A Primer On Kratom
The Kratom Controversy
An ancient substance is making its way through the United States and is causing addiction, destruction, and even alleged deaths among unsuspecting users. The drug is called kratom, and it comes from a Southeast Asian plant, Mitragyna speciosa. This drug is still legal in most areas of the United States, mainly because it is too new here for proper research and regulation. However, the government is working to learn more about the dangers of the substance and put laws in place that would protect citizens from the detrimental effects of this drug.
Ohio has experienced a drastic rise in the sale and use of kratom in the past two years, and state officials have been investigating the possibility of banning the dietary supplement. This has not occurred without dispute, however, and several advocacy groups claim the substance is harmless and instead provides needed health benefits.
History of Kratom
Kratom was used in Thailand and surrounding countries for centuries, by farmers who chewed the leaves to increase their energy while working long hours, to treat medical conditions, numb pain, and to participate in religious ceremonies. When used in small amounts, it works as a stimulant and increases energy. When taken in large doses, kratom produces sedative effects like narcotics.
Many believe that kratom is not a safe substance, however. It was banned in Thailand in 1979 and in Malaysia in 2003 because of its risks to human health and behavior. But in recent years, it has been smuggled into the United States from Thailand and other Southeast Asian countries and is now being sold legally in many areas of our country. The lack of experience with and knowledge of this substance in Western countries makes it particularly dangerous, as most users first start taking it without fully knowing its potential.
Still a Legal Substance
This new drug is sold openly in many areas of the United States. Kratom, also referred to as ‘ketum’ or ‘kakuam,’ is promoted as a natural painkiller and also an option for self-treating opioid addiction. Some people use it as a substitution to heroin or other opioid medications, but the problem is that kratom is addictive as well, and it is dangerous.
“It’s a fascinating drug, but we need to know a lot more about it,” said Dr. Edward W. Boyer, a professor of emergency medicine at the University of Massachusetts Medical School and a co-author of several scientific articles on kratom. “Recreationally or to self-treat opioid dependence, beware — potentially you’re at just as much risk as with an opiate.”
It’s true that kratom is legal in most cases in the United States. It is categorized by the Food and Drug Administration as a botanic dietary supplement. It is dispensed as leaves to chew or smoke, or sold as a pill, extract or gum, much of the time labeled “not for human consumption.” More commonly, kratom is brewed as a beverage. This tea is served at bars in Colorado, Ohio, New York, Florida, and across the country, often without the user fully knowing the drug’s potential for danger.
Kratom is a substance that can act like both a stimulant and an opioid. Its main compounds have the ability to interact with opioid receptors in the brain, sedating the individual, decreasing pain, and increasing pleasure. These compounds also have the potential to react with other brain receptors to produce stimulant effects. Usually, when taken in small amounts, the individual feels the stimulant effects. When taken in large doses, the user feels the sedative effects.
Other Names For Kratom
According to the National Institute on Drug Abuse, reported health effects of kratom use include:
- Dry mouth
- Loss of appetite
- Increased urination
- Respiratory depression
- Weight loss
- Skin darkening
FDA Warnings about Kratom Use
- In a document stating information about kratom use and overdose, the Centers for Disease Control and Prevention (CDC) reported that between 2010 and 2015, calls to poison centers associated with kratom use increased from 26 in 2010 to 263 in 2015, and more than 40% of the calls to the poison centers were serious or life-threatening cases.
- According to the Food and Drug Administration kratom use has been connected to at least 44 deaths.
The Food and Drug Administration (FDA) began issuing a series of warnings about kratom in 2017. According to a press release last year:
“Over the past several years, a botanical substance known as kratom has raised significant concerns given its increasing prevalence and potential safety risks. Today, the agency issued a public health advisory related to the FDA’s mounting concerns regarding risks associated with the use of kratom.
The FDA knows people are using kratom to treat conditions like pain, anxiety, and depression, which are serious medical conditions that require proper diagnosis and oversight from a licensed health care provider. We also know that this substance is being actively marketed and distributed for these purposes. Importantly, evidence shows that kratom has similar effects to narcotics like opioids, and carries similar risks of abuse, addiction and in some cases, death. Thus, it’s not surprising that often kratom is taken recreationally by users for its euphoric effects. At a time when we have hit a critical point in the opioid epidemic, the increasing use of kratom as an alternative or adjunct to opioid use is extremely concerning.”
One of the main concerns is that kratom is an addicting substance, causing users to experience cravings for it and withdrawal symptoms when they stop taking the drug. Withdrawal symptoms of kratom include:
- Muscle aches
- Emotional changes
- A runny nose
- Jerky movements
The fact that kratom itself is addicting is interesting because it is often marketed as a treatment option for withdrawal symptoms for opioids and other substances. According to the FDA, there is no evidence that kratom is effective in treating withdrawal symptoms, and in fact, the only thing it seems to do is replace one addictive substance with another. What is more, there are no known treatments for kratom addiction since this substance is so new in our culture.
“It’s very troubling to the FDA that patients believe they can use kratom to treat opioid withdrawal symptoms. The FDA is devoted to expanding the development and use of medical therapy to assist in the treatment of opioid use disorder. However, an important part of our commitment to this effort means making sure patients have access to treatments that are proven to be safe and effective. There is no reliable evidence to support the use of kratom as a treatment for opioid use disorder. Patients addicted to opioids are using kratom without dependable instructions for use and more importantly, without consultation with a licensed health care provider about the product’s dangers, potential side effects or interactions with other drugs.”
