Up the magic tree

Up the magic tree

The krathom plant is both therapeutic and addictive, but should it be classified as a herb or a drug?

SOCIAL & LIFESTYLE
Up the magic tree

At the back of his house by a canal, the old man takes us to see his home-grown krathom tree. Standing more than 2m tall, the plant sprouts green leaves of different sizes, the biggest larger than a person's palm, their shape vaguely resembling those of the bodhi tree. Nearby, goats bleat and cows moo, mixing with the occasional roar of passing long-tailed boats.

"I've chewed krathom leaves since I was young," says the 63-year-old Muslim man who lives in an eastern suburb of Bangkok. Speaking on the condition of anonymity, he adds that every morning before he starts work on his farm, where he raises cows and goats, he takes a krathom leaf _ Mitragyna speciosa, an intoxicating plant _ and chews it fresh.

"I would chew three or four more during the day. They help me stay fresh and be able to endure the heat. They also help sooth your throat when you have coughing fits. The leaves also have healing qualities when used with animals.

"When my goats are sick, especially with diarrhoea, I feed them krathom, and they get better every time.

"The krathom tree is for my own consumption," he adds, looking at the tree. "The police come once in a while however, and I was asked to trim its branches so the tree wouldn't look so conspicuous. Many people think that krathom is consumed only by Thai Muslims, but just ask Isan construction workers who have to work all day in the sun, I'm sure they chew the leaves too."

Krathom _ therapeutic and addictive, herb and drug _ has been in the news in the past month. In a move that can be seen as both legally and medically progressive, the Ministry of Justice has pushed for the decriminalisation of the plant, which has been outlawed for the past 70 years. Put in the same category as cannabis and magic mushrooms, the plant is classified into category 5 of the Narcotics Acts (1979). The ministry's committee, however, has cited the use of the herb as an integral part of Thai culture _ at least in several communities _ and its medicinal properties as the reasons to lift the ban.

The Office of Narcotics Control Board's secretary-general Pongsapat Pongcharoen has worked with Ministry of Justice on the issue, and earlier this month they put forward their conclusion to the Ministry of Public Health in order to complete the process of legalising the leaves _ at least in their natural form.

The problem with krathom, the police have said, is when users boil the leaves in large quantity and mix them with cough syrup, soda and ground-down neon bulbs _ known in street argot as 4x100 _ which then transforms the leaves into a hard drug with much stronger effects.

Justice Minister Chaikasem Nitisiri said that krathom should be legally listed as psychoactive substance, but that processing the herb into more powerful drugs, like 4x100, would be strictly outlawed.

Health-wise, experts chip in on the pros and cons of the leaves.

According to Supaporn Pitiporn, the chief pharmacist from Chao Phya Abhaibhubejhr Hospital, the country's leading medical centre that offers traditional Thai medicine and Thai herbal wisdom, krathom is cultivated in some parts of Southeast Asia and it is abundant in southern Thailand.

The use of the herb has been widespread throughout the country and it's an inseparable part of traditional culture in southern Thailand.

According to an Administrative Committee of Substance Abuse Academic Network report, it's estimated that 404,548 people in Thailand used krathom in 2011, and of them, 180,000 were in the South.

Farmers who are engaged in heavy labour in the field generally consume the stimulant to keep them alert and help with physical labour.

''They usually chew about two leaves raw to serve as a pick-me-up,'' Supaporn said.

In low doses, the bitter-tasting leaves are used to treat minor illnesses like diarrhoea, headaches and muscle aches. A couple of briefly roasted leaves boiled with water to make tea can also help regulate blood sugar levels. A mix of crushed krathom leaves and rice whisky (lao khao) is used to heal herpes wounds.

And krathom's recreational effects make people feel relaxed and uplift their mood, as well as promote a good sleep.

''When being used in moderation and in a sensible manner, the herb doesn't bring serious side effects,'' she said.

According to her, people who consume a large amount of krathom leaves may feel nausea, dizzy, depression and sleepy. People who have used of the herb long-term may develop constipation and experience a lack of appetite and loss of weight. Other unwanted side effects include sleep problem and darkening of the skin.

