The popularity of the herbal supplement kratom has soared in recent years, with many people using the green plant powder to ease the symptoms of opioid withdrawal. Proponents of kratom argue that the largely unregulated substance could potentially solve the nation’s opioid crisis.
But government officials and drug abuse experts say kratom has no valid medical use and is just as addictive as stronger opioids. Kratom can even be deadly, according to the Food and Drug Administration. The government agency says the over-the-counter substance has been linked to 44 deaths since 2011.
Kratom comes from the leaves of Mitragyna speciosa, a tree that grows in Thailand, Malaysia, Vietnam and other parts of Southeast Asia. The leaves of the tropical plant can be chewed, smoked or brewed into tea. Kratom powder can be ingested in pill form.
Depending on the dose taken, kratom can have almost polar opposite effects. In small doses, it acts as a stimulant, producing an energetic euphoria, increased alertness and talkativeness. But in higher doses, the drug acts more like a sedative and has strong painkilling properties.
Kratom is known by a number of different names, including:
In the United Kingdom, kratom is sometimes called “herbal speedball.”
The primary active ingredient in kratom is mitragynine. When mitragynine is broken down by the body, its major byproduct, or metabolite, is 7-hydroxymitragynine. Both chemicals act on the brain’s opioid receptors, causing a euphoric release of dopamine while dulling pain signals.
But experts who study kratom say its ingredients don’t bind to those receptors in exactly the same way as heroin, oxycodone and other opioids. As a result, kratom is much weaker. According to a 2016 study in the Journal of the American Chemical Society, 7-hydroxymitragynine is about one-tenth as potent as morphine, and mitragynine is about one-hundredth the strength of morphine.
Kratom does not require a prescription and is widely available except in five states and a handful of U.S. cities that have banned it. The supplement is commonly sold in tea bars, head shops, vape stores and online. Some convenience stores even carry it.
For hundreds of years, laborers in Southeast Asia have chewed on kratom leaves to boost energy and ease work-related muscle pain. Some people in Southeast Asia use it as an alternative to opium.
In the United States, kratom has become a popular herbal remedy to ease the symptoms of heroin and opioid withdrawal. In addition, some people use kratom to relieve chronic pain, depression and anxiety. Others use it recreationally to get a kratom high.
Kratom’s other purported medicinal uses include relieving inflammation, fever, cough and diarrhea.
According to the FDA, however, no reliable scientific evidence exists to support any therapeutic use of kratom, including its use as a treatment for opioid withdrawal symptoms.
The agency has also warned the public and health care professionals about the dangerous, and sometimes deadly, risks of using kratom. In a statement issued in February 2018, FDA Commissioner Scott Gottlieb declared that the chemical compounds in kratom are, in fact, opioids. He emphasized the potential for kratom addiction and abuse.
Kratom can cause a number of opioid-like side effects, including nausea, constipation, dry mouth, itching and a loss of appetite. Other kratom side effects can include sweating, increased urination, elevated heart rate, vomiting, drowsiness, weight loss, darkening of the skin, frequent urination and insomnia.
Serious risks and side effects of kratom include:
Even small doses of kratom can cause uncomfortable side effects such as agitation and anxiety.
Consuming kratom regularly can lead to addiction and dependence. Chronic kratom users who suddenly stop using it may develop a multitude of uncomfortable withdrawal symptoms.
Symptoms of kratom withdrawal include:
As kratom use has soared over the past several years, so have calls to poison control centers. The Centers for Disease Control and Prevention noted a tenfold increase in calls about kratom to poison control centers between 2010 and 2015 — most of which came from health care providers.
The February 2018 alert from the FDA reported 44 deaths across the nation associated with kratom use.
Among them was Christopher Waldron, a 27-year-old Florida man who was found dead in his apartment on July 7, 2017. Waldron’s mother told a local television news station that her son had been struggling with an opioid addiction for more than a decade and was using the herb instead of prescription pain pills.
Following an autopsy, the Hillsborough County Medical Examiner ruled Waldron’s cause of death as “intoxication by Mitragynine (Kratom).”
Nancy Knoebel also lost her son to kratom. Andrew Turner, 27, was using kratom to treat heroin withdrawal symptoms, according to the Washington Post. The medical examiner concluded that he died from the “toxic effects” of the herb.
“If kratom hadn’t killed him, he’d be alive and sober,” Knoebel told the Washington Post. “It was like someone ran a red light and killed him.”
John and Lauren Eden blame kratom for their 22-year-old son’s death by suicide. Bags of the herb were found in his apartment after the University of Georgia junior shot himself with a .45 caliber handgun inside a gas station, according to the Atlanta Journal Constitution.
The American Kratom Association, however, has challenged the notion that kratom is a deadly substance. The group says that a number of the cases included in the FDA’s list of 44 kratom-linked fatalities were questionable and that other factors appear to have been involved in those deaths.
Kratom is currently banned in Alabama, Arkansas, Indiana, Tennessee, Wisconsin and several U.S. cities. It’s also a controlled substance in 16 countries, including Thailand and Malaysia.
While kratom is not currently regulated by the U.S. government, the Drug Enforcement Administration lists kratom as a “Drug of Concern,” along with DXM and Salvia divinorum.
The DEA attempted to classify kratom as a Schedule I controlled substance in 2016, but it halted the plan amid an outcry from members of Congress and proponents of the kratom industry.
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