Fans of the herb kratom say it offers pain relief, calms anxiety, and can help ease opioid withdrawal symptoms. However, several federal government agencies have issued warnings that it acts like a prescription-strength opioid and could be easily abused.
But first, what exactly is this polarizing botanical drug?
What is kratom?
Kratom is a tropical tree (Mitragyna speciosa) related to coffee that is native to Southeast Asia. Leaves from the tree have been used for centuries as a traditional remedy for pain.
The leaves can be eaten raw but are usually crushed and made into a powder. The powder is then consumed in capsules, smoked or brewed in teas.
According to the U.S. Drug Enforcement Administration, consumption of kratom in low doses produces simulating effects. However, in large amounts it acts as a sedative and can lead to psychotic symptoms, as well as psychological and physiological dependence.
Potential to treat addiction
While the DEA believes kratom can cause dependence, a new study investigates if certain components in kratom can treat addiction.
Scott Hemby, professor of pharmaceutical science at High Point University, studied kratom's drug compounds and discovered that mitragynine (MG) and 7‐hydroxymitragynine (7-HMG) have the largest psychoactive properties. Hemby's team isolated the two compounds and used rats to study the effects they had on the brain. The rats gave themselves dosages by pushing a button and appeared to take HMG but not MG. Therefore, the team determined that HMG had addictive properties but not MG — meaning there may be a way to increase the effects of one compound and lessen the other for the benefits of treating addiction.
"It's kind of the yin and yang of kratom," Henby told Business Insider. "We're at the precipice of something promising here." However further tests are needed to determine if this method will be effective in humans.
While these preliminary finds sound promising, the government still isn't on board with the idea that kratom is a safe method for treating addiction.
Why there is concern
The DEA includes kratom on its Drugs of Concern list (substances that aren't regulated by the Controlled Substances Act, but that could pose risks to people who abuse them), and the National Institute of Drug Abuse has identified kratom as an emerging drug of abuse.
A report by the Centers for Disease Control and Prevention (CDC) in April 2019 listed kratom as the cause of death in 91 overdose cases in the U.S. from July 2016 to December 2017. In looking into the almost 28,000 overdose deaths during that time frame, 152 of the deceased tested positive for kratom — which doesn't mean that's what caused the death but does indicate its presence. Toxicology testing procedures vary by state.
In new research, scientists find that kratom is reportedly linked to serious side effects like coma, seizures and death. Researchers looked at reports from the National Poison Data System, which is the data warehouse for the nation’s 55 poison control centers. They found 2,312 people had called a center about kratom.
Of those reports of kratom exposures, the most commonly reported symptoms reported were agitation (18.6%), rapid heartbeat (16.9%) and drowsiness (13.6%). There were also reports of more serious symptoms including seizures (6.1%), hallucinations (4.8%) and coma (2.8%). They also studied death certificate reports from the County Medical Examiner's Office in New York State and found that kratom was also listed as a cause or contributing factor in the deaths of four people.
In their study, published in the journal Pharmacology, the researchers concluded, "Our findings suggest kratom is not reasonably expected to be safe and poses a public health threat due to its availability as an herbal supplement."
The study's findings mirror research published earlier this year based on calls to poison control centers due to kratom use.
Between 2011 and 2017, poison control centers across the U.S. received 1,807 calls about kratom. Two-thirds of those cases occurred between 2016 and 2017. An overwhelming percentage involved men over the age of 20 in a residential setting who intentionally consumed the drug. The most common side effects were agitation/irritability and rapid heart rate. Of those cases, 11 people died from complications related to kratom exposure.
In the February 2018 report, FDA Commissioner Scott Gottlieb, M.D. said, "There is no evidence to indicate that kratom is safe or effective for any medical use. And claiming that kratom is benign because it’s 'just a plant' is shortsighted and dangerous. After all, heroin is an illegal, dangerous, and highly-addictive substance containing the opioid morphine, derived from the seed pod of the various opium poppy plants."
Gottleib warned of potential side effects including changes in neurologic and cardiovascular function. He also cited 44 reported deaths "associated with the use of kratom."
Even after that warning, the FDA said several companies were still claiming their kratom products could treat opioid addiction and withdrawal. Gottlieb issued direct warning letters to these companies in May 2018.
"Despite our warnings that no kratom product is safe, we continue to find companies selling kratom and doing so with deceptive medical claims for which there’s no reliable scientific proof to support their use," said Gottlieb in a press announcement. "As we work to combat the opioid epidemic, we cannot allow unscrupulous vendors to take advantage of consumers by selling products with unsubstantiated claims that they can treat opioid addiction. Far from treating addiction, we’ve determined that kratom is an opioid analogue that may actually contribute to the opioid epidemic and puts patients at risk of serious side effects."
Consumer Reports points out other possible dangers associated with kratom:
- Kratom has been found to be laced with opioids, including tramadol and hydrocodone.
- There's little research about drug interactions, and users are mixing kratom with legal and illegal drugs, which can be dangerous.
- Some users who have turned to kratom to kick an opioid addiction have become hooked on kratom instead.
In February 2018, the CDC warned people not to use kratom in any form due to an outbreak of salmonella. FDA and state agencies tested a variety of kratom products and found 37 different products tested positive for salmonella.
It kratom legal?
In 2016, the DEA announced plans to list kratom as a Schedule 1 substance, which would add it to the ranks of LSD, heroin, marijuana and ecstasy. The plan would have essentially banned kratom, but the DEA changed course and instead gave the public a chance to comment.
Now, the substance is mostly legal in the U.S., depending on where you live. According to the American Kratom Association, several cities, counties and seven states (Alabama, Arkansas, Indiana, Rhode Island, Tennessee, Vermont and Wisconsin) and the District of Columbia have banned or seriously restricted the use of kratom.
While supporters are working hard to keep kratom legal, the DEA and detractors argue that the substance is not safe.
"We’ve learned a tragic lesson from the opioid crisis," Gottleib said. "That we must pay early attention to the potential for new products to cause addiction and we must take strong, decisive measures to intervene."
Other scientists weigh in
A group of scientists challenged the FDA report in an Feb. 2018 open letter to the DEA and the White House, circulated by the American Kratom Association.
"The available science is clear that kratom, although having effects on opioid receptors in the brain, is distinct from classical opioids (e.g. morphine, heroin, oxycodone, etc.) in its chemistry, biological effects, and origin (kratom is a tree in the coffee family, not the opium poppy family)," they wrote.
"Importantly, as commonly used in raw plant form, it does not appear to produce the highly addictive euphoria or lethal respiratory depressing effects of classical opioids."
The group included researchers and scientists from Johns Hopkins University, Columbia University and the University of Florida.
"It is our collective judgment that placing kratom into Schedule I will potentially increase the number of deaths of Americans caused by opioids because many people who have found kratom to be their lifeline away from strong opioids will be vulnerable to resumption of that opioid use, whether their prior opioid use was for relief of pain or due to opioid addiction."
Editor's note: This story was written in early February 2018 has been updated with new information.