Kratom: Deadly Drug or Herbal Cure for Opioid Epidemic?

DEA has backed off a potential ban of an herbal stimulant many use to treat opioid addiction

Kratom, an herbal stimulant with opioid-like qualities, has been used as a way to wean people of their opium addictions, but the DEA wants to put a stop to it.
Kratom: Deadly Drug or Herbal Cure for Opioid Epidemic?

For decades, people in Thailand have used kratom, an herbal stimulant with opioid-like qualities, as a way to wean their opium addictions. That's recently become a trend stateside, as America continues to grapple with a deadly opioid abuse epidemic. More and more opioid-addicted Americans are trading in prescription painkillers for kratom, a much-less deadly and addictive alternative. But the U.S. Drug Enforcement Administration wants to put a stop to it.

Earlier this fall, the DEA announced it would classify kratom as Schedule 1 – the tier for drugs such as marijuana, LSD and heroin that are thought to have no known medical benefit – effectively banning it across the country. The federal agency claimed that lack of evidence and increased incidences of toxicity prove the drug to be dangerous and harmful. But public outcry has led the DEA to rescind its ban to allow for an extended comment period, which ends December 1st. It's an unprecedented move – one that allows kratom researchers to show the drug's therapeutic effects. "It gives us an opportunity to put a scientific foot into the door," says pharmacologist Chris McCurdy, interim chair of the Department of BioMolecular Sciences at the University of Mississippi.

For those unfamiliar with kratom, here's what you should know about the herbal drug, its effects on a person, and what a DEA ban would mean for research.

What is kratom?
Kratom (scientific name mitragyna speciosa) is a tropical tree in the coffee family indigenous to Southeast Asia, particularly Thailand, Malaysia, Myanmar and Indonesia. Studies have found that in low doses, the substance derived from it can act like a stimulant relative to caffeine, while higher doses create a sedative effect. That is because of two alkaloids in the plant: mitragynine, its main compound, and 7-hydroxmitragynine. It has been used in Southeast Asia as a therapeutic medicine since the 1800s.

Kratom can be consumed in leaf, capsule or tablet form or brewed into a tea. A concentrated extract of kratom is also available, but buyers beware. "When people start trying to extract the active chemicals, that's when people run into a much greater risk of toxicity," said pharmacologist Walter Prozialeck.

What is kratom used for?
For everything from recreation to self-medication. Some people have used it for an energy boost while others have taken kratom in place of highly addictive prescription painkillers to deal with chronic pain. Then there are those consumers who use kratom to manage their opioid addiction and manage withdrawal symptoms. In fact, kratom has been used to wean opium addicts in Thailand for at least nine decades.

What are kratom's side effects?
Little has been studied about kratom's full range of side effects. What is known is that high dosages of kratom (10-15 grams) can lead to nausea and constipation, according to a 2012 review of available scientific literature on kratom conducted by Prozialeck. Some cases of seizures have occurred, although it's unclear if kratom or a combination of substances was responsible. "It's not that kratom is devoid of adverse events," said toxicologist Ed Boyer, who studied one of the seizure cases with McCurdy in 2008. "The scientifically responsible statement is that we don't know what the full range of those consequences are and under what circumstances they occur."

Research has also shown that people can become addicted to or dependent on kratom. A 1975 study out of Thailand –  where kratom is now banned – found that withdrawal symptoms and psychiatric issues could occur after prolonged use. Subsequent studies through the years have verified those findings.

But is it deadly?
That's not entirely clear. While the U.S. Centers for Disease Control and Prevention reports that poison centers across the country have received 660 called related to kratom-use over a five-year period, many of those incidences seem to have also involved another substance including ethanol and narcotics. Over 65 percent of reported kratom exposure resulted in minor to moderate side effects; while about 26 percent saw no effects at all. Less than a tenth of reports resulted in life-threatening symptoms or death, according to the CDC. But in one fatality, the person who used kratom also had anti-depressants and a mood stabilizer present in their system.

"Most people who looked at the reports of deaths associated with kratom have found, in the mass majority of cases, there have been these compounded factors," said Prozialeck, who teaches pharmacology at Midwestern University. "It's not clear that kratom has been the cause of death."

The same goes for the nine fatalities reported in Sweden, which the DEA citied in part as justification for its ban. Swedish doctors have attributed those deaths to krypton, a derivative of kratom that is adulterated with a blend of caffeine and O-Desmethyltramadol, a potent opioid synthetic. To blame kratom would be misleading.

Interesting enough, all toxicity and fatality reports have emerged in the West. Earlier this year, Dr. Darshan Singh, a Malaysia-based scientist, published a study that found such reports "non-existent" in South East Asia, which has a longer history of kratom use. By contrast, prescription opioid overdose has accounted for about 68 percent of U.S. emergency room visits in 2010, according to the Stanford University School of Medicine.

Have states banned kratom?
Yes. Kratom is illegal in Alabama, Arkansas, Indiana, Tennessee, Vermont and Wisconsin, according to the American Kratom Association, a fledgling advocacy group. Florida has also banned the plant-based painkiller, but only in Sarasota County. Most other states have introduced bills that sought to restrict or ban kratom, but those measures have failed. New York is the only state with pending legislation.

Should it be banned or regulated?
Most researchers agree that a blanket ban on kratom is unwarranted. There are far too many anecdotal reports citing kratom's benefits to dismiss, Prozialeck said. But he and other scientists do recognize kratom's hazards, and believe the drug should be strictly regulated. The lack of quality control measures or standardization has led to the proliferation of kratom in head shops, online or in gas stations, Prozialeck said. Since kratom's unregulated, users who buy from these vendors won't know if the product has been chemically altered, let alone which strain they're getting. "Some vendors have been less than scrupulous in what they're selling, and that's where many of the problems have risen," he said.

What would a federal ban mean for kratom research?
Banning kratom would spell the end of most research. Licensing requirements would prohibit researchers from studying kratom if the DEA were to classify it as a Schedule 1 substance. Most scientists are licensed to test Schedule 2 to Schedule 5 drugs, McCurdy said. Schedule 1 licenses are few and far between, and are heavily restricted. To get one, you would have to jump through a dizzying amount of bureaucratic hoops.

Since he only licensed for Schedule 2-5, McCurdy has shut down his kratom research until the DEA finalizes its decision. He has instead shipped 12 years of research to a colleague with Schedule 1 clearance who is currently studying the plant's abuse liabilities. If the DEA does ban kratom, then most of the scientific research may go the way of McCurdy's.

"Once something goes into Schedule 1, it's incredibly difficult, if not impossible, to get out of Schedule 1," McCurdy said. "If you're going to schedule an item, it would be far better to put it in a schedule that has some medical use that would allow work to be done by a broader group researchers."