Where is it found?

Purslane is a cosmopolitan annual succulent plant found growing in all continents except Antarctica. Although considered an aggressive weed in the some countries, it has very important nutritional and medicinal properties (Berdonces, 2009; Duke et al., 2009; Mabberley, 2008).

Parts of the plant used:

Leaves, stems, and seeds.

How is it used?

The plant can be eaten cooked as a potherb and the juice can be ingested to treat diverse ailments. The seeds have important medicinal value, since they can lower blood glucose as well as show cyto-toxicity toward certain cancer cell lines (Al Sheddi et al, 2015; Quattrochi, 2012; Duke et al., 2009).

What is it used for?

The leaves contain various active ingredients (mainly alkaloids) that are hallucinogenic, and can cause psychosis, stimulation (euphoria), and sedation as well. Additionally, the phytochemicals contained in the plant have analgesic, astringent, stimulant, and tonic actions. The plant has been popularly used as a substitute for opium, but has been banned in various countries across the globe due to the potentially addictive nature of some of its components (Anwar, 2016; Pantano, 2016). Kratom contains chemical substances that posses opioid (analgesic or sedative) effects. Additionally, this species contains two psychoactive chemicals, which have both stimulant (mitragynine) as well as sedating or narcotic (7-hydroxymitragynine) effects (Griffin, 2016; Ratsch, 2011).

Studies by Váradi et al. (2016), suggest that the chemical compounds and their analogs contained in kratom could potentially be a promising new generation of novel pain relievers. Until the discovery of kratom’s chemical constituents, opioid compounds were thought to be found only in the opium poppy (Papaver somniferum - Papaveaceae. However, some sources mention that kratom use could potentially be more dangerous than that of opium (Ismail et al., 2017; Mabberley, 2017).

Kratom preparations are also used in Asia as local anesthetics, as well as to treat various health problems such as hypertension, diabetes, dysentery, gastrointestinal parasites, and stomachaches. The leaves are also applied externally as poultices, alone to treat wounds or in combination with other medicinal plants for splenomegaly (abnormal enlargement of the spleen). Natives in various Asian countries consume the leaves for their stimulant ability, as well as to combat fatigue and as a substitute for opium. The plant chemicals exert a morphine-like effect at high doses (Pantano et al., 2016; Ismail et al., 2017).

Kratom’s main alkaloids, mitragynine and 7-hydroxymitragynine, modulate opioid receptors, and exert their effects as partial agonists at mu-opioid receptors and competitive antagonists at kappa- and delta-opioid receptors. These phytochemicals also seem to exert diverse activities at other brain receptors, including adrenergic, serotonergic, and dopaminergic receptors, for example. This could provide an explanation for the complex pharmacological profile of the plant’s raw extracts (Krugel and Grundmann, 2017).

Very high doses of mitragynine were found in two people who died after ingesting a product containing kratom, although the cause of death was not due primarily to this compound in either case (Domingo et al., 2017).

Kratom has also been used as a treatment against opium addiction (Wiart, 2002; Ismail et al., 2017). Products made from this plant are used in Thailand and Malaysia to treat various health problems, including intestinal worms, cough, diabetes, hypertension, chronic musculoskeletal pain, and gastroenteritis. The leaves are also used for their antipyretic (fever reducing), anti-inflammatory, and analgesic effects. Even though the plant has been proven to possess important medicinal applications, the irresponsible “recreational” use of kratom, alone or in combination with other substances (including caffeine, alcohol, and certain pharmaceutical drugs), has spread to various countries around the world, including the United States (Anwar et al., 2016).

Reports from Thailand mention that a combination (“cocktail”) of kratom with various other chemical substances, including certain pharmaceuticals, has caused various deaths. Additionally, in Sweden, a product purportedly containing kratom as well as caffeine, and a pharmaceutical analgesic (O-desmethyltramadol), caused the death of nine people (Pantano et al., 2016). Various kratom products advertised on the internet purportedly contain some of its main active ingredients (Griffin et al., 2016).

Anwar et al. (2016) evaluated the calls made to U.S. poison centers related to exposure to kratom in a five-year period (from 2010 to 2015). There was a tenfold increase in the number of calls (from 26 in 2010 to 263 in 2015). Approximately 90.2% (595) of the people who called stated they had ingested the plant. Within these calls, some reported using kratom combined with other substances (multiple exposures). The other substances commonly reported included ethanol (alcohol), other plants, benzodiazepinic drugs, narcotics, and acetaminophen (paracetamol).

A 23-year-old male was admitted to a hospital’s emergency room complaining that for the past 4 days, he had painless jaundice, light stools, and dark urine. This was 7 days after his last ingestion of a kratom product. This case is another example of the plant’s potential toxicity to the liver. Some people employ kratom as a psychostimulant since its use is currently legal in various countries (Drago et al., 2017).
A case of acute hepatitis in a 31-year-old male caused by the ingestion of a kratom herbal tea was successfully treated with N-acetylcysteine (Mousa et al., 2017).

Fluyau and Rivadigar (2017) mention that the plant’s bioactive ingredients show certain benefits such as stimulant and sedative actions and also antinociceptive (pain relieving) effects. The compounds contained in kratom apparently inhibit pro-inflammatory mediator release and vascular permeability and may stimulate the immune system. Additionally, the plant possesses antidepressant and anorectic actions. Despite certain beneficent effects, kratom may also have a negative side, causing arrhythmias, seizures, memory impairment, hepatic cholestasis, coma, and, in certain cases, death. Kratom use can also elicit diverse and contradictory psychological manifestations ranging form euphoria and feeling relaxed to manifestation of serious symptoms including psychosis, hostility, and aggressive behavior.

A 22-year old male presented with severe headache, disorientation, and aphasia after ingesting Adderall and a product containing kratom. The patient’s initial blood pressure was high but returned to normal after his admission to the hospital. This case scenario suggests that ingesting products containing kratom could cause posterior reversible encephalopathy syndrome. This should be taken into account when patients are admitted to hospital emergency centers presenting symptoms such as cephaleas (headaches), confusion, and visual disturbances (Castillo et al., 2017).

A study undertaken by Lydecker et al. (2016) found multiple packaged commercial Kratom products that likely contained artificially elevated concentrations of 7-hydroxymitragynine. This alkaloid is the plant’s main bioactive ingredient associated with some of the deleterious side effects on users. Since the quality control of various herbal products in many countries is less than optimal, the authors of the study emphasized the great importance of increased dietary supplement oversight of herbal supplements containing kratom.