Chula research: Kratom's Pain Relief, Anti-Inflammatory, and Detox Benefits

Dr Thongchai Sooksawate, a lecturer from the Faculty of Pharmaceutical Sciences at Chulalongkorn University, presents his ongoing research on to use of Kratom plants as analgesic, anti-inflammatory drugs, and detoxification aids for substance addiction, offering natural alternatives to chemical medications.  

“Kratom”, a local medicinal plant, has regained prominence in Thai society after being listed as a Category 5 narcotic substance for over half a century.  Today, fresh green Kratom leaves are openly sold along roadsides, in markets, on produce trucks, and at hawker stalls.  Some vendors offer ready-to-drink Kratom tea and seedlings for home cultivation or agricultural plots.

Kratom is favoured among labourers who chew the fresh leaves for energy. While some claim medicinal benefits like blood sugar reduction, scepticism remains regarding addiction risks and potential adverse effects and questions have arisen about addiction, symptoms, medicinal benefits, usage, and potential consequences.
In this article, Associate Professor Dr Thongchai Sooksawate, Lecturer at the Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, will address concerns about the Kratom plants.

“Kratom has been a long-standing remedy in Thai traditional medicine, commonly found in almost every home.  It serves various purposes such as welcoming house guests, socializing at important events, and providing a tonic and stimulant for strenuous work,” says Thongchai.

He highlights the challenges in the past, to conduct medical and pharmaceutical research on Kratom and the recent opportunities for research following its removal from the list of controlled substances. Thongchai’s research focuses on utilizing standardized Kratom extract and its active substance, mitragynine, as natural painkillers and withdrawal aids from narcotics such as methamphetamine and morphine.

“Kratom plants hold potential for both Thai traditional and modern medicine, underscoring the need for further research to harness its medical benefits.”

Kratom: From Traditional Remedy to Legalization

Kratom, a native plant found throughout Thailand, is densely distributed in the southern, lower central, eastern, and western regions. The name of Kratom varies according to each locality and the plant has been historically valued for its medicinal properties, such as in treating diseases, reducing pain, and increasing stamina for work. However, in 1943, the plant fell under government control due to concerns about revenue loss from opium taxes. When opium prices soared, consumers sought alternatives and Kratom leaves became one.

Subsequent classifications as a Category 5 narcotic in 1979, following the Narcotics Act B.E. 2522, further restricted the use and research potential of the Kratom plant, as well as a handful of other native plants, such as Cannabis, Magic Mushrooms, and Opium.

The argument made was that these plants, including Kratom, may cause addiction and withdrawal symptoms. As a result, the Kratom plants largely disappeared from people’s lives and was difficult to study for medical benefits or research in humans was not possible.
In 2019, legislation was revised and the Narcotics Act No. 7 B.E. 2562 unlocked Kratom for human research and medical purposes.  Subsequently, the Narcotics Act No. 8 2564 (2021) removed Kratom from the list of Category 5 narcotics entirely.  

Most recently, the Kratom Act B.E. 2565 (2022) legalized the cultivation, possession, and sale of Kratom.  However, processing into food, medicine, herbs, or cosmetics requires legal approval and the import and export of Kratom plants must be authorized by the Office of the Narcotics Control Board (ONCB). 

Kratom in Local Wisdom and Culture

Kratom has been deeply intertwined with people’s lifestyles in various social, cultural, and medicinal contexts throughout history:

•    Kratom in Social Gatherings: Fresh Kratom leaves have been a staple offering at cultural festivities, ordination ceremonies, weddings, and funerals. Traditionally served alongside betel nuts, piper betel, tea, and tobacco, they symbolize hospitality and welcome for house guests. Additionally, chewing Kratom leaves while enjoying tea or coffee at local teahouses and coffee shops has long been a social custom.

Moreover, among participants in activities, such as bullfighting, cockfighting, or traditional performances like shadow puppetry in the South, chewing Kratom leaves are preferred to enhance alertness and set the mood for music and entertainment.

•    Kratom as a Stimulant: Laborers across various industries, including agriculture, farming, rubber plantations, fishing, and transportation, often chew fresh Kratom leaves before starting work. Believing it boosts stamina and endurance, they rely on Kratom to enhance productivity.

•    Kratom in Folk and Traditional Medicine: In folk medicine practices, Kratom holds a significant place. Folk healers commonly use Kratom either alone or as part of traditional remedies to address a wide range of ailments and symptoms.  From flu and diarrhoea to high blood pressure and diabetes, Kratom is believed to offer relief.  It is also used to enhance virility, aid sleep, and even manage withdrawal symptoms from drug addiction, such as from opium and heroin.

