As previously mentioned, despite Mitragyna speciosa Kratom’s relatively long history of human use, Kratom and Kratom use has rarely been studied extensively, even in countries where Kratom use is traditional.
Such a country, Thailand, actually banned Kratom in 1943 (a ban which is now under discussion), and has also held strong anti-Kratom positions, in accordance with its generally aggressive and repressive anti-drug policy.
In Thailand itself, scientific knowledge of Kratom is still quite limited, and not always based on first-hand sources: in 1966, for instance, Norakanphadung Prayun quoted the mistaken notion in the "Thai Narcotic Book” that Kratom acted like a mixture of opium and cocaine, a notion that had been circulating for some time, fist introduced by K. S. Grewal at the University of Cambridge in 1932, who had studied Kratom and mitragynine.
Most of the South-East Asian research on Mitragyna speciosa Kratom is actually heavily burdened with traditional cultural beliefs and rumours, and tangible socio-political tensions.
It is also in Thailand, for instance, that ethnological researchers conducting a survey of long-time Mitragyna speciosa Kratom users reported some alarming popular beliefs on users of Kratom, rumours stating that heavy users might develop dark patches of skin discoloration on their cheeks and other physical degradations. Due to the scarcity of studies on Mitragyna speciosa Kratom, these reports are prevalent, especially online, and are often quoted “as is”, with no contextualisation.
However, it is very important to stress that these claims and rumours circulating about heavy Mitragyna speciosa Kratom users were not backed by any actual observation or documentation of such symptoms actually occurring. These researchers were quoting collected local rumours circulating about Kratom users, and nothing else.
And yet descriptions of these Kratom “symptoms” often come up in Kratom related literature, described as a real potential danger of regular Kratom use.
This is just one example of the mechanics at play in Kratom research, where very little existing information, and very little actually documented observation is quoted and quoted again, and thus becomes more and more accepted as factual observation while based on little more than hearsay.....a situation which doesn’t really help with getting a clear view of what the consequences
of heavy, daily Mitragyna speciosa Kratom use might be.
We should keep in mind that despite such reports, no actual long-term, human based scientific research or studies exist on Mitragyna speciosa Kratom use. It seems that most of the assessment of long-term consequences of Mitragyna speciosa Kratom use are either extrapolated from animal studies (usually using pure extracted alkaloids, such a mitragynine, and not actual Mitragyna speciosa Kratom leaf or leaf products), and such anecdotes and popular belief collected anthropologists.
In Thailand, a famous and often quoted 1975 survey of long-term Kratom users (“A Study of Kratom Eaters in Thailand”, by Sangun SUWANLERT) was published, mentioning clinical problems in long time heavy users, some with as much as 40 years of daily heavy consumption, problems such as insomnia, anorexia, loss of libido, hallucinations, delusional behaviour, aggression and schizophrenia have been reported, as well as physical problems such as weight loss, dry mouth, prostate enlargement…
Yet, however alarming some elements of these Thai reports might seem, it is also now well known that many of those people reporting “Kratom addiction” were using Mitragyna speciosa Kratom either as a home remedy for opiate addiction or in conjunction with an ongoing opiate dependence, which makes scientifically definitive claims on addiction issues and physical dangers quite inconclusive.
Furthermore, some of these Kratom users were also long-term poly-drug users, using drugs that themselves could also have caused most of the severe physical symptoms described.
On a more socio-economical note, it should be taken into account that these generally poor Kratom users' living conditions were not in themselves healthy, users often aged rapidly by years of hard physical labour, little hygiene or access to medical facilities.
Other, more moderate reports, mention mild physical withdrawal symptoms in heavy users when Kratom use is quit abruptly, lasting a few days, symptoms which are said to include heavy fatigue, bone and muscle aches, irritability, hostility, aggression, runny nose and eyes, diarrhea, and muscle jerking.
This is the case in a 1994 study conducted by the Malaysian Ministry of Health, which surveyed 54 people who had been using Mitragyna speciosa Kratom for 1 to 20 years.
Yet nearly all subjects (94.3%) were or had also been former users of other drugs, such as opiates or cannabis who had switched to Kratom use.
Mild withdrawals where reported by users when stopping Kratom, but they also point out that these withdrawal symptoms were much less severe than with opioids. Other medical tests showed these users to be healthy overall, and that the biochemical tests showed no significant discrepancies with normal references ranges.
