A Dangerous Alternative to Opiates or a Potential Treatment for Heroin? Kratom Debated

Mary Ann Lee, KLJ Online Content Editor[1]

Kratom, a plant-based substance that has been used for many years as a stimulant by farmers in southern Thailand, has caught the attention of authorities in the United States.[2] This long-used herbal drug with stimulating and pain relieving properties has created a commotion recently as authorities in six states have banned its sale.[3] However, in the remaining forty-four states kratom remains legal,[4] and users can even buy the product on Amazon for $19.99 (eligible for free shipping through Amazon Prime).[5] Critics of kratom liken the drug to other addictive controlled substances and proponents claim it could be used as a treatment for heroin, methamphetamine, and cocaine addiction.[6]

Kratom is derived from the leaves of the kratom plant, or the Mitragyna speciosa and the effects of the plant come from the alkaloid mitragynine, which targets the same receptors in the brain as morphine.[7] Taken in small quantities, kratom stimulates users and gives them additional energy, similar to caffeine.[8] Ingested in larger quantities, it relieves pain. Initially grown and produced in many Southeast Asian countries as a treatment for stomach aches, diarrhea, or mild pain relief, kratom is now illegal in Thailand, Australia, Myanmar and Malaysia, but remains legal and freely available in the majority of the United States.[9] Kratom is available in powder, pill, liquid extract, leaf resin, processed leaf, and whole leaf forms.[10] It can be ingested through pills, mixed with other foods, or brewed into a tea. Many users obtain kratom from online retailers or in stores where prices start at $6.99.[11] The use of kratom has increased significantly: according to the Drug Enforcement Agency (DEA), there was one report of seized mitragynine, the primary alkaloid in kratom, in 2010, 44 reports in 2011, and 81 reports in the first six months of 2012.[12]

Authorities have begun to consider banning kratom as sales have skyrocketed in the past year, but researchers claim the drug could be used to treat heroin, cocaine, or methamphetamine addiction. On one hand, critics rail against the drug, likening it to salvia, K2, spice and bathsalts, an illicit alternative to addictive and harmful controlled substances.[13] On the other hand, proponents of kratom claim its stimulating properties pose minimal risks and its pain relieving properties could be utilized as a treatment for heroin, cocaine, or methamphetamine addiction.[14]

Researchers at the University of Mississippi obtained a grant from the National Institute of Health to begin studying the effects and potential therapeutic uses of kratom.[15] Animal studies found that isolating the mitragynine compound in kratom blocked all symptoms of morphine withdrawal, working better than methadone.[16] “Mitragynine completely blocked all withdrawal symptoms and could provide a remarkable step-down-like treatment for people addicted to hardcore narcotics such as morphine, oxycodone or heroin,” the lead researcher, Christopher McCurdy, explained.[17] In another related study, researchers discovered rats chose kratom over cocaine, which marked the first time rats chose any drug in this class over cocaine.[18] The mitragynine produced the same effect on the rats, but had no effect on the rats’ other activities: it provided relief from the withdrawal without inhibiting the rats’ behavior or ability to function normally.[19]

Organizations such as the American Kratom Association advocate for kratom to remain legal.[20] The Transnational Institute, or TNI, released a policy briefing to the United Nations advocating for its legalization, describing criminalization as “unnecessary and counter-productive given decades of unproblematic use.”[21] According to TNI, kratom use has existed as a part of Thai culture through religious ceremonies and everyday use.[22]

While there are no known fatal overdoses from kratom, withdrawal and overdose is possible.[23] Emergency rooms have begun to see the number of patients suffering from kratom overdose and withdrawal increase as its popularity increases.[24]  This has prompted the DEA to list kratom as a drug of concern and the Food and Drug Administration (FDA) to issue an alert about kratom, authorizing its agents to detain without physical examination products from a list of known kratom importers.[25] In the alert, the FDA states, “there does not appear to be a history of use or other evidence of safety establishing that kratom will reasonably be expected to be safe as a dietary ingredient” and warns that there is no evidence proving that there is no “significant or unreasonable risk of illness or injury.”[26]

Alabama joined Vermont, Tennessee, Arkansas, Wisconsin, and Indiana in banning kratom on May 10, 2016.[27] Alabama classified kratom as a schedule I drug, the same category as ecstasy and heroin.[28] Other states, such as Kentucky and North Carolina, have introduced legislation to ban the plant.[29] Whether kratom has the potential to help addicts recover from their addictions or states should ban the drug because of its potential for abuse and remains to be seen. Regardless, more research is necessary to determine the effects of kratom and other drug alternatives as their popularity continues to climb.

