Edit 5/2/2018: VICE published an astonishingly honest, in-depth examination of the current state of kratom research and regulation. It may be lengthy, but damnit, it’s worth your time.

Edit 3/18/2018: Marc T. Swogger, Ph.D., published an article, “Is Concern Around Kratom ‘Drug Hysteria’?” via Medscape. Dr. Swogger notes that preexisting studies show people are successfully using kratom as an opioid replacement, and to manage pain. Additionally, there is no scientifically-supported evidence that kratom is linked to liver damage, seizures, or premature death.


Kratom. It’s been in the news lately, and there continues to be a lot of controversy surrounding it’s safety profile and legality. But after further research, I can confidently state that it’s all complete and utter nonsense.

I believe this plant is being painted in an absurdly negative light, and I wish more people took a second to think critically before demonizing yet another resource that appears to have helped people break their opioid addiction.

Mitragyna Speciosa

Photo by Uomo vitruviano (Own work) [CC BY-SA 3.0 or GFDL], via Wikimedia Commons

Mitragyna speciosa (kratom) is a medicinal herb indigenous to Southeast Asia, found in Thailand, Malaysia, and Myanmar, among other regions. Kratom is a tropical deciduous tree that is part of the Rubiaceae family (the coffee family). The tree can grow up to 15 meters (50 feet) tall, producing broad leaves which contain over 40 psychoactive alkaloids. Some of these alkaloids act in a considerably weak, yet similar manner to opioids. And as a result, kratom has been used by millions of people in the United States as an “opium substitute,” often as a remedy for opioid withdrawal. Some evidence suggests kratom has been used for opioid withdrawal since the early 19th century.

Statistics

On February 6th, 2018, the FDA released a new analysis suggesting that 44 deaths in the U.S. had been associated with kratom since 2011. But all of those cases except one involved people who were found to be on multiple drugs at the time of death—the vast majority of which were either illicit or prescription drugs that carry well-known fatal risks. That single incident report includes no information on the death apart from the subject’s age and ethnicity. The report does show that the individual tested positive for high levels of mitragynine (the main active compound in kratom), but like the rest of those cases, says nothing about how the substance was determined to have contributed to their death. This excellent Huffington Post article further investigates these cases.

However, even if those 44 deaths were accurately attributed to kratom, that number is dwarfed by the death rates associated with opioids or prescription painkillers (or alcohol, or tobacco—Tylenol, even). Over the past two decades, almost the same number of people in the U.S. have been killed annually by lightning strikes than the total number of people who have ever died with kratom present in their system In 2010, 19,154 people died of opioid overdoses. In 2016 alone, 3,373 deaths were caused by methadone, a prescription medication given to people with opioid addiction. Even Suboxone, a brand-name buprenorphine/naloxone combination medication used for opioid addiction, has been associated with several hundred deaths in the US over the past ten years.

Once more: Hundreds of thousands of people have tragically died from opioid overdoses. 44 deaths have been erroneously associated with kratom, 43 of which were using multiple drugs simultaneously.

There’s a lot of numbers there, so let’s sum it all up. An increasingly promising, safer substance that can ease opioid addiction is on course to be classified as a Schedule I substance, while government-approved prescription drugs being used for the same purpose continue to kill thousands. You’d be pretty hard-pressed to find a safer alternative to what people are using kratom for.

Mechanism of Action

Paraphrased from this CNN article:

Scott Hemby chairs the Department of Basic Pharmaceutical Sciences at High Point University in North Carolina and has been researching the abuse liability or “addictiveness” of kratom.

What’s key about kratom’s compounds is that they don’t bind to opioid receptors the same way heroin or oxycodone do. I quote: “Just because it binds, it doesn’t mean it has the same efficacy” as an opioid.

Rather, kratom’s compounds “sit on different parts of the receptor” and “fit differently than the chemicals in heroin and oxycodone.” And that distinction means it doesn’t lead to overdose fatalities the way opioids do.

A university department head says kratom doesn’t lead to the same overdose fatalities due to its fundamental mechanism of action. And respiratory depression is by far the most common way people die when they overdose on opioids.

We are doing ourselves a disservice by equating the dangers of kratom with other opioids.

Conspiracy?

If I had to guess, I’d say that this is the DEA/FDA’s current scheme:

  1. Make the general public associate kratom with opioids.
  2. As the public already is aware of the opioid epidemic, kratom becomes demonized among newly informed general population.
  3. Suddenly, criminalizing kratom becomes easier than regulating it.

Let’s not forget any past or present evidence which has suggested some people in our government have been (or currently are) in cahoots with the pharmaceutical industry.

Here’s an idea: how would drug companies make money if people found a helpful substance to use that they didn’t sell? Sounds oddly familiar, doesn’t it? Oh wait—didn’t a similar situation happen with marijuana? Didn’t we ban marijuana because it was “dangerous,” but then years later allowed drug companies to synthesize its active compound (THC) and sell it under the brand name Marinol?

Yes. Yes, we did. I think it’s not entirely unlikely that we’ll do the same thing with kratom.

Current Trajectory

At the end of this debate, what needs to be put into perspective is that we are touting this as dangerous—apparently more dangerous and addictive as Fentanyl, Vicodin, etc., hence the proposal to make kratom a Schedule I substance.

Schedule I means less research, more people going to jail for another victimless crime, and potentially more deaths from those who will turn back to hard drugs because they don’t have access to a safer alternative.

How does any of this make sense? I’d wager that any rational person who knows this information will agree that it doesn’t. We are clearly making the wrong move here. Sadly, kratom isn’t as popular as marijuana so it’s far easier for this stuff to fly under the radar.

We live in an age where people in power can create an image that favors their particular interest by suppressing information and diverting attention elsewhere. Distract, discredit, and then do anything you want. We should be studying and regulating kratom—not causing mass hysteria.