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.
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."
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 late February 2018, the CDC warned people not to use kratom in any form due to an outbreak of salmonella. So far, 28 people in 20 states are believed to have become ill after consuming kratom in pills, powder or tea. The CDC believes that kratom is the likely source of the outbreak.
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."
Some scientists weigh in
A group of scientists challenged the FDA report in an 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.