Fans of the herb kratom say it offers pain relief, calms anxiety, and can help ease opioid withdrawal symptoms. However, a new report from the Food and Drug Administration says the popular herbal substance acts like a prescription-strength opioid and is associated with several dozen deaths.
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.
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.
Between 2010 and 2015, the Centers for Disease Control and Prevention noted a tenfold increase in calls about kratom to poison control centers across the U.S., from 26 to 263. About 42 percent of those cases involved non-life-threatening symptoms that required some treatment. About 7 percent were classified as major and life-threatening.
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."
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.
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."