Natural pain remedy or deadly narcotic?
Kratom is at the centre of an acrimonious battle among U.S. federal agencies and on social media about whether it can help curb the opioid epidemic or make it worse
LAURIE MCGINLEY and KATIE ZEZIMA
Andrew Turner’s years in the military left him suffering from posttraumatic stress disorder, anxiety, back pain and the effects of an injury that mangled his hand.
“I was a broken toy,” he said. Tossed aside. Barely able to get off the couch.
Then he started using an herbal supplement that he says saved his life: kratom.
Nancy Knoebel’s 27-year-old son began using kratom after he stopped taking medication to treat his heroin addiction. But he was having withdrawal symptoms, so he turned to an herbal remedy. Within a few months, Knoebel’s son was dead from what a medical examiner determined were the “toxic effects” of kratom.
“If kratom hadn’t killed him, he’d be alive and sober,” Knoebel said. “It was like someone ran a red light and killed him.”
Rapidly rising in popularity, kratom is hailed as a readily available pain remedy that is safer than traditional opioids (such as oxycodone), an effective addiction withdrawal aid and a pleasurable recreational tonic. Kratom also is assailed as a dangerous and unregulated drug that can be purchased on the internet, a habit-forming substance that authorities say can result in opioid-like abuse and death.
Now, the compound is at the centreof an acrimonious battle on social media, in U.S. federal agencies and at all levels of government — a fight over whether kratom could help curb the nation’s opioid epidemic or make it dramatically worse.
The Drug Enforcement Administration is weighing whether to place kratom, which comes from a leafy southeast Asian tree, in the same category of illegal drugs as heroin. It’s the second time the agency has tried to curb access to kratom, delaying a final decision in 2016 after an outcry from the public, dozens of members of Congress and a demonstration at the White House.
This time, the DEA is getting high-profile support for a crackdown from the Food and Drug Administration, which has repeatedly warned about the dangers of the substance and says it has identified 44 deaths associated with its use since 2011. On Tuesday, the agency said the new computer model it developed shows that kratom contains opioid compounds with potentially deadly side-effects such as seizures and depressed breathing. The FDA emphasizes that there is no evidence that kratom is safe for any medical use, including for the treatment of opioid withdrawal symptoms.
“Claiming that kratom is benign because it’s ‘just a plant’ is shortsighted and dangerous,” FDA Commissioner Scott Gottlieb said in a statement. “After all, heroin is an illegal, dangerous, and highly addictive substance” derived from opium poppies.
Gottlieb’s stance has sparked a torrent of criticism from kratom backers. The American Kratom Association, a non-profit organization that promotes access to kratom, called the FDA’s model “garbage in, garbage out.” The group contends that the agency’s conclusions contain “clear mistakes,” including the allegation that the compound can cause breathing problems.
Some scientists worry that a ban could shut down research on kratom as a potentially important pain medication while leaving current users without safe alternatives.
Scientists think that kratom binds to opioid receptors in the brain, leading to pain relief and possibly an aversion to traditional opioid drugs.
“It seems like a lot of people have used kratom to get off more dangerous opioids or to treat intractable pain not managed successfully with drugs,” said Columbia University research chemist Andrew Kruegel, who has authored studies on the pharmacology of botanics. “And if you take their lifeline, some fraction may go back to heroin or fentanyl or even prescription opioids.”
Bertha Madras, a professor of psychobiology at Harvard Medical School, said such claims that kratom is beneficial are not scientifically substantiated. There haven’t been any human clinical trials that show definitively how kratom acts in the body or how it interacts with other drugs.
“I support the FDA on this,” Madras said. “I really believe they have taken a cautionary stance, which is to protect the American public.”
The tropical tree causing the furor, Mitragyna speciosa, is native to countries including Indonesia, Malaysia and Thailand. A member of the coffee family, kratom was long popular with southeast Asian farm workers who would take it to boost productivity and as a substitute for opium. Taken in small doses, kratom acts as a stimulant; at higher doses, it can be used for sedation.
Kratom surfaced in the United States about a decade ago; an estimated three million to five million people use it, according to the American Kratom Association. People consume it by swallowing capsules of finely ground powder, drinking kratom tea or chewing and swallowing the plant’s bitter leaves. Some “toss and wash” by putting a clump of powder in their mouths, followed by a slug of water.
Essentially unregulated, kratom is widely available on the internet and is sold in some head shops, gas stations and corner stores. It has been banned for sale and possession in at least five states and in several cities, including the District of Columbia and San Diego.
Depending on how it is marketed, the FDA considers kratom either an unapproved drug or a new dietary ingredient whose safety has not been proved, making it subject to enforcement actions, including seizure.
(Under Health Canada rules, kratom remains unauthorized for sale as a consumable natural health product. )
In August 2016, the DEA announced plans to temporarily place kratom’s active materials in Schedule 1 of the Controlled Substances Act “to avoid an imminent hazard to public safety.” It said kratom had a high potential for abuse, did not have any currently accepted medical use and was not considered safe even when used under medical supervision.
The agency received more than 23,000 comments, mostly negative, along with complaints from dozens of members of Congress, spurring it to withdraw the plan to wait for a comprehensive medical evaluation and recommendation from the FDA.
While the FDA’s assessment has not been released, Gottlieb has made it clear that he does not want to repeat the agency’s past mistakes in failing to put the brakes on the opioid crisis.