What is kratom and what are the health risks associated with it and its derivatives?

- Kratom, a tropical plant extracted from the leaves of the Mitragyna specius tree in Southeast Asia, where it is native. Kratom has been used in various forms, but its effects on the brain and body raise increasing health concerns, especially with the proliferation of concentrated and semi-synthetic products derived from it.

Kratom has effects that may be stimulating or sedative depending on the dosage and product formulation. Its psychological effect is mainly due to alkaloid compounds, most notably mitragynine.

When this substance is metabolized in the body or changed during processing and drying, it may be transformed into a more powerful compound known as 7-hydroxymitragynine (7-OH), which in turn can be transformed into mitragynine pseudoindoxyl. These compounds, specifically 7-OH, interact with mu opioid receptors in the brain, which are the same receptors that play a role in regulating pain, breathing, and the functioning of the digestive system.

For this reason, kratom and its derivatives can have effects similar to the effects of some opioids, although the strength of the effect varies depending on the substance, concentration, and dose. The risk increases with semi-synthetic and concentrated products containing derivatives such as 7-OH, MGM-15, and mitragynine pseudoindexyl.

These substances do not represent natural kratom in its traditional plant form, but rather are isolated or chemically concentrated, which can amplify opioid-like effects and increase the risk of physical dependence, addiction, and overdose. Toxicology experts warn that high doses or highly concentrated products may lead to slowed breathing, which is one of the most serious complications of substances with an opioid effect.

Some patients have also reported withdrawal symptoms similar to those that may occur when stopping heroin or fentanyl. Among the symptoms and complications associated with poisoning with kratom or some of its derivatives are: In severe cases, serious complications or death may occur.

Concerns increase because some kratom products and its derivatives can be easily purchased from various stores in some US states, in gas stations, smoke shops, and some food stores, and are sold in the form of powders, tea leaves, capsules, tablets, or concentrated extracts. Also, these products are not always subject to uniform regulation or verification of their ingredients and concentration.

US authorities have designated some semi-synthetic derivatives, including MGM-15 and Mitragynine pseudoindoxyl, as Schedule I controlled substances on an emergency basis, due to their high potential for abuse and lack of currently accepted medical use under this classification. As for natural kratom itself, it is not federally approved in the United States as a medicine, nutritional supplement, or legal food additive, and its regulation varies between states, as some states have imposed restrictions on it or its derivatives, while other states have completely banned some of these products.

The renewed interest in the danger of these substances came after products containing three compounds related to kratom were found near two students at the University of Mississippi in the American state of Mississippi who died on September 21. Investigations showed that the products contained mitragynine pseudoindexyl, MGM-15, and 7-OH.

However, the authorities have not yet confirmed that these compounds were the direct cause or one of the causes of death, because autopsy results and toxicology reports had not been released at the time the information was published. This incident highlights the difference between natural plant kratom and semi-synthetic and concentrated derivatives that may carry much greater risks, especially when the true concentration of the substance is not known or it is taken in high doses.