The herb kratom seems to be suffering an identity crisis. Is this botanical substance a dietary supplement — or is it an addictive drug?
Whatever kratom is and does, it is associated with at least 36 deaths from kratom-containing products, according to Adriane Fugh-Berman, M.D., a professor in the department of pharmacology and physiology at Georgetown University Medical Center. She spoke with HealthCentral via telephone.
“Kratom is addictive,” she says. “This is a recreational drug currently misclassified as a dietary supplement.”
Consumers use it on their own to treat depression, anxiety, and pain. Kratom is also known to produce euphoria or a “high.” It’s still unclear whether kratom is an opioid or not, but it does reduce symptoms of opioid withdrawal and is often used for that purpose.
“Kratom activates opioid receptors, so if it looks like an opioid and acts like an opioid, it probably is an opioid,” says Dr. Fugh-Berman.
This unapproved product puts users at risk for abuse and addiction — as well as death — says the Food and Drug Administration (FDA). The agency issued a public health advisory about kratom in November 2017.
The Drug Enforcement Administration (DEA) originally attempted to regulate kratom as a drug in August 2016, Dr. Fugh-Berman says, but was opposed by the American Kratom Association and other supporters.
In what’s considered by many to be a historic response, the DEA ultimately backed down. Kratom was sent back to the FDA to be regulated as a dietary supplement. Since the FDA’s advisory, however, the DEA has been evaluating kratom to determine whether to classify it as a Schedule 1 narcotic such as LSD, cocaine, and heroin.
“It’s not clear who funds the American Kratom Association but it does not have the hallmarks of a grassroots group,” says Dr. Fugh-Berman. “It seems to be promoting kratom in a way that’s clearly unethical. Companies are making big money selling kratom.”
The group’s website proclaims: “Never give up, never surrender” — which can be left to the reader’s interpretation.
Dr. Fugh-Berman warns that: “This is not a safe drug. People should get professional, medication-assisted treatment for opioid addiction through conventional means.”
Kratom is grown in Southeast Asia. “Remember that just because it comes from a plant doesn’t mean it’s not a recreational drug — think about marijuana and heroin,” she says.
Nomenclature for the lay person can sometimes be confusing when it comes to referring to a product as a supplement or a drug. An example of how this works can be seen with the popular supplement, St. John’s wort.
“It’s OK to say that ‘It improves emotional well-being,’ but not that 'It treats depression,’” says Dr. Fugh-Berman.
Protecting public health
The Columbus Post-Dispatch recently reported that a regular female customer buys kratom in a local shop to alleviate her chronic spinal cord pain. She’s been on pain medication for 20 years and finally can reduce her pain medication, she says. The enthusiastic user also reports she’s more alert.
Kratom users can also freely purchase the product on the internet, which worries Dr. Fugh-Berman. She believes consumers don’t fully understand the risks they are taking — or what they are taking.
Meanwhile, the FDA says U.S. poison control centers continue to receive hundreds of calls about kratom, and that it can cause serious side effects including seizures, liver damage and withdrawal symptoms. It also may have undesirable interactions with other drugs.
What users report on online forums and share amongst each other is one thing, but proving scientific claims through a rigorous testing process, and bringing kratom to market is quite another. “To date, no marketer has sought to properly develop a drug that includes kratom,” according to the FDA.
It is detaining kratom shipments, conducting seizures, and destroying kratom products. The herb is a controlled substance in 16 countries, and is banned in at least five states.
FDA Commissioner Scott Gottlieb, M.D, notes in his advisory statement that the agency’s chief concern is for the safety of Americans. He’s not opposing kratom — he just wants to see the science, and to see the herb undergo the same rigorous testing as similar products on the market.
“To those who believe in the proposed medicinal uses of kratom, I encourage you to conduct the research that will help us better understand kratom’s risk and benefit profile, so that well-studied and potentially beneficial products can be considered. In the meantime, based on the weight of the evidence, the FDA will continue to take action on these products in order to protect public health.”
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Stephanie Stephens is a digital journalist, host and producer focused on health and lifestyle. Steph does audio and video and has shot a TV pilot for the powerful age 45+ demo. She’s an accomplished red carpet host, having interviewed more than 250 celebrities. When she’s not working (when is that?), she’s working out doing HIIT, strength training, yoga or running. Steph is very involved in humane causes in Southern California and is owned by seven cats. Join her on Twitter, Facebook, YouTube, Instagram, LinkedIn, and Google+.