphylline , rhynchophylline , mitralactonal, raubasine , and mitragynaline. The alkaloids mitragynine and 7-hydroxymitragynine are responsible for many of
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1664-471: The United States. The U.S. Drug Enforcement Administration (DEA) stated in 2013 that there is no legitimate medical use for kratom, and in 2019, the U.S. Food and Drug Administration (FDA) said that there is no evidence that kratom is safe or effective for treating any condition, and that there are no approved clinical uses for kratom. Kratom is commonly ingested by chewing, as a tea, powdered in capsules or pills , or extracted for use in liquids. Kratom
1716-476: The area in which they reside. The excellent water economy within the evergreen species is due to high abundance when compared to deciduous species. Whereas deciduous trees lose nutrients whenever they lose their leaves. In warmer areas, species such as some pines and cypresses grow on poor soils and disturbed ground. In Rhododendron , a genus with many broadleaf evergreens, several species grow in mature forests but are usually found on highly acidic soil where
1768-507: The best known of true extracts being almond , cinnamon , cloves , ginger , lemon , nutmeg , orange , peppermint , pistachio , rose , spearmint , vanilla , violet , rum , and wintergreen . Most natural essences are obtained by extracting the essential oil from the feedstock , such as blossoms , fruit , and roots , or from intact plants through multiple techniques and methods: The distinctive flavors of nearly all fruits are desirable adjuncts to many food preparations, but only
1820-570: The brain including 5-HT 2C and 5-HT 7 serotonin receptors , D 2 dopamine receptors , and A 2A adenosine receptors . Mitragynine stimulates α 2 -adrenergic receptors , inhibiting the release of norepinephrine (noradrenaline); other compounds in this class include dexmedetomidine , which is used for sedation, and clonidine , which is used to manage anxiety and some symptoms of opioid withdrawal. This activity might explain why kratom can be dangerous when used in combination with other sedatives. Kratom also contains rhynchophylline ,
1872-466: The complex effects of kratom, but other alkaloids may also contribute synergistically . The effects of both mitragynine and 7-HMG remain disputed despite substantial study. Both are partial agonists of the μ-opioid receptor . While most data indicates agonism at all three opioid receptors, other data suggests the alkaloids are antagonists of the δ-opioid receptor with low affinity for the κ-opioid receptor . 7-HMG appears to have higher affinity at
1924-437: The condition. Serious toxicity is relatively rare and generally appears at high doses or when kratom is used with other substances. Herb–drug interactions may result when kratom is combined with alcohol , sedatives , benzodiazepines , opioids , caffeine , cocaine , yohimbine , or monoamine oxidase inhibitors (MAOIs). Rhabdomyolysis is one of the rare and serious complications of this herb at high dosage. In July 2016,
1976-475: The consumption of contaminated pills, powder, tea, or unidentified sources of kratom. An analytical method using whole genome sequencing applied to samples from the infected users indicated that the salmonella outbreak likely had a common kratom source. Kratom is a botanical with a known addiction liability and, in vulnerable individuals, dependence may develop rather quickly with tolerance noted at three months and four- to ten-fold dose escalations required within
2028-511: The consumption of kratom. According to the U.S. DEA and a 2020 survey, kratom is used to alleviate pain, anxiety, depression, or opioid withdrawal . In Thailand, a 2007 survey found that the lifetime, past year, and past 30 days kratom consumption rates were 2.32%, 0.81% and 0.57%, respectively, among respondents aged 12–65 years, and that kratom was the most widely used recreational drug in Thailand. Kratom may be mixed with other psychoactive drugs , such as caffeine and codeine . Starting in
2080-588: The corolla-tube is 2.5–3 millimetres (0.098–0.12 in) long. Mitragyna speciosa is indigenous to Thailand, Indonesia, Malaysia, Myanmar, and Papua New Guinea. It was first formally described by the Dutch colonial botanist Pieter Korthals in 1839, who named it Stephegyne speciosa ; it was renamed and reclassified several times before George Darby Haviland provided the final name and classification in 1859. As of 2013, kratom has been studied in cells and in animals, but no clinical trials have been conducted in
2132-552: The evergreen nature of the plant, for instance: The longevity of individual leaves in evergreen plants varies from a few months to several decades (over 30 years in the Great Basin bristlecone pine ). Japanese umbrella pine is unique in that it has its own family of which it is the only species. Evergreen and deciduous species vary in a range of morphological and physiological characters. Generally, broad-leaved evergreen species have thicker leaves than deciduous species, with
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2184-417: The first few weeks. Kratom addiction carries a relapse risk as high as 78% to 89% at three months post-cessation. In cases of severe addiction, an approach similar to the treatment of opioid addiction may be warranted. Respiratory depression is the leading cause of death from opioid use. Although evidence is sparse, the risk of respiratory depression caused by taking kratom appears to be low, but, as of 2016,
