Kratom: balm for opioid addicts or bane of law enforcement?

The kratom tree, specifically its glossy green leaves, has been used for centuries by Asians to boost energy, treat coughing, diarrhea, chronic pain and opium addiction.

Kratom leaves

Kratom, known in the scientific world as Mitragyna speciosa, is a member of the Rubiaceae family, which also includes coffee plants. However, it is not an innocuous plant. The past ten years have seen kratom grow in popularity in the U.S. Whether that is good news or bad news very much depends upon your viewpoint.

The Union County Sheriff, via his October 2nd request that the Board of Supervisors make kratom illegal in this county, clearly believes that the “supplement” is bad news. There is a danger that local consumers can unknowingly purchase an herbal drug that, while legal, is generally acknowledged to have addicting qualities, and which is not required to have FDA marketing approval. Kratom has been declared illegal in several states and individual municipalities.

In low doses, the plant produces mild stimulation, possibly increasing alertness, stamina, and sociability. Larger doses produce the Morphine-like pain relief effects. Higher doses or regular use may produce sedative effects, weight loss, fatigue, tachycardia, dizziness, hypotension, constipation, tremor, anorexia, seizures, and psychosis. Tolerance and/or dependence may develop more slowly than with traditional opioids. Little to no respiratory depression is generally seen. Typical users in the U.S. are educated white males, aged 31-50, about half of whom earn at least $75,000 per year.

More scientifically valid research is needed on this “herbal supplement.” According to US Pharmacist, more than half of the available scientific literature on kratom has been published since 2012, and there are few, if any, controlled clinical trial results that have been published. It’s proponents state that it is a boon to opioid victims who are trying to rid themselves of that addiction. They claim that kratom relieves the pain of withdrawal, allowing addicts to free themselves of opioid addiction and regain a normal lifestyle. Its opponents believe that it produces addiction and psychoses, and is akin to “jumping from the fire into the frying pan; you may survive, but you will be burned.”

In August 2016, with more than a little prompting from the “herbals” industry, the U.S. Drug Enforcement Administration (DEA) proposed classifying kratom as a schedule I drug. Schedule I drugs are deemed to have no approved medical use, and, therefore, no legal reason to exist in the U.S. Drugs in this category include Heroin, LSD, Ecstasy, bath salts and (surprise!) Marijuana. Once a drug is listed as a DEA Schedule I, it is practically impossible to get it removed from the list, and it becomes very difficult to obtain the drug for legitimate research.

Kratom Legality map. Click to enlarge

Proponents of  kratom, led by The American Kratom Association, quickly rallied their forces against the DEA proposal and produced a large wave of public interest and comments. This resulted, fairly quickly, in an almost-unheard-of decision by the DEA to put a hold on the proposed scheduling action. Currently, the situation “continues to be under review.”  The Food and Drug Administration now is preparing an eight-factor analysis of kratom’s safety.

But there’s the rub. Manufacturers of dietary supplements (which includes “herbals”) are not required to obtain approval from the FDA before marketing dietary supplements. In 1994, the Dietary Supplement Health and Education Act (DSHEA) defined dietary supplements as a category of food, which put them under different regulations than drugs. They are considered, by law, to be safe until proven otherwise.

The Food and Drug Administration typically “vets” herbals and dietary supplements far less enthusiastically than it does potential prescription medications. It has a 75 day process for supplements, compared to the average 10 years from laboratory to market for prescription items. It actually does not “approve” supplements per se. If it happens to identify a problem, however, it can effect the removal of the product from the legitimate market. Some supplement makers skip the process, hoping the FDA won’t notice.

Lack of oversight of the purity and standardization of supplement products on the market in the U.S. adds to the confusion surrounding these products. Much of the use of herbal supplementary products depends upon anecdotal information and traditional usage. There is no enforcement of standardization of content and/or dosage delivery from product to product.

Given that it is currently legal in the U.S., the biggest medical concern is the potential adulteration of products being sold as kratom. “In the United States, there’s nothing to protect people from an adulterated product,” says Edward Boyer, a professor of emergency medicine at Brigham and Women’s Hospital and faculty member at Harvard Medical School. One known adulterant of kratom is hydrocodone, one of the opioids causing addiction problems throughout the country.

In the U.S., the billion dollar plus and rapidly growing kratom industry mostly comprises retailers who buy the raw product from farmers in Asia or from a distributor. In states where it is legal (which includes Mississippi), kratom can be purchased in its various forms in kava bars, head shops, convenience stores, truck stops, etc., as well as online. Most is currently sold via Craigslist and online retailers such as Kratom-K and Kratora Quality Ethnobotanicals. Two ounce “K-Shots”  are popular in our vicinity.

Consumers of these products are urged to perform your own “due diligence” before purchasing and consuming this, or any other, dietary supplement. You should possess a good working knowledge of the herbal product itself, as well as of the seller who provides the product. The fact that the item is for sale in a local setting does not necessarily mean that any responsible agency has validated its content, purity or safety on your behalf.

By: Nan Shiverdecker, R.Ph.

To see more about Sheriff Edwards’ request: Kratom should be declared illegal in Union County.