Due to its mode of action, Mitragyna speciosa Kratom could become a potential alternative to methadone, which is now commonly used in the detoxification process from opiates and opioids addiction, especially if its partial binding action on μ opioid receptors is confirmed by further research. The main advantage would be avoiding the replacement of an addiction by another, as this is often the case in opiate
The idea is not really new, since Mitragyna speciosa Kratom affects the brain much like opiates, has similar effects and does temper opiate craving, qualities that have been known and made use of by South-East Asian opiate users for quite some time.
Alongside its use as a stimulant helping with physical labour, Mitragyna speciosa Kratom also has a history of traditional use as an opiate substitute in some parts of South-East Asia, reported in western literature as early as the 19th century.
Many current opiate addicts in Thailand are reported to chew Mitragyna speciosa Kratom leaves or drink Kratom extracts when opium or opiates are not available.
Some users also deliberately combine opiate and Kratom use, for economic reasons, Mitragyna speciosa Kratom leaves being cheaper than manufactured opiates.
Inspired by this traditional use, H. Ridley reported as early 1897 that the leaves of Mitragyna speciosa were a possible cure for opiate addiction, a phenomenon that had been spreading in the Western world with the increased availability of opium preparations and the new synthetic opiates.
In more recent times, mitragynine has actually been used in New Zealand experiments, to treat methadone addiction detoxification. Other reported experiences include actual Mitragyna speciosa Kratom leaves, which were administered whenever the patient experienced withdrawal symptoms, over a 6-week treatment period.
In 1999, Pennapa Sapcharoen, director of the National Institute of Thai Traditional Medicine in Bangkok, in a country which chose to ban Kratom since 1943, announced that Kratom could potentially be prescribed both to opiate addicts and to patients suffering from depression, while also stressing that further research would be necessary.
Similarly, in 2005, Dr. Mustafa Ali Mohd, Associate Professor at the University Malaya, Pharmacology Department, announced his desire to study the effects of Kratom use in Malaysia. As of 2006, he has been conducting research at the Shimadzu-Universiti Malaya Medical Centre for Xenobiotics Studies (SUCCXES), stating that toxicity of Kratom is negligible, and that Kratom should be investigated as an alternative to methadone as it is far safer, cheaper, and has fewer side effects. Unfortunately, Malaysia has since made Mitragyna speciosa Kratom illegal, which will hinder such research.
What are the mechanisms at play in Mitragyna speciosa Kratom’s apparent ability to tamper and relieve opiate withdrawal symptoms while causing little addiction itself ?
Opiates tend to bind to the brain’s μ and delta opioid receptors, hence inducing the powerful pleasurable effects felt by the users.
Opiate addiction, however, is mainly result of the binding that occurs with these μ opioid receptors. Yet Mitragyna speciosa Kratom's active alkaloids apparently bind mainly with the delta opioid receptors, a binding action which causes pleasure / relief yet with little addiction potential. Furthermore, whole Mitragyna speciosa Kratom leaf contains a complex alkaloid make up, which implies synergistic action between alkaloids yet to be researched, and which probably further tampers its addiction potential.
It is this cross-tolerance mechanism and opioid receptor interaction of opiates and Mitragyna speciosa Kratom, and especially of mitragynine's μ receptor crossover, which seems the most promising in the treatment of opiate addiction, as it might be increased by the presence of opiate drugs, and direct the receptor binding to where it is needed, automatically regulating the attachment ratio and modulating it towards the delta receptors over a short time.
Using this mechanism, the addict would, ideally, stop use of the opioid narcotic they are addicted to, while the binding of mitragynine to the delta receptors would moderate the cravings and withdrawal symptoms.
Mitragynine could also perhaps be used as a maintenance drug for opiates addicts not wishing to quit but trying to moderate an out of hand addiction, which is quite similar to the Mitragyna speciosa Kratom use of South-East Asian opiate addicts.This mechanism has not been studied enough yet, but is very promising.
Description of actual “Kratom addictions” could imply that a small amount of binding occurs directly with the μ receptors, but it seems that this would usually be at a level too low to cause more than a moderate addiction mechanism.
Some have claimed that this μ binding action could increase if large amounts of mitragynine are consumed regularly, implying that Mitragyna speciosa Kratom might have a tangible addictive potential, yet one which is really dependent on dose, frequency and method of intake – this field also needs further, thorough and objective research.
What is certain, however, is that Mitragyna speciosa Kratom’s rather unique action on opioid receptors gives it a considerable advantage over current opiate addiction treatment and detoxification options, which involving addiction forming drugs such as methadone for the easing / control of withdrawal symptoms.