Users of kratom de­fend banned herbal sup­ple­ment

FDA de­clares plant un­safe, will pro­hibit im­ports by the end of this month

Baltimore Sun - - FRONT PAGE - By Mered­ith Cohn

For a na­tion in the grips of an opi­oid epi­demic, Scott Car­pen­ter’s story sounds fa­mil­iar: He took pre­scrip­tion painkillers for chronic knee pain, and the pills be­came an on-again, off-again habit.

He broke the cy­cle four months ago when he started tak­ing a herbal sup­ple­ment called kratom to con­trol his crav­ings.

“It was a game-changer,” said the 51-year-old Den­ton man who works in con­struc­tion. “I took it and was think­ing to my­self, this is how nor­mal peo­ple feel.”

The South­east Asian plant de­riv­a­tive, which has been used for gen­er­a­tions by peo­ple over­seas for pain, and mood dis­or­ders, and to boost en­ergy, is gain­ing a fol­low­ing in the United States. It can also help wean some­one off ad­dic­tive opi­oids, some say. But im­ports of capsules, teas and other kratom prod­ucts will be cut off at the end of Septem­ber, when a U.S. Drug En­force­ment Ad­min­is­tra­tion ban of the plant’s ac­tive com­pounds goes into ef­fect.

The DEA says the goal of the ban is avoid­ing “an im­mi­nent hazard to pub­lic safety,” as agency of­fi­cials fig­ure out how to Scott Car­pen­ter shows the pow­dered form of kratom.

reg­u­late what they con­sider an in­creas­ingly pop­u­lar recre­ational drug.

The DEA plans to “sched­ule” kratom in its top tier of con­trolled drugs, which in­cludes heroin, LSD and mar­i­juana. That’s a cat­e­gory re­served for com­pounds with no ac­cepted med­i­cal use, a high po­ten­tial for abuse and a lack of safety, said Todd Ed­wards, a spokesman for the DEA’s Bal­ti­more District Of­fice.

Agency of­fi­cials say kratom pro­duces “opi­oid-like ef­fects” and is of­ten mar­keted as a le­gal al­ter­na­tive to con­trolled sub­stances. The DEA re­ports that law en­force­ment na­tion­wide has seized more of the sup­ple­ment in the first half of 2016 than in any pre­vi­ous year, ac­count­ing for mil­lions of doses il­le­gally mar­keted as treat­ments for which they haven’t been ap­proved.

While the agency con­sid­ers kratom dan­ger­ous, it is also con­cerned about the du­bi­ous pu­rity and con­sis­tency of the de­riv­a­tive be­ing used; herbal sup­ple­ments are not gov­ern­ment-reg­u­lated. There have been more than 660 calls to U.S. poi­son cen­ters be­tween 2010 and 2015 linked to kratom, up from two calls be­tween 2000 and 2005, ac­cord­ing to the U.S. Cen­ters for Dis­ease Con­trol and Preven­tion.

Ed­wards said the agency has not been in­volved in any Bal­ti­more area cases, and Bal­ti­more health of­fi­cials say they’ve not come across kratom much. The state Depart­ment of Health and Men­tal Hy­giene, though, said there have been five kratom­re­lated deaths in the past two years.

That’s a frac­tion of the num­ber of over­dose deaths from opi­oids. In Mary­land last year, there were 748 deaths re­lated to heroin, 340 at­trib­uted to fen­tanyl and 351 re­lated to pre­scrip­tion painkillers.

Au­thor­i­ties none­the­less see po­ten­tial peril from Kratom.

“The Depart­ment of Health and Men­tal Hy­giene urges Mary­lan­ders to avoid tak­ing sub­stances for the pur­pose of ex­pe­ri­enc­ing a high,” said Dr. Howard Haft, deputy sec­re­tary for pub­lic health. “At the most ex­treme range, we see such opi­oids as heroin and fen­tanyl con­tribut­ing to fa­tal over­doses on an epi­demic scale.”

There have also been in­stances of fa­tal over­doses re­lated to syn­thetic sub­stances, he said, and now kratom is pos­ing “a threat to life if used.”

Kratom has been on a fed­eral watch list for years, and a half-dozen states al­ready have banned it, ac­cord­ing to the Amer­i­can Kratom As­so­ci­a­tion. Users have been able to buy the sup­ple­ment on­line, how­ever.

The im­pend­ing ban frus­trates kratom users; al­most 133,000 have signed a WhiteHouse.gov pe­ti­tion to keep it le­gal.

Users like Car­pen­ter say al­ter­na­tive over-the-counter and pre­scrip­tion med­i­ca­tions were not only less ef­fec­tive than kratom for pain and ad­dic­tion but car­ried side ef­fects. Car­pen­ter said kratom also im­proved his anx­i­ety and mood, al­low­ing the sin­gle fa­ther of a 10-year-old boy to get through his home and work day more even-tem­pered and clear-headed.

Such tes­ti­mo­ni­als have pro­lif­er­ated on­line as the once “un­der­ground” prod­uct has be­come more widely used in the United States over the last 15 to 20 years, said Wal­ter C. Prozialeck, chair­man of the depart­ment of phar­ma­col­ogy at Mid­west­ern Univer­sity.

