Kratom – the most controversial drug no one has ever heard of

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It’s not the most popular drug.   In fact, if you asked the average person, he or she would probably say they had never even heard of Kratom.   Yet, mitragyna speciosa, also known as Kratom, is a plant in the coffee family that has been used in traditional medicine in parts of Africa and Southeast Asia for centuries.   Traditionally, laborers and farmers would chew kratom leaves to provide energy and pain relief.   The tropical Kratom tree is native to Thailand, but its usage has been illegal there since 1943.   The official rationale for the ban is the substance’s alleged potential for abuse, although many sources attribute the ban to decreased revenues from opium taxes after many users switched to kratom to manage their withdrawal symptoms.   It should be noted, however, that Thailand now seems to be attempting to legalize kratom once again.

The tropical Kratom tree is native to Thailand, but its usage has been illegal there since 1943.

Low doses of kratom often have a stimulating effect, like a strong cup of coffee, while higher doses can provide pain relief and slight sedation.   The main active substances in kratom are ­mitragynine and the more potent 7-hydroxymitragynine, drugs that react to opioid receptors in the brain in a similar way as prescription painkillers or heroin.  Unlike typical opioids, however, the herb is typically brewed as a tea, or scooped as a powder into coffee.  It can be purchased online, in head shops (stores that sell drug-related items), and even in some gas stations.  Allison Hussey, a writer for Indy Week, wrote about her experience trying a kratom beverage at bar in Carrboro, NC, describing the substance as a “green-brown sludge, ostensibly ladled from some South Pacific swamp.”  Despite its unappealing appearance and taste, kratom has become popular in the United States among people trying to fight opioid substance abuse.

There have been numerous kratom success stories, ranging from the mother of two who weaned herself off prescription pain pills, to a student who uses kratom to focus on schoolwork.  In yet another success story, a retiree “found a legal alternative for chronic arthritis pain.” A recovering alcoholic and addict wrote an endorsement for kratom, stating, “Thank you God for your miraculous plants, and screw you America for making them illegal.”

In late August, the Drug Enforcement Administration announced its intent to classify Kratom as a Schedule I drug…

Because “making it illegal” is exactly what the federal government intends to do.  In late August, the Drug Enforcement Administration announced its intent to classify Kratom as a Schedule I drug, on the same level as drugs such as heroin, LSD, and ecstasy.  In the statement, the DEA reported “law enforcement nationwide has seized more kratom in the first half of 2016 than any previous year and easily accounts for millions of dosages intended for the recreational market.”  The announcement also stated that kratom has satisfied the three factors needed to constitute a Schedule I controlled substance under the Controlled Substances Act of 1970: (1) high potential for abuse; (2) no currently accepted medical use in treatment in the United States; and (3) lack of accepted safety for use under medical supervision.

There is some evidence that kratom is addictive, and can cause serious nausea and withdrawals; however, coffee, which is in the same family as kratom, and enjoyed by law students everywhere, is also addictive and known to cause nausea and withdrawals after discontinued use.  In an article for NPR, entitled “Kratom Advocates Speak Out Against Proposed Government Ban,” David Kroll, a pharmacologist and medical writer, stated that in an animal study, it was very difficult for mice to get addicted to mitragynine, the main active ingredient in kratom, unlike traditional opioids.

While many opponents of kratom often equate the potential for its abuse to painkillers or heroin, the risk of overdose associated with using kratom is substantially less.  According to data from the Centers for Disease Control and Prevention, “from 1999 to 2014, more than 1650,000 people have died in the U.S. from overdoses related to prescription opioids.”  2014 was the worst year so far for opioid addiction; more than 14,000 people died in 2014 from overdoses involving prescription opioids, and almost 2 million Americans abused or were dependent on prescription opioids.  The three most common drugs involved in prescription opioid overdose include: methadone (a synthetic opioid commonly, and perhaps ironically, prescribed to treat opioid addiction); Oxycodone, such as OxyContin; and Hydrocodone, such as Vicodin.

There have been no confirmed cases of kratom overdose…

In contrast, there have been very few reported kratom-linked deaths, and cases that have been reported have all involved multiple drugs.  Kratom also does not cause some of the same side effects as opioids, including respiratory depression, or “hypoventilation”—a process in which breathing becomes too slow or shallow, or ceases completely. Hypoventilation is the telltale symptom of a traditional opioid drug overdose.  In addition, there have been no confirmed cases of kratom overdose throughout its long history of use, mainly because the physical characteristics of the substance make it very difficult for users to be able to ingest enough kratom to overdose before vomiting.

For two legislative sessions in a row, Florida contemplated passing a bill banning kratom; however, in a December 2015 report, the Florida Department of Law Enforcement stated “Kratom does not currently constitute a significant risk to the safety and welfare of Florida residents.  Additionally, the report cites that the Florida Department of Health found “there are no pervasive health issues can be attributed to the ingestion Kratom products in Florida.”

In an article for Vice, Mala Szalavitz writes, “In the case of kratom, during an epidemic of opioid misuse which is absolutely known to be rapidly killing people, it seems odd to call for a ban of a substance that, whatever its long term risks are, is clearly safer in the short term.”

