The curse and cure of kratom

The curse and cure of kratom

Concern is growing over rising use of the '4x100' drug cocktail among young Muslims in the South, but science could be about to turn the much-maligned leaf into the next groundbreaking medical treatment.

The recipe for the kratom cocktail “4x100” is simple. Unlike cooking up methamphetamine, or ya ba, it does not require sophisticated knowledge of pharmaceuticals. And the ingredients for 4x100 are easy to find.

Simple mix: 4x100 is named after its four main ingredients — kratom leaves, cough syrup, Coca-Cola and ice. Kratom leaves are a mild stimulant and were traditionally chewed by farmers and labourers.

Spectrum followed a group of three men in their twenties into the woods in the border province of Pattani to see how they blend the drug cocktail, made of kratom leaves.

The dark-green oval leaves of the kratom tree can grow up to 18cm long and 10cm wide. A member of the coffee family, the leaves are a mild stimulant, and were traditionally chewed by farmers and physical labourers needing a boost or some light pain relief.

Kratom trees, which are indigenous to Thailand, have been illegal for more than 60 years. But the law has done little to deter drug users, who increasingly turn the traditional leaf into a sweet-tasting drink.

Proponents of kratom say it is not strong enough to be considered a drug, while critics warn it can cause aggressive behaviour and psychotic episodes.

Those addicted to the leaves lose weight and their facial skin darkens. Withdrawal symptoms are similar to prescription painkillers, including mood swings and muscle tremors.

ANYTHING BUT ALCOHOL

Mr Sunny*, the oldest of the three men, said he and his friends shun alcohol because of Islamic principles.

Home blend: Drug users start by crushing kratom leaves by hand before boiling a batch of 4x100.

“Although kratom is illegal, using it is not barred by Islamic law,” said the father of two, who has a steady job. “Kratom is not alcohol, it is a kind of herb.”

The three men were happy to show how easy it is to make 4x100, which is named after its four main ingredients — kratom leaves, cough syrup, Coca-Cola and ice.

Cooking meth is a tricky process in which the wrong formula can lead to explosions, but no safety mask is required when making kratom.

Mr Lee*, who is thin and wears a T-shirt and tight jeans, said he sometimes plays the guitar while the others are preparing the cocktail. “It’s like we are getting together for a coffee and a chat.”

The straightforward ingredients for the cooking session are 30 fresh kratom leaves, boiling water, cough syrup and two of the small 240ml cans of Coca-Cola.

“We make it whenever we feel like it,” said the third member of the group as he stirred the juice. “We mostly do it in the afternoon to chill out,” he added, since the drink makes him sleepy.  

There have been reports of people mixing pharmaceutical drugs and strange ingredients such as the ash from mosquito coils into 4x100 concoctions, but Mr Sunny said he never deviates from the original recipe.

The second-hand pot used to cook the cocktail was well-worn and covered in burn marks. Mr Sunny found it in the woods, where it had likely been discarded by another drug user. It was out of shape but good enough for making 4x100.

“Someone probably kicked it away to get rid of the evidence,” he said, suggesting another group of cocktail makers might have left the scene in the hurry for fear of being caught.

It was obvious the location had been used to cook 4x100 before and there were empty cans of Coke and bottles of cough syrup scattered around.

The spot was down a dirt track a few kilometres away from the main road, in a district where insurgency-related violence has struck several times in the past year.

HIGHS AND LOWS

Best served chilled: Once the ingredients for 4x100 have been cooked together, the pot is cooled down in a container of ice before consumption.

Although kratom is illegal, it is still widely popular since the tropical tree is found across Thailand and Malaysia.

According to the Office of the Narcotics Control Board, an increasing number of Thais are using leaves from the tree, known botanically as Mitragyna speciosa.

A total of 1.23 million people were found to have used or taken kratom in 2011, compared to 1.08 million in 2008, according to an ONCB nationwide survey. It is consumed nationwide but the highest proportion of users is in the South, where 282,082 people took kratom in 2011.

Arrests for kratom possession rose when seizures of the drug went up from 13 tonnes in 2008 to 33 tonnes in 2012, although this levelled out and 14 tonnes were confiscated in 2013.

The ONCB warns the drug can have a detrimental effect on the nervous system and mental health.

But kratom has a long history of household use. Chewing the fresh leaves is a remedy for stomach aches, while others grill kratom leaves and eat them with chilli paste for a pick-me-up snack. The herb is also used to ease opium withdrawal.

The Kratom Act 1943 made the tree illegal. However the ban was not just aimed at the drug’s psychoactive qualities.

A Senate report in November 2003 said kratom was first banned because the government of the day wanted to boost tax revenue, a high portion of which came from opium levies.

Back then, the government had monopolised the opium trade and was earning revenue from levies charged on it. But since opium prices were high, some users shifted to taking kratom leaves to help with withdrawal.

