Mitragynine pseudoindoxyl has recently attracted increasing attention as a promising analgesic alternative for pain management with considerably fewer side effects. Here, we describe the first enantioselective and scalable total synthesis of this natural product in addition to its C-20 epimeric congener, speciogynine pseudoindoxyl. The characteristic spiro-5-5-6 tricyclic system of these alkaloids is formed via a protecting group-free cascade relay process in which oxidized tryptamine and secologanin analogs are used. Furthermore, we uncovered that mitragynine pseudoindoxyl exists and acts not as a single molecular entity but as a dynamic ensemble of stereoisomers in protic environments, thus, it exhibits structural plasticity in biological systems. Accordingly, these synthetic, structural, and biological studies provide a basis for the planned design of mitragynine pseudoindoxyl analogs, which can guide the development of next-generation analgesics.