2236-434: The most frequently identified co-occurring substances. Overdoses of kratom are managed similarly to opioid overdoses , and naloxone can be considered to treat an overdose that results in a reduced impulse to breathe, despite mixed results for its utility, based on animal models. From October 2017 to February 2018 in the United States, 28 people in 20 different states were infected with salmonella , an outbreak linked to
2288-423: The nutrients are less available to plants. In taiga or boreal forests , it is too cold for the organic matter in the soil to decay rapidly, so the nutrients in the soil are less easily available to plants, thus favoring evergreens. In temperate climates, evergreens can reinforce their own survival; evergreen leaf and needle litter has a higher carbon-nitrogen ratio than deciduous leaf litter , contributing to
2340-409: The onset of symptoms) of median 20.6 days. Reported liver biopsies tend to show cholestasis ; however, blood biomarkers can show a range of cholestatic, mixed, or hepatocellular injury patterns. The majority of users do not seem to develop liver injury, and it is unclear which users are at heightened risk. The mechanism by which kratom causes liver damage in some people is unknown and poorly studied, but
2392-780: The opioid side effects of constipation, dizziness, hypotension, dry mouth, and sweating. Long-term use of high doses of kratom may lead to development of tolerance, dependence, and withdrawal symptoms, including loss of appetite, weight loss, decreased libido , insomnia, muscle spasms, muscle and bone pain, myoclonus , watery eyes , hot flashes , fever , diarrhea , restlessness, anger, and sadness. This may lead to resumption of use. Frequent use of high doses of kratom may cause tremors, anorexia, weight loss, seizures , psychosis and other mental health conditions. Kratom use may worsen existing mental health conditions. In case reports associating kratom use with psychosis, it remains unclear whether kratom use directly caused psychosis or simply unmasked
2444-726: The plant was controlled in Denmark, Latvia, Lithuania, Poland, Romania, and Sweden. Kratom is a controlled substance in Bulgaria. The sale, import, and export of kratom have been prohibited in the UK since 2016 under the Psychoactive Substances Act . In 2017, kratom was designated a Schedule 1 illegal drug (the highest level) in the Republic of Ireland , under the names 7-hydroxymitragynine and mitragynine . Kratom
2496-448: The plant. The exact temperature which evergreen roots can handle depends on the species, for example, Picea Glauca (White Spruce) roots are killed at −10 °F (−23 °C). In areas where there is a reason for being deciduous, e.g. a cold season or dry season, evergreen plants are usually an adaptation of low nutrient levels. Additionally, they usually have hard leaves and have an excellent water economy due to scarce resources in
2548-450: The μ-opioid receptor than mitragynine. These compounds display functional selectivity and do not activate the β-arrestin pathway partly responsible for the respiratory depression, constipation, and sedation associated with traditional opioids . Both mitragynine and 7-HMG readily cross the blood-brain barrier . Mitragynine also appears to inhibit COX-2 , block L-type and T-type calcium channels , and interact with other receptors in
2600-620: Was increasing rapidly, with 1807 kratom exposures and a 52-fold increase occurring over the years 2011 to 2017. Most exposures occurred intentionally by adult males in their homes, with 32% of the incidents requiring admission to a health care facility and half of the admissions as a serious medical condition. Multiple-substance exposures were associated with a higher number of hospitalizations than kratom-only exposures and involved 11 deaths, including two due to kratom alone. Post-mortem toxicology testing detected multiple substances for almost all those who died, with fentanyl and fentanyl analogs being
2652-788: Was previously scheduled to become an illegal substance in Indonesia in 2024 once new regulations from the Indonesian National Narcotics Agency (BNN) go into effect. However, in 2024, a revision to a regulation by Ministry of Trade legalized production and export of kratom leaves. Later in September 2024, Indonesia's Ministry of Cooperatives and Small Medium Business stated that Indonesia will start building downstream industries for kratom exports. These developments made kratom legal to export and manufacture in Indonesia. Evergreen In botany , an evergreen
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#17327808885732704-488: Was reported in a person who was exposed to the medications paroxetine (an antidepressant ) and lamotrigine (an anticonvulsant and mood stabilizer ) in addition to kratom. For 173 (26.2%) exposure calls, no effects were reported, or poison center staff members were unable to follow up regarding effects. A 2019 report from the American Association of Poison Control Centers (AAPCC) noted that kratom use
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