When approaching Thai research, one also has to consider the tense political context of Thailand, where a rather harsh “war on drugs” has been a pretty good excuse for the government to send military / paramilitary forces on “drug eradication” missions- which often lead to the death of drug dealers, killed in “self-defence” (2,274 suspected dealers are said to have been killed in 2003, during a crackdown on methamphetamine / yaba).
Drug users, are sent to army run ( ! ) detoxification camps or clinics, where their criminal charges are dropped if they can get “clean”.
In such a context, it might be easier for a user to claim being a Kratom addict than a yaba user. And stories of physical degradation due to “the dangers of Kratom use” are always useful to motivate and justify a strong military offensive in areas with political unrest, such as regions with politically separatist intentions (Mitragyna speciosa Kratom use, for instance, is widespread in the South of Thailand, a place which has a Muslim majority and political tension…) and arrest, move to army run rehabilitation camps or even kill “dealers” in the process.
With such issues at stake, Thailand is hardly a stable context in which to level-headedly assess the consequences of Mitragyna speciosa Kratom use, and stories of the “Kratom detox” clinics of Thailand are to be taken with a pinch of salt, even though Kratom use is traditional and common in Thailand.
In such a context, (where one should also not forget the eventual personal / social bias of the researchers against what is often perceived as backwards rural customs) the conclusions of the existing Kratom studies are quite relative- and it would be questionable to assume that Kratom, and traditional Kratom use was the sole cause of all these problems.
It is also worth reminding ourselves that the most popular mode of using Mitragyna speciosa Kratom is, traditionally, chewing fresh Mitragyna speciosa leaves. Given that leaves are actually wet-weight of the plant, doses taken are actually lower than tea or whole dried leaf doses.
And this mode of use, daily chewing of fresh leaves, induces a slow delivery of the daily dose, which enhances the stimulant effects and probably stabilises the dosage needed and used. Mitragyna speciosa Kratom’s stimulant effects predominate once a tolerance to the sedative / opiate like effects develops, and the unpleasant effects of overdosing on the stimulant component keeps users from overindulging in a habit based on opiate like effects.
The first formal case reporting Kratom related addictive symptoms was done in 1957 by L. C. Thuan. A subject had withdrawal symptoms when quitting Kratom use, but was otherwise physically and mentally in a state described as "quite normal," in good health and with a normal weight, and actually never increased his Kratom use level. This is probably much closer to the reality of Kratom addiction.
In the same line of thought, A. Marcan describes Mitragyna speciosa Kratom use in Malaysia as very common, yet with no bad reputation, stating that Kratom “addicts” were not known to change either in character or physical health.
It seems unlikely that Kratom users outside South-East Asia would face risks, real or fantasised, such as the ones described in the Thai reports, notably because most recreational users don't consume anywhere near the same amount of Kratom as people from South-East Asia, nor have the same poly-drug abuse regimen or share the same difficult living conditions.
Yet such reports were and still are used politically against Kratom, pretty much in the same way anti Coca chewing reports abound (the most famous being the U.N. E.C.O.S.O.C. report, which has lead to the scheduling of coca leaf, and has since been sharply criticised for its lack of precision, arbitrary conclusion and racist / derogatory connotations) despite the actual lack of level headed, scientific research.
More recently, contrasting reports on Kratom and Kratom use have began to appear in Thailand, with the declarations Pennapa Sapcharoen for instance (director of the National Institute of Thai Traditional Medicine in Bangkok) announcing that Mitragyna speciosa Kratom could potentially be medically prescribed both to opiate addicts and to patients suffering from depression, while also stressing that further preliminary research would be necessary.
Such an encouraging recognition of Mitragyna speciosa Kratom’s potential as medicine and of its usefulness in treating opiate addiction is quite a change from the vision of Kratom as a dangerous addictive drug, from which users need to be detoxified, portrayed in the previously mentioned Thai reports.
In conclusion, let’s say that one should really keep in mind the socio-political context underlying the compilation of such reports on Kratom use and that it is relatively safe to assume that such health problems are unlikely to occur in occasional, responsible Mitragyna speciosa Kratom users.
With Kratom becoming more and more easily available outside South-East Asia, and the growing scientific interest in Mitragyna speciosa, a solid corpus of empirical data is starting to build up, which has made it possible to dismiss some of the bias, errors and inconsistencies of early, socio-culturally biased research on indigenous Kratom use.