What is Kratom?
Kratom is an herbal supplement which can be used as a stimulant in low doses, and a sedative or pain reliever in larger doses.
It has been used to treat chronic pain, depression, anxiety, digestive ailments, fatigue, panic attacks, symptoms of fibromyalgia and to help enhance mood, increase energy, suppress appetite and lower blood pressure.
It is also widely used as an aid for withdrawal from opium dependence.
The main active ingredients of Kratom are the alkaloids mitragynine and 7-hydroxymitragynine which can have analgesic (pain relieving) effects.
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The herbal extract comes from the leaves of an evergreen tree (Mitragyna speciosa) that grows in Thailand, Malaysia, Papua New Guinea, Indonesia and other parts of Southeast Asia.
Kratom is also known by the street names ithang, thang, kakuam, thom, ketom, biak, kratho, or ketum.
It can be taken as a liquid extract for higher concentrated doses. Side effects may include nausea, constipation, muscle tremors, tongue numbness, dry mouth, itching, sweating, dizziness, hallucination and the need to urinate.
In larger doses or when mixed with other drugs it may cause seizures, brain swelling, liver damage, trouble breathing, cardiac arrest and even death when mixed with other substances.
Official FDA Stance
The FDA has issued several warnings addressing illegal marketing of the drug’s unproven ability to treat opioid withdrawal, heavy metals found in Kratom products, and a recall on Kratom products due to a risk of salmonella.
There are no FDA approved uses for the drug. The FDA is concerned that kratom, which affects the same opioid brain receptors as morphine, appears to have properties that expose users to the risks of addiction, abuse, and dependence.
In November 2017, the FDA issued a public safety advisory warning consumers not to use kratom because “it appears to have properties that expose users to the risks of addiction, abuse, and dependence.”
Use to Manage Opioid Withdrawal
Kratom has long been used to self treat opioid withdrawal in Southeast Asia and is increasingly being used in the U.S. for self-management of pain or withdrawal from opioid drugs such as heroin and prescription pain relievers.
Kratom interacts with opioid receptors which can lead to sedation, pleasure, and decreased pain in high doses and sociability, energy and alertness in small doses.
Though used to treat opioid addiction issues, some studies have shown that Kratom may lead to its own addiction problems.
An FDA crackdown on Kratom is considered by many proponents to be a result of a campaign by Pharmaceutical companies to eliminate this alternative product.
State by State Assessment
Kratom is currently banned in six states: Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin.
There are also active bans in several U.S. cities and counties including Denver, Colorado, Jerseyville, Indiana, and Sarasota County, Florida as well as in other countries including Australia, Bhutan, Malaysia, and Myanmar.
Across the U.S. there are active pushes both to ban Kratom and to secure its legality. Below is a state by state assessment of Kratom’s current legality and any pending efforts to change its status.
The Future of Kratom : Bans, Regulations & Legality
While Kratom is still legal under federal law, the FDA has issued multiple consumer warnings. In 2016, the DEA threatened to add Kratom to the list of Schedule 1 drugs, a class for drugs such as heroin that have no valid medical uses and a high potential for abuse.
However, the DEA’s attempt to ban Kratom was put on hold after a massive response from Kratom advocates including patients, doctors, congressional representatives and the public who said it helped with opioid withdrawal and chronic pain management.
In 2018, the Department of Health and Human Services announced its recommended to the DEA to ban Kratom, in spite of the public backlash.
While a number of deaths have been associated with Kratom use, those deaths involve other drugs or alcohol as well. Unless it is banned on a federal level, States will continue to regulate or not regulate as they see fit.
With advocates on both sides, more research is needed.
Many believe that at a minimum education, research and regulation on dosages and contamination are needed to improve safety.
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