However, not everyone believes the sale and use of kratom should be outlawed. Groups like the American Kratom Association have been promoting this substance and its health benefits for years. According to these consumer groups, this herbal alternative helps during treatment for opioid addiction, by reducing cravings for other drugs and alcohol, although there is no scientific research to back those claims up. Kratom is also said to help relieve chronic pain and mental health problems like depression.
According to the American Kratom Association website, “nearly 5 million Americans safely use kratom as a part of their health and well-being regimen and have done so for decades. Kratom is regulated by the U.S. Food and Drug Administration (FDA) as a dietary ingredient/supplement, and people who use kratom do so for the same reasons as people who use dietary ingredients, supplements, and who drink coffee, tea, or other caffeinated beverages. Surveys show that kratom consumers are educated, middle-income, employed, and have health insurance – they are largely the soccer moms and dads of America.”
Advocates of kratom sale and use also claim that the main substances in kratom are impossible to overdose on. They state that nearly all of the reported deaths in 2016-2017 that were linked to kratom were not actually attributed to kratom alone, but to a combination of substances found in the individuals’ systems. Unfortunately, the role each substance plays in an overdose death is extremely difficult to determine, as substances react and interact with each other in different ways.
Legal Action Against Kratom
In the state of Ohio, kratom is being sold and used in many different areas, including bars, convenience stores, health stores, and gas stations. According to officials, it has caused problems including hallucinations, seizures, addiction, and overdose death. The Ohio Board of Pharmacy recently recommended that kratom is classified as a Schedule I controlled substance. This would put the substance in the same class as heroin, LSD, cocaine, and other illicit drugs. This recommendation follows on the heels of the U.S. Food and Drug Administration research, which has been considering similar measures, and dubs kratom as having a “high potential for abuse,” “no accepted medical use,” and lacking “accepted safety for use in treatment under medical supervision.”
Several other states and large cities have gone through with the kratom ban, including Alabama, Arkansas, Indiana, Rhode Island, Vermont, Wisconsin and the District of Columbia. Florida and New Jersey have proposed and then set aside similar bills until more is known about kratom’s health risks. Kratom use among soldiers is also forbidden by the army, and the FDA banned the import of this drug. The Drug Enforcement Administration has listed kratom as a “drug of concern” but not a controlled substance. Other areas of the county have not yet seen high incidences of the use of this drug, and many are waiting to see what further research shows and what other states do.
The Ohio Board of Pharmacy did not make their recommendation without a great deal of research and input by others. The board received and reviewed more than 6,000 emails about the proposed reclassification the past few months. One of the main concerns the board wanted to address was how buyers would know the content of the substance they were using since the drug is in essence unregulated. The substance becomes more dangerous and even deadly when combined with other drugs. “The bottom line is that there are some good, positive properties to it, but it’s pretty dangerous for society, in general, the way people use drugs,” said Brad Lander, clinical director of addiction medicine at Ohio State University’s Wexner Medical Center. “A lot of people probably could use it safely without a problem, but there are going to be a lot of people who are going to have a problem with it.”
The FDA recently took action against kratom products being imported into the United States, by seizing hundreds of shipments of the substance and warning consumers about the dangers of this product. “In response to a request from the Drug Enforcement Administration (DEA), the FDA has conducted a comprehensive scientific and medical evaluation of two compounds found in kratom. Kratom is already a controlled substance in 16 countries, including two of its native countries of origin, Thailand and Malaysia, as well as Australia, Sweden, and Germany.”
Residents of Ohio will soon know what the future holds for kratom sellers. The ban will be revisited in upcoming sessions in 2019. Until then, individuals are being warned to learn the facts and to be careful about what they ingest, including substances labeled as supplements.
Be Careful of New Substances
Our country has seen this same problem many times before. New drugs are constantly emerging, either being imported to the United States from other countries or being synthesized right here in our communities. Sometimes, as with kratom, the substance is naturally found in nature, which gives people a false sense of security. Unfortunately, not every natural substance is safe, and consumers need to be careful about what they use, where it comes from, and what it is mixed with. This is particularly true about products that are not regulated by the FDA, are called supplements, or are labeled as not for human consumption when they were clearly meant to be consumed.
It is important for parents to be aware of new drug trends so they can have conversations with their teens about the dangers of trying these substances. In general, any substance that is supposed to help someone feel good or experience a feeling of euphoria, even if it is legal, should be treated with caution. As in the case of kratom, countries that have witnessed the effects of this drug in the past have banned the substance, and possibly the only reason it is still legal in the United States is we simply don’t know enough about it.
Drug addiction is a serious disease, and prevention is important. Parents, schools, and community groups can all work together to educate the public about the dangers of new drug trends. For those already struggling with addiction, the best way to achieve sobriety is to enroll in a trusted treatment program, either a residential or outpatient rehab.
Is Kratom Legal in Ohio?
In August 2019 after receiving nearly 7,000 comments The Ohio Board of Pharmacy decided to put off naming Kratom as a schedule 1 substance – the same category as LSD and Heroin. For the time being Kratom remains legal in Ohio.