Prozialeck pub­lished a re­view of kratom stud­ies in 2012 and found re­search into the plant’s power as a pain re­ducer and ad­dic­tion treat­ment promis­ing, though still in the be­gin­ning stages.

He called tak­ing kratom off the mar­ket un­war­ranted, since much of the danger is not likely from the plant but from other drugs com­bined with it by users or un­scrupu­lous deal­ers.

“There have been some re­ally bad drugs of abuse the DEA has banned, like bath salts,” he said. “They caused a high but also had a ten­dency to cause psy­chi­atric ef­fects in some in­di­vid­u­als. There was also syn­thetic mar­i­juana, which wasn’t mar­i­juana but had an ef­fect sim­i­lar to THC, the ac­tive con­stituent of mar­i­juana. In each of those cases there was more ev­i­dence the drugs were harm­ful. It’s less clear with kratom.”

An­drew Kruegel, an as­so­ci­ate re­search sci­en­tist at Columbia Univer­sity who stud­ies kratom, said its long-term health ef­fects still need to be ex­plored. But he sees the A se­lec­tion of Scott Car­pen­ter’s kratom sup­ply, which he has used to ease his knee pain since he broke a de­pen­dence on pre­scrip­tion painkillers. most prom­ise in de­vel­op­ing kratom into new types of pain re­liev­ers, with­out some of the dan­gers posed by tra­di­tional opi­oid­based pre­scrip­tion painkillers.

Kratom’s ac­tive com­pounds — mi­trag­y­nine and 7-hy­drox­ymi­trag­y­nine — ac­ti­vate the same opi­oid re­cep­tors in the brain that the pre­scrip­tion painkillers do but in unique ways that avoid some of the side ef­fects, he said. Kratom is less likely to cause de­pen­dence or res­pi­ra­tory de­pres­sion, which is what kills peo­ple who over­dose.

The com­pounds in kratom “are very ex­cit­ing from the re­search per­spec­tive be­cause they pro­vide an op­por­tu­nity to ad­dress the opi­oid over­dose epi­demic that is cur­rently sweep­ing our na­tion through the de­vel­op­ment of new, safer drugs for pain,” Kruegel said.

His re­search team will ap­ply for a li­cense from the DEA to con­tinue kratom re­search dur­ing the ban, but Kruegel said he’s con­cerned that the ban on im­ports will make ob­tain­ing plant ma­te­rial dif­fi­cult.

He’s also con­cerned that the DEA’s move will stig­ma­tize kratom, fur­ther com­pli­cat­ing drug de­vel­op­ment. “I do not think there is clear ev­i­dence at present that kratom use rep­re­sents an im­mi­nent pub­lic health hazard, which would war­rant emer­gency place­ment on Sched­ule 1,” he said. “The sci­en­tific lit­er­a­ture in cells and an­i­mals, and anec­do­tal ev­i­dence in hu­mans, sug­gests that kratom may be safe, but more re­search is needed be­fore mak­ing an in­formed reg­u­la­tory de­ci­sion.”

Signs warn­ing cus­tomers of the ban are al­ready go­ing up in lo­cal smoke shops, with one Bal­ti­more County store owner la­ment­ing that kratom — sold for $1 a cap­sule — now makes up more than 40 per­cent of busi­ness.

Oth­ers say they aren’t sure what they’ll do when kratom is no longer avail­able.

Michelle Mead­ows, a 28-year-old Rich­mond, Va., restau­rant man­ager and stu­dent, said kratom helped her kick her long­time heroin ad­dic­tion last year and she still takes it to stave off crav­ings.

She first bought kratom on­line in 2014 to get high, but “it had lit­tle recre­ational ap­peal,” she said, “and this comes from the same woman who would in­gest mul­ti­ple boxes of cough medicine and in­hale car­bon diox­ide from soda bot­tles as a teenager.”

Mead­ows said af­ter a three-week heroin binge last spring, she de­cided she’d had enough and de­cided to try her left­over kratom stash to treat her­self. She took it on a reg­u­lar sched­ule to avoid the pain and dis­com­fort of detox­i­fi­ca­tion, even­tu­ally wean­ing her­self down to once a week.

The sup­ple­ment gives her a lift in en­ergy and mood, sim­i­lar to caf­feinated cof­fee or tea, she said.

“I have de­vel­oped a spir­i­tual con­nec­tion to this plant,” she said. “It has al­lowed me to be­come a pro­duc­tive mem­ber of so­ci­ety. It has al­lowed me to be the best mother, wife and stu­dent that I can be. It has given memy life back”

MATTHEW COLE/BAL­TI­MORE SUN ME­DIA GROUP PHO­TOS

Scott Car­pen­ter drives in a screw while at work in East­port on Thurs­day af­ter­noon. Car­pen­ter, who uses kratom to re­lieve chronic pain, is wor­ried about the pend­ing FDA ban.

MATTHEW COLE/BAL­TI­MORE SUN ME­DIA GROUP

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