Supaporn noted that krathom leaves show great promise as a painkiller and cough remedy and also have therapeutic value for coping with diabetes _ a quality that is also professed by traditional belief. Further studies, however, need to be conducted with regards the possibility of the medicinal properties and krathom's toxicity to humans.

''Years of a ban on krathom leaves made it difficult for academics and researchers to study this herb properly,'' she said.

Although krathom leaves have medicinal properties, there are numerous documented potential risks to health associated with the plant that must be considered.

Dr Apichat Jariyavilas, a psychiatrist from Srithanya Hospital, said studies showed the use of low to moderate amounts of krathom offers stimulating effects that can speed up the physical and mental processes.

Krathom leaf is made up of mitragynine, an active alkaloid, he continued. In high doses, the substance in the plant can induce central nervous system depression that makes users feel numb and lethargic.

Using krathom leaves can become a habit. People who consume the leaves for a long period of time can form an addiction or dependence as the body gets used to the substance and it requires higher amounts to get the same effects. Heavy, prolonged use of krathom leaves can be harmful to the body and the mind. It's doesn't particularly mean death, but there are significantly high risks of life-threatening problems to a certain extent.

''The adverse effects can vary from person to person and from time to time,'' Dr Apichat said.

He explained that the prolonged use of krathom can trigger the development of constipation or even formation of intestinal polyps that are caused by the stringy central veins of the leaf, as they cannot be digested by the body.

Chronic abusers of krathom leaves may have episodes of whole-body tremors. More serious side effects of heavy use are paranoia and visual hallucinations. A substance in the leaf can make users distort perception which can lead them to hurt themselves and others.

Users who have an intense craving for the plant may exhibit withdrawal symptoms of runny nose, nausea, muscle pains and depression. Many of them feel anxious and aggressive.

According to the Thanyarak Institute on Drug Abuse, there were 10,454 krathom addicts who received treatment from hospitals and other centres nationwide last year, compared to 1,977 from the previous year. The psychiatrist pointed out that professional treatment for substance addiction involves withdrawal-preventing therapy to help patients stop taking drugs quickly and as safely as possible, behaviour therapy that can help them cope with the drug craving, and relapse and motivational enhancement development.

''A drug is a drug. It has potential to cause harm,'' he said. ''We don't encourage patients to temporarily substitute a substance that has less side effects for a stronger substance. We encourage them to receive standard treatment. A patient with intense withdrawal symptoms may require admission to a hospital or a treatment centre.''

It's doubtful, Dr Apichat said, whether the idea of krathom legalisation would help reduce the number of amphetamine users. This is because there are those with poly-substance dependence who use different addictive substances.

''It can be possible that a user will use both amphetamine and krathom leaves at the same time,'' he said.

He noted that nicotine in cigarettes and caffeine in coffee give stimulating effects and the substances can be addictive. But side effects seem trivial by comparison to krathom leaves.

But the doctor backs up Supaporn's view of making the most of the herb's potential painkilling benefits.

''What we do need is further studies. If it's approved, chemical precursor control measures would be issued to prevent misuse of the substance extracted from the plant,'' he said.

CORRECTION

In the story entitled ''Liquid Danger'' published on Oct 1 this year, a number of cosmetic fillers were named as permanent fillers. They are actually temporary hyarulonic acid cosmetic fillers.

In Thailand, cosmetic fillers are categorised as a pharmaceutical product. The import and use of fillers must therefore be approved by the Thai Food and Drug Administration (FDA).

Here is a list of FDA-approved temporary Hyarulonic acid cosmetic fillers.

Esthelis Basic, Esthelis Soft, Fortelis Extra, Modelis, Juvederm Ultra XC, Juvederm Ultra Plus XC, Juvederm Voluma, Perfectha Derm, Perfectha Deep, Perfectha Subskin, Restylane Vital, Restylane Vital Injector, Restylane Vital Light, Restylane Vital Light Injector, Restylane, Restylane Lidocaine, Perlane, Perlane Lidocaine, Restylane Sub Q, Revanesse Ultra.

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