•    In Thai traditional medicine literature, numerous recipes feature Kratom as a key ingredient.  These formulations can be found in works such as Khun Sophit Banalak’s Book of Traditional Medicine, Phaetthayasaat Songkhro (The Study of Medicine), Manual for Students of Traditional Medicine by Phrayā Phitsanuprasatwēt, and Inscription of the Medicine Remedies, Wat Ratcha Orasaram Ratchaworawihan. These ancient texts prescribe Kratom for various ailments including dysentery, diarrhoea, stomach cramps, and body aches, among others.

“Mitragynine”: An Analgesic and Anti-inflammatory Agent in Kratom Leaves

Kratom leaves have long been utilized as a medicinal herb, either independently or as a part of traditional remedies, to address various health conditions. The therapeutic properties stem from mitragynine, a compound unique to Kratom plants and not present in other botanicals within the same family.

Research indicates that mitragynine exhibits moderate to potent anti-inflammatory and analgesic effects, suggesting its potential as a precursor for producing pain-relieving medications akin to the chemical tramadol.

The analgesic and anti-inflammatory properties of mitragynine in Kratom leaves probably contributed to its popularity among labourers as a stimulant and fatigue reliever.  These individuals often chew fresh Kratom leaves before commencing work, believing it enhances strength, energy levels, endurance, and resistance to fatigue and discomfort under the sun. Assoc. Prof Dr Thongchai further noted that studies on the routine use of Kratom in Southern Thailand have not shown a definite increase in health issues.

Kratom: Potential Benefits for Various Ailments

In addition to its analgesic and anti-inflammatory effects, research suggests Kratom may have therapeutic potential in treating a myriad of other conditions.  These include but are not limited to reducing blood sugar and lipid levels, alleviating diarrhoea, suppressing appetite, combating parasites and microbes, as well as offering anti-anxiety, anti-depressant, and psychotic effects.

Kratom: Facilitating Treatment and Detoxification from Dangerous Narcotic Drugs

A key aspect of Kratom’s potential lies in its ability to serve as a substitute or aid in managing withdrawal symptoms associated with addiction to substances such as alcohol, opium, heroin, or other drugs.

“Although Kratom exhibits morphine-like analgesic effects, it is less dangerous and poses a lower risk of addiction,” explains Assoc. Prof. Dr Thongchai.  “In certain regions, Kratom has been embraced as a detoxification agent for withdrawal from other strong narcotics, offering an alternative to the use of chemical-based drugs for detox.”

With Kratom having a morphine-like effect, concerns arise about its use in the production of other narcotic drugs. This is unlikely, however, as Kratom cannot be used as a reactant to drug production, and it is difficult to use the active ingredients of Kratom in the production of other narcotics. Extracting pure mitragynine, an active ingredient in Kratom, is a complicated and costly process,” said Assoc. Prof. Dr Thongchai.

Kratom Products

Although Kratom is not an illegal drug anymore, the use of Kratom plants in other products must be carefully studied due to the other laws which control the production of those products, cautioned  Thongchai.

“If you brew Kratom juice or tea at home for personal consumption, you can do so without permission. However, processing Kratom into various products, such as medicine, herbal products, food, supplements, and cosmetics for sale, requires approval from regulatory bodies, like the Food and Drug Administration (FDA) or the Provincial Public Health Offices,” advised Assoc. Prof Dr Thongchai.

Caution When Using Kratom

While Kratom has medicinal properties with few adverse effects, it is advisable to “use only when necessary”.

“For adults, use Kratom only when necessary, and maintain proper health care practices, such as a balanced diet, regular exercise, adequate rest, and stress management.  If using Kratom or Kratom products, follow directions, consult experts, and be mindful of potential risks, including:

•    Avoid using Kratom with children. Due to the risk of unwanted side effects such as epilepsy, psychosis, and neurological symptoms.  Initial use of Kratom may lead to the use of more dangerous narcotics.

•    Pregnant women should not use Kratom. Due to the risk of addiction in the unborn child.

•    People with liver or kidney diseases should avoid Kratom.

•    Use Kratom as prescribed and avoid overuse. 

•    Discontinue use if experiencing side effects such as palpitations, nausea, and vomiting.

•    Consult a doctor or pharmacist before using Kratom while taking regular medication or if experiencing discomfort from regular Kratom use.

Thongchai added the following cautions regarding the use of Kratom in combination with modern medicine or other drugs:

•    People who use medicinal cannabis are prohibited from combining it with Kratom as it may increase the toxicity of cannabis.

•    People with diabetes should be cautious.  Research has shown that Kratom contains substances that help lower blood sugar, and when combined with diabetes medication or regular insulin injections, it can result in hypoglycemia.

In conclusion, while Kratom offers many benefits, its misuse can lead to harmful effects. “Some individuals use Kratom recreationally by mixing it with other substances, like cough syrup, mosquito repellent, carbonated water, or even powder in fluorescent lamps.  This creates a concoction known as 4x100, which poses serious health risks,” warned Thongchai. “Kratom and cannabis should be used for medicinal purposes only, and efforts should be made to prevent abuse.”