One of the most debated aspects of the kratom controversy is whether kratom has any actual medical benefit, or is just a more approachable way to “get high.”  According to the 145,906 people who have signed a petition on WhiteHouse.gov to keep the substance legal, “kratom has been shown numerous times in reports from users to help recovering Opiate addicts, treat pain, combat depression and anxiety, and much more.”  Although kratom has yet to be clinically studied in humans, the results of some animal studies have shown that certain compounds in kratom have the potential to reduce pain while simultaneously decreasing addictive and potentially deadly side effects.

If the DEA finalizes it decision to place kratom on the controlled substances list, the drug may find itself in a catch-22 situation—it will be even harder to prove the medicinal use of the substance because it is already banned, partly for allegedly not having a medicinal use.  Scientists can obtain a license to study Schedule I drugs, but according to an article by Scientific American, these licenses are “quite hard to acquire” and they “significantly slow down research.”

Kratom is currently categorized as a dietary supplement under the Federal Food, Drug, and Cosmetic Act.

According to the American Kratom Association, “the spread of misinformation, both scientific and anecdotal, about Kratom has created a challenging regulatory environment.”  Kratom is currently categorized as a botanic dietary supplement under the Federal Food, Drug, and Cosmetic Act. Because it is categorized as a dietary supplement, the FDA cannot restrict its sale unless it is proven unsafe or producers claim it treats a medical condition.  For this reason, some kratom products are often labeled “not for human consumption” to avoid application of the Act, despite instructions often present on the other side of the label, directing customers on how to brew kratom tea at home.

In July, the FDA issued an important alert banning the import of kratom, on the basis that “there does not appear to be a history of use or other evidence of safety establishing that kratom will reasonably be expected to be safe as a dietary ingredient.”  In the alert, the FDA also described kratom as “a botanical substance that poses a risk to public health.”  Even though kratom is not currently controlled under the Federal Controlled Substances Act, there are some States that have imposed regulations or prohibitions against kratom possession and/or use.

[T]he North Carolina General Assembly also proposed to identify kratom as a controlled substance in North Carolina.

This past summer, the North Carolina General Assembly also proposed to identify kratom as a controlled substance in North Carolina.  During the 2015—2016 legislative session, Republican Senator Tom McInnis initially sponsored a bill to add kratom to the controlled substances list, which would have made it a criminal offense to possess and/or sell kratom.

When meeting to discuss the proposed bill back in May, McInnis told the Senate Heath Care Committee, “Twenty-three bodies they’ve had on the slab over there have tested positive for kratom.  It’s time to put the brakes on this product before the next epidemic starts.”  McInnis later conceded that the 23 people who had died with kratom in their system also had other illegal drugs in their systems as well.

During the committee meeting, Republican Senator Tommy Tucker held up a crudely spray-painted roadside sign advertising kratom for help with addiction, recognizing the drug’s strong “street presence.”  Yet, other Senators at the committee meeting recognized the State’s lack of conclusive data on the substance; Democratic Senator Gladys Robinson of Guilford acknowledged the consequences of adding kratom to the controlled substances list with little data to back up that decision, asking “Have we talked to the medical society or anybody in North Carolina that’s doing research?” Robinson asked.  “If you’re making it a felony, that means incarceration.”  Senator Terry Van Duyn, D-Buncombe, stated, “I’d really like to hear some data.  This all feels very anecdotal for me.”

Meanwhile, outside the committee meeting, kratom vendors and advocates gathered in support of the substance.  Elizabeth Gardner, who serves kratom drinks at her business Krave Kave Bar in Carrboro, NC, brought a tray of kratom tea to outside the committee room.  Senator McInnis declined to try any, stating, “They brought us several samples, which we immediately put in the trash.”  Kratom supporters not only appeared in person to advocate for the substance, but many legislators found their email inboxes flooded with emails from concerned kratom supporters asking legislators not to ban kratom.

The General Assembly seemed to recognize the unanticipated opposition to the bill, as well as the lack of data on the substance, when it passed House Bill 747, a bill to conduct a study on “the impact on the public health of the use of kratom.”  The NC legislature also decided to tack onto the bill the study of unrelated nitrous oxide “whippets” or “hippie crack.”

The bill also bans the sale and purchase of kratom to any person under 18.  Gardner, the owner of Krave Kave bar, said the 18-and-up requirement would not hurt her business, which did not serve underage customers anyways unless a parent signed a waiver.  Gardner went on to say “I don’t know anyone in the industry who sells to children.  I don’t know children who want this product, because it doesn’t taste good.”  While both the House and Senate passed the bill, it was referred to the House Committee on Rules, Calendar, and Operations, where it was left to die in the final days of the legislative shuffle.

The consensus on kratom is that there is no consensus.

The consensus on kratom is that there is no consensus.  It seems there are just as many advocates claiming kratom to be a “wonder drug” which gave them their lives back, as there are opponents declaring kratom to be the next “drug of abuse.”  A bipartisan group of 45 Congressmen recently signed two letters to be sent to Chuck Rosenberg, the acting administrator of the DEA, as well as to Office of Management and Budget Director Shaun Donovan, asking the Obama administration to delay the ban on kratom.  The letter states, “This hasty decision could have serious effects on consumer access and choice of an internationally recognized herbal supplement.”  While most reports on kratom state that more research still needs to be done on the substance, the DEA could have finalized control of the drug as early as September 30, 2016. The ban is expected to last at least two years, although the agency could move to make the scheduling permanent. As of December 1, 2016, the DEA still has not added kratom to its list of Controlled Substances.