Botanists say pure kratom can help treat mild illnesses such as diarrhoea, but many agree it should be a controlled substance.

Kratom is not classed as a narcotic drug by the United Nations Office on Drug and Crime but is considered a plant-based "new psychotropic substance". The US calls kratom a “drug of concern”. As such, laws on the use of the plant vary between states.

In Thailand, kratom is classified as a Category 5 substance under the Narcotic Drug Law of 1979.

NO DETERRENT

Weak enforcement of the law banning kratom has failed to deter its cultivation. Mr Sunny has a small kratom tree in his backyard, but it does not provide enough leaves for daily consumption. When he wants to make 4x100, he can buy 30 kratom leaves for 200 baht from a local dealer.

Asked if his supplier is linked to southern insurgents, he shrugs and says no. “He is a village leader.” Those who don’t want to brew 4x100 themselves can buy it in various forms, including a powdered version or ready-to-drink.

But Mr Sunny prefers to blend it himself using fresh leaves. “It smells better and I can adjust the formula,” he said.

High time: The cocktail makes users feel ‘floaty’.

Some users mix 4x100 with drugs such as ya ba for a stronger high and the cocktail is now competing with methamphetamine as one of the most-used drugs in the South. 

In 2013, the Justice Ministry considered legalising kratom to help wean addicts off harder drugs, including meth.

However, public opinion was largely against legalising kratom, which many people associate with the insurgency in the South.

“Kratom does not make us more violent. It’s the opposite in fact. After we drink 4x100 we feel like we are floating and have a nice sleep,” Mr Sunny said.

In 2011, the Transnational Institute advocated legalising kratom use in recommendations published on the UN Office on Drug and Crime website. The organisation said kratom is an integral part of southern Thai culture.

“Criminalisation of kratom is unnecessary and counterproductive given decades of unproblematic use,” report author Pascal Tanguay wrote.

The report also recommended revising “thresholds for sentencing in regards to boiling 4x100, which should not be considered as the production of a new drug” and called for “unhindered access to kratom for scientific research and to explore medicinal properties, especially its potential as a substitution drug to manage alcohol and drug dependence”.

ON TRIAL IN THE LAB

The debate over kratom’s medicinal use has so far lacked scientific evidence. However, this is about to change since the Prince of Songkla University in Hat Yai is studying the potential beneficial properties of kratom.

Ekkasit Kumarnsit, an assistant professor in the Department of Physiology's Faculty of Science, said “the research should end the debate over the medicinal use of kratom”.

Mr Ekkasit and Dania Cheaha, from the same university, have recently finished writing the first report from two-and-a-half years of research.

The study looks at whether kratom could be used as an antidepressant for patients recovering from alcohol addiction.

The report, soon to be published, says alkaloid-rich extracts from kratom leaves “may attenuate ethanol withdrawal without rapid eye movement [REM] sleep disturbance”.

Many antidepressants help alleviate alcohol withdrawal symptoms, but most cause sleep disturbances. According to the research findings, kratom could serve as an antidepressant without the undesirable side effects.

Mr Ekkasit and his team came to their conclusions by testing kratom leaves from natural sources in Songkhla and Satun provinces on about 40 rats. The scientists used electroencephalography to analyse the rats' brain activity.

“Our scientists put sockets containing intracranial electrodes on the animals’ heads,” Mr Ekkasit said. “The electrodes were permanently fixed to the skull to detect signals from specific brain areas and transfer them to the computer for analysis.”

The team found alkaloid extracts from kratom alleviated ethanol withdrawal with no impact on REM sleep, showing the herb has a promising “hallmark as an effective antidepressant”.

Mr Ekkasit stressed he is not calling for kratom to be legalised, but said science should be used to help people make informed decisions about the drug. “Let the scientific results speak,” he said.

Despite the potential health benefits, he added repeated consumption can make users increasingly dependent.

“When users don’t drink kratom they get certain withdrawal symptoms, like coffee addicts. Kratom use has to be overseen,” he said.

The team, meanwhile, is conducting further research into how kratom could be used to aid morphine and opium withdrawal.

Preliminary evidence from that research is due to be published soon. Mr Ekkasit declined to elaborate but believes the findings “should provide the information to decide the legal status of kratom”.

Drug developers: Dania Cheaha, left, and Ekkasit Kumarnsit, second left, and their team are studying the effects of kratom on rats. They hope their work will progress treatment for alcoholics.

In the name of science: A team at Prince of Songkla University attached sockets containing intracranial electrodes to the skulls of 40 lab rats. The electrodes were then used to measure how an alkaloid-rich extract from kratom leaves affected activity in specific brain areas.

Hope for addicts: Researchers think kratom could serve as an antidepressant to alleviate alcohol withdrawal symptoms without negative side effects.

Hauled in: Kratom seizures like this 250kg haul in Chumphon are increasingly frequent in the South, which a high percentage of users.

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