Mitragyna speciosa

Mitragyna speciosa is a tropical evergreen tree of the Rubiaceae family native to Southeast Asia. It is indigenous to Cambodia, Thailand, Indonesia, Malaysia, Myanmar, and Papua New Guinea, where its dark green, glossy 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 a tea. Kratom contains multiple alkaloids (primarily, mitragynine and to a lesser extent, 7-hydroxymitragynine) that bind to opioid receptors, mostly as partial μ-opioid agonists. Kratom can also be subjectively stimulating to some, though this is likely not achieved through typical stimulant mechanisms (such as reuptake inhibition or release of monoamines), nor is this a universal effect. 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. Kratom has been used for managing chronic pain, for treating opioid withdrawal symptoms, or for recreational purposes. It is under preliminary research for possible antipsychotic and antidepressant properties. Kratom use has not been shown to positively affect mental health. Anecdotal reports describe increased alertness, physical energy, talkativeness, sociability, sedation, changes in mood, and pain relief following kratom use at various doses. The onset of effects typically begins within five to ten minutes and lasts for two to five hours. 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 liver injury. Addiction is a possible risk with regular use: when use is stopped, withdrawal symptoms may occur. Serious toxicity is relatively rare and generally appears at high doses or when kratom is used with other substances. A small number of deaths have been connected to the use of kratom, most commonly when mixed with other substances. As of 2018, kratom is a controlled substance in sixteen countries. Some countries, like Indonesia and Thailand, have recently moved toward regulated legal production for medical use. There is growing international concern about 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.