Kratom, indigenous to Southeast Asia, has a long-standing tradition that goes back over a century. This leafy tree, known scientifically as Mitragyna speciosa, has been utilized for various purposes across the region. Despite its extensive history, the narrative surrounding kratom is complex and layered. While there is a lack of severe negative consequences attributed to its use, some mild issues have been noted, particularly with intense or prolonged consumption. Users have reported experiences such as constipation, weight loss, insomnia, skin pigmentation changes, and decreased sexual drive.3 Moreover, mild dependence can develop, with withdrawal symptoms typically manifesting as joint pain, sweating, and mood changes, reflecting the less intense nature of kratom’s side effects compared to many other controlled substances.4
In modern times, the landscape of kratom use is evolving, particularly among younger populations in urban centers. Cocktails composed of kratom powder mixed with cough syrup, yogurt, and coffee—dubbed “Asean”—are increasingly popular in regions like Myeik and several towns in Mon State.5 A similar trend occurs in Thailand, where blends of kratom leaves with Coca-Cola and cough syrup, called “4×100” or “Sii khoon roi,” are consumed. However, these concoctions often present risks, especially when combined with pharmaceutical substances, such as cough syrup containing codeine, which can heighten kratom’s effects. Disturbingly, reports have surfaced about users adding harmful substances like crushed mosquito coils and gases from fluorescent bulbs, although these sensationalized claims lack consistent evidence.6
Globalization of Practices and the Emergence of a ‘Kratom Threat’
The increasing consumption of kratom has been met with scrutiny, particularly in the United States and certain European nations. Authorities have expressed concerns about potential health risks associated with kratom despite it lacking recognized medicinal benefits. Unlike Southeast Asia, where kratom holds cultural significance, its adoption in Western contexts is more recent and less deeply rooted. In these regions, kratom products often appear as processed food supplements containing high concentrations of isolated alkaloids like mitragynine, diverging significantly from the traditional forms consumed in Southeast Asia. There have been cases of lethal overdoses involving kratom in the US and Europe, but investigations frequently reveal that other substances, rather than kratom itself, were pivotal in these incidents.7 Assertions claiming kratom has no therapeutic value starkly contrast the documented historical uses in Southeast Asia, reflecting deep-seated ethnocentrism and biases while dismissing its potential to aid in opioid withdrawal and recovery efforts.8
Currently, kratom is not classified under international control, meaning that UN member states have the discretion to regulate its cultivation and consumption. The legal status of kratom is inconsistent; while some US states impose regulations or outright bans, it remains illegal in Australia but is permissible in New Zealand with a medical prescription. In Southeast Asia, kratom sits in a gray area: it is illegal in nations like Singapore, Vietnam, and Malaysia, while remaining criminalized in Myanmar under the Narcotic Drugs and Psychotropic Substances Law of 1993, which enforces heavy penalties for cultivation and distribution. Despite the lack of severe public health consequences, criminalizing kratom seems unnecessary, as enforcement efforts do little to deter its usage and come at great fiscal and social costs.9
Countering this trend, Thailand recently decriminalized kratom and has initiated a regulated market. This marks a significant shift, particularly given Thailand’s historical prohibition which began as early as 1943. Initially, the government aimed to control the switch from opium to kratom, perceiving it as competition. While enforcement was lax for years, the early 2000s saw harsher crackdowns, especially in the south where kratom use was prevalent among ethnic communities. The 2019 reforms in Thailand allowed for both medical and recreational use of kratom, as well as cannabis, establishing a legal framework that could benefit local livelihoods and cultural practices.10
Rehabilitating Kratom Cultural Heritage through Decriminalization and Legal Regulation in Myanmar?
As the WHO’s Expert Committee on Drug Dependence deliberates on kratom’s future, it’s essential to revisit existing policies surrounding this versatile plant. Myanmar, possessing a rich legacy of kratom usage, stands at a crossroads. Transitioning from a predominantly prohibitive stance towards decriminalization and regulation could yield marked benefits for both authorities and communities. Legalizing kratom would facilitate health programs, including potential substitution therapy for those struggling with addiction, enhance quality control measures, and create employment opportunities in regions suited for kratom cultivation. Additionally, easing the criminalization of kratom would reduce the burden on the justice system and help rectify historical human rights violations exacerbated by drug-related law enforcement practices.
The global momentum toward cannabis reform offers valuable insights for kratom policy discussions, emphasizing the importance of prioritizing public health and social equity. Engaging local stakeholders in regulatory processes is paramount to ensure that initiatives are equitable and culturally sensitive. The global discourse on drug policy has often propagated division and conflict, perpetuating cycles of oppression that must be addressed. It is increasingly vital for communities and stakeholders to seek inclusive solutions that foster safety, promote developmental progress, and contribute to peace in Myanmar and similar contexts.
Endnotes
1. Balasingam Vicknasingama, Suresh Narayananb, Goh Teik Benga, and Sharif Mahsufi Mansora, ‘The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy’, published in International Journal of Drug Policy 21 (2010) 283–288;
2. Assessment conducted in Mon State in 2020 by Mon Area Community Development Organization (MACDO), upcoming report;
3. Singh D, Narayanan S, Vicknasingam B, ‘Traditional and nontraditional uses of Mitragynine (Kratom): a survey of the literature’, Brain Res Bull. 2016;126(Pt 1):41–46. doi:10.1016/j.brainresbull.2016.05.004
4. Singh D, Muller CP, Vicknasingam BK, ‘Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users’, Drug Alcohol Depend. 2014;139:132–137. doi:10.1016/j.drugalcdep.2014.03.017
5. Thura Myint Lwin and Renaud Cachia, ‘Methamphetamine use in Myanmar, Thailand, and Southern China: assessing practices, reducing harms’, TNI https://www.tni.org/en/ats-harmreduction
6. Pascal Tanguay, ‘Kratom in Thailand: Decriminalization and Community Control?’, TNI and IDPC https://www.tni.org/en/briefing/kratom-thailand-decriminalisation-and-community-control
7. UNODC, Current NPS Threats, Volume II, January 2020, p. 2. https://www.unodc.org/documents/scientific/Current_NPS_Threats_Volume_II_Web.pdf
8. See: https://ufhealth.org/news/2020/kratom-tea-study-stirs-new-support-relieving-opioid-dependence https://www.sciencedirect.com/science/article/abs/pii/S0376871619301966
9. UNODC, Patterns and Trends of Amphetamine-Type Stimulants (ATS) and Other Drugs of Abuse in East Asia and the Pacific 2006, A Report from Project: TDRASF97 Improving ATS Data and Information Systems, June 2007, p. 121.
10. See: https://www.hrw.org/news/2008/03/12/thailands-war-drugs
11. Pascal Tanguay, ‘Kratom in Thailand: Decriminalization and Community Control?’, TNI and IDPC https://www.tni.org/en/briefing/kratom-thailand-decriminalisation-and-community-control
12. Kratom production needs FDA approval, Bangkok Post, 4 September 2021. https://www.bangkokpost.com/thailand/general/2175551/kratom-production-needs-fda-approval
13. Wahyono, S, et al., Kratom: Prospek Kesehatan dan Sosial Ekonomi, Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia, 2019.