Poisonings from herbal supplement, kratom, are rising

PHILADELPHIA — An unregulated herbal product that advocates say can relieve pain and help with opioid withdrawal has been linked to at least four deaths in the Philadelphia region, but with many authorities failing to track kratom poisonings, there’s no way to know if there are more deaths related to the substance.

Kratom, derived from the leaves of a Southeast Asian tree that is part of the coffee family, has gained popularity in recent years. It is sold online, in gas stations and in smoke shops, and is typically brewed as a tea, chewed, smoked or ingested in capsules.

An estimated 3 million to 5 million people use kratom, according to the American Kratom Association, a Colorado-based nonprofit founded in 2014 to promote the herbal product. It has become a billion-dollar business, according to the Botanical Education Alliance, another kratom advocacy group.

The U.S. Drug Enforcement Administration announced in 2016 it would reclassify kratom as a Schedule 1 drug, similar to heroin or marijuana, a step other nations have taken. But the industry groups lobbied to keep it on store shelves.

The U.S. Food and Drug Administration says the active ingredient in kratom, mitragynine, is an addictive substance that acts on the brain’s opioid receptors — and is indeed an opioid. Though touted as a stimulant (at low doses), sedative (at high doses), painkiller, and addiction therapy, kratom has no medical value, the FDA declared in February, and has been linked to at least 44 deaths nationally, though the agency admits tracking is haphazard. The kratom industry, meanwhile, disputes the FDA’s science and data collection, insisting no one has died from kratom use.

Still, there are troubling indicators that poisonings are on the rise.

The American Association of Poison Control Centers has seen a sixfold increase in calls — from 97 in all of 2016, to 635 so far in 2018 — to its national hotline for kratom use. Since 2016, it has recorded 10 deaths associated with kratom, three for the product alone, others in combination with other substances. Such mixtures, scientists say, can be especially dangerous because many users don’t think kratom could compound the impact of other opioids, making overdose more likely.

NMS Labs, a nationally known forensic laboratory in Willow Grove, started testing for mitragynine about five years ago and is seeing more of it in postmortem toxicology cases, said vice president Barry Logan, a senior scientist. From January to June, there were 303 deaths in which mitragynine was found, often in combination with other opioids, he said.

In Pennsylvania, OverdoseFreePA, a website that tracks overdose fatalities, reported there were 27 deaths in 2017 in which mitragynine was present. Thirty-seven of Pennsylvania’s 67 county coroners contribute to the database.

Since 2016, Bucks and Montgomery counties each have recorded a death that coroners attributed to mitragynine. Chester County found two deaths where mitragynine was listed as the sole cause of death.

Those three counties, along with Philadelphia, have also found at least 19 other deaths where mitragynine was present in postmortem toxicology reports, alongside drugs like heroin, fentanyl, and cocaine. Delaware County has not found mitragynine in any toxicology reports.