An over-the-counter supplement called kratom has been linked to nearly 91 overdose deaths between 2016 and 2017, according to a new report from the Centers for Disease Control (CDC). But many kratom advocates and those who have benefited from the supplement are questioning the report, arguing that the study is based on weak data.
The CDC report examined data from more than 27,000 overdose deaths between 2016 and 2017. Approximately 152 of these deaths, or .56% of all the overdose deaths studied by the CDC, tested positive for kratom, according to postmortem toxicology reports. In 91 of these cases, kratom was determined by the medical examiner or coroner to be a cause of death; in only seven of these cases, however, kratom was found to be the only substance found in the deceased’s system.
A plant grown primarily in southeast Asia, kratom has traditionally been crushed and made into a powder to put in tea as a method of pain relief. Recently, however, it’s increasingly been taken as a supplement and used as an alternative to opioid painkillers.
The CDC study is significant, in part because it “adds to the growing evidence demonstrating the need for caution in use of this drug,” says Linda Richter, Ph.D., director of research policy and analysis at Center on Addiction. “Although more evidence of its role in drug-related deaths is needed… the findings from this analysis and others should be a cause for concern for those who consider this, or any, psychoactive drug to be harmless.”
It also reaffirms what we already know: that kratom use is on the rise, particularly in the wake of the opioid crisis. Many people who have been addicted to opioids have touted the drug as a way to help them overcome their addiction. “As with other ‘natural” or herbal drugs, it is seen by many people who use it as a safe alternative to opioids,” says Richter. Indeed, the report shows that the number of deaths associated with kratom has more than doubled since 2011, when there were only 44 kratom-related deaths on the record. And as kratom use has risen in the United States, however, the FDA has increasingly come out against the drug, warning consumers that it has the potential to be highly addictive and that at high doses, it contains similar “properties” to opioids. The FDA has also urged the Drug Enforcement Agency (DEA) to classify kratom as a Schedule I drug in the same class as heroin or cocaine.
In response, the American Kratom Association issued a strongly worded letter accusing the FDA of deliberately misrepresenting data in order to portray kratom as a dangerous drug, arguing that many of the deaths attributed to kratom were attributable to a contaminated sample of the drug or even to entirely different drugs. “The FDA has relied on a strategy of manipulating, obscuring and ignoring science in its inexplicable zeal to impede public access to the natural botanical kratom,” the letter said. “This was clearly an unprofessional review.”
As is the case with many drug studies, when it comes to the link between kratom and overdose deaths, it’s difficult to parse exactly how much of a role kratom may have played versus other substances taken at the time of death. The CDC report is pretty clear on this point: although 152 overdose cases tested positive for kratom (a very small percentage, it’s worth noting, of the total overdose deaths studied in the report), it’s unclear what other substances may have been in their systems at the time of death. Indeed, in 80% of the kratom-involved deaths in the study, the people who died have a history of abusing substances, primarily heroin and fentanyl, and that “postmortem toxicology testing detected multiple substances for almost all decedents” — meaning that kratom was not necessarily the sole culprit. Only seven of the decedents studied in the report tested positive for kratom and kratom only, and even the CDC says that doesn’t necessarily mean that “the presence of additional substances [can] be ruled out.”
None of this is to say that kratom is necessarily 100% safe, or that it’s the wonder opioid addiction treatment that many of its proponents, such as those on the r/kratom subreddit, have claimed it to be. It does, however, indicate that more research needs to be done on kratom and exactly how people are taking it, so we can formulate the best policies and risk reduction methods from there. If nothing else, says Richter, the report is further proof that kratom should be subject to standard testing processes and “its manufacture and sale should be regulated to help ensure that the product that people are consuming is safe and effective.”