[1] J.D. expected May 2017.
[2] Melissa Brown, States Ban Kratom Supplement Over Abuse Worries, ABC News (May 20, 2016, 11:32 AM), http://abcnews.go.com/Technology/wireStory/states-ban-kratom-supplement-abuse-worries-39256673.
[3] Id.
[4] Id.
[5] See Amazon.com, search “Kratom” in search bar. http://www.amazon.com/Kratom-K-com-Kava-112-Capsules/dp/B009RCO0LC/ref=sr_1_4?ie=UTF8&qid=1463975267&sr=8-4&keywords=kratom.
[6] Compare Larry Greenemeier, Should Kratom Use be Legal?, Scientific American (Sept. 30, 2013), http://www.scientificamerican.com/article/should-kratom-be-legal/ with Thomas Fuller, A Fading Thai Drug Finds Its Resurgence in a Cocktail, The New York Times (July 23, 2012), http://query.nytimes.com/gst/fullpage.html?res=9E05EFDC103EF930A15754C0A9649D8B63.
[7] Larry Greenemeier, Should Kratom Use be Legal?, Scientific American (Sept. 30, 2013), http://www.scientificamerican.com/article/should-kratom-be-legal/; Barbara Lago, New Hope for Addicts, Ole Miss University of Mississippi News: Ole Miss News Blog (January 25, 2013), http://news.olemiss.edu/new-hope-for-addicts/.
[8] Melissa Brown, States Ban Kratom Supplement Over Abuse Worries, ABC News (May 20, 2016, 11:32 AM), http://abcnews.go.com/Technology/wireStory/states-ban-kratom-supplement-abuse-worries-39256673.
[9] Jon Fernquest, Kratom leaves: Are they really a dangerous drug?, Bangkok Post (Sept. 6, 2015 at 8:07 pm), http://www.bangkokpost.com/learning/learning-from-news/682364/kratom-leaves-are-they-really-a-dangerous-drug-with-video; Larry Greenemeier, Should Kratom Use be Legal?, Scientific American (Sept. 30, 2013), http://www.scientificamerican.com/article/should-kratom-be-legal/; Melissa Brown, States Ban Kratom Supplement Over Abuse Worries, ABC News (May 20, 2016, 11:32 AM), http://abcnews.go.com/Technology/wireStory/states-ban-kratom-supplement-abuse-worries-39256673.
[10] Drug and Chemical Evaluation Section, Drug Enforcement Administration, KRATOM, (January 2013) available at http://www.deadiversion.usdoj.gov/drug_chem_info/kratom.pdf.
[11] http://krakenkratom.com/kratom-powder-leaf-online.
[12] Drug and Chemical Evaluation Section, Drug Enforcement Administration, KRATOM, (January 2013) available at http://www.deadiversion.usdoj.gov/drug_chem_info/kratom.pdf.
[13]See United States Drug Enforcement Administration, United States Department of Justice, Drug Facts Sheets, http://www.dea.gov/druginfo/factsheets.shtml.
[14] See Barbara Lago, New Hope for Addicts, Ole Miss University of Mississippi News: Ole Miss News Blog (January 25, 2013), http://news.olemiss.edu/new-hope-for-addicts/.
[15] Id.
[16] Id.
[17] Id.
[18] Id.
[19] Id.
[20] About Us, American Kratom Association (last visited May 23, 2016), http://www.americankratom.org/about.
[21] Pascal Tanguay, Kratom in Thailand: Decriminalisation and Community Control?, Transnational Institute (May 3, 2011), https://www.tni.org/en/briefing/kratom-thailand-decriminalisation-and-community-control.
[22] Id.
[23] Kari Huss, Asian leaf ‘Kratom’ making presence felt in US emergency rooms, NBC News: US News (Mar. 19, 2012 1:48 pm), http://usnews.nbcnews.com/_news/2012/03/19/10760892-asian-leaf-kratom-making-presence-felt-in-us-emergency-rooms.
[24] Id.
[25] Drug and Chemical Evaluation Section, Drug Enforcement Administration, KRATOM, (January 2013) available at http://www.deadiversion.usdoj.gov/drug_chem_info/kratom.pdf; United States Food and Drug Administration, Import Alert 54-15, (Jan. 22, 2016) available at http://www.accessdata.fda.gov/cms_ia/importalert_1137.html.
[26] United States Food and Drug Administration, Import Alert 54-15, (Jan. 22, 2016) available at http://www.accessdata.fda.gov/cms_ia/importalert_1137.html.
[27] Melissa Brown, States Ban Kratom Supplement Over Abuse Worries, ABC News (May 20, 2016, 11:32 AM), http://abcnews.go.com/Technology/wireStory/states-ban-kratom-supplement-abuse-worries-39256673.
[28] Id.
[29] William R. Toler, Kratom ban could cost N.C. jobs, Richmond County Daily Journal (May 21, 2016), https://yourdailyjournal.com/news/local-news-5/34197/kratom-ban-could-cost-n-c-jobs; John Null, Bill that Would Ban Kratom, Synthetic Opioids Clears Kentucky Senate, WKMS Murray State’s NPR Station (Feb. 19, 2016), http://wkms.org/post/bill-would-ban-kratom-synthetic-opioids-clears-kentucky-senate.