Kratom, also known as Mitragyna speciosa, is a plant that grows naturally in Thailand, Malaysia, Indonesia, and Papua New Guinea. It is marketed as a product that helps to treat muscle pain, diarrhea, and opiate withdrawal.
This is because the plant has some opioid properties, along with some other benefits. Typically, the manufacturing process from plant to powder looks something like this:
- Harvesting: The leaves are harvested at various maturity levels, as this alters the chemical properties of the plant. Red strains are more mature, white strains consist of younger leaves.
- Drying: Leaves are dried either quickly in the sun or more slowly in the shade depending on the strain and the desired application.
- Crushing: After the drying process, leaves are either shredded, ground, or a combination of both processes to form the final product.
The product is then packaged and shipped in various ways. There are a variety of strains and manufacturers of the supplement. It comes in pill, powder, and other forms. If it has so many great benefits, what is the problem then? Why is there such a debate over kratom in the United States?
The main reason is that kratom itself contains potentially addictive opioids, which is only one of the reasons the FDA warns people not to use it. The other is that the FDA disputes those who market the supplement declaring it as cure or at least a treatment for opioid addiction. According to warning letters sent to two companies, Mitra Distributing and Chillin Mix Kratom, these claims are illegal.
The other problem the drug faces is that the FDA also issued a mandatory recall for all powders produced by Triangle Pharmaceuticals, LLC when they tested positive for salmonella. While the import of kratom has been banned, it is still sold as incense, can be found on the internet, or even ordered in bars where is it sold as “ketum” says the New York Times.
While the FDA emphasizes negative issues, proponents still continue to hail the benefits of kratom. While the agency says these claims are deceptive those who advocate for its use maintain it may just be a part of the solution to a health crisis raging out of control in the U.S. Here’s how we can keep it real about kratom.
An Addiction Solution
No matter who you talk to, it is clear that the United States is still in the grip of an opioid epidemic, and while we have made some progress, there is still a long way to go. So what have we done so far to make any difference at all?
- Increased Awareness: The opioid crisis is well known, and this results in the development of allies against the spread of addiction, advocates for better control of prescriptions, and activists who spearhead research and treatments.
- Reduction of Stigma: Addiction is a problem that bridges all socio-economic boundaries, and the less stigma there is associated with it, the easier it is for those who are struggling to openly seek help.
- More Treatment Programs: As communities become aware of issues and underserved demographics are better served by other nonprofits and organizations, the options for treatment become more widespread.
- Experimenting with Changes: One thing that is clear is that despite progress, opioid addiction continues to be a large problem in our country. Fewer prescriptions are being written and naloxone is more readily available.
This is where kratom often comes into the discussion. While progress is being made, antidotes and treatments don’t seem to be enough to stop the rising issues. Adding kratom to the mix as a treatment and potential cure for addiction seems to only make sense.
The problem with this approach is that kratom itself has an image problem, and that image is directly related to the problems manufacturers and distributors have had with the FDA and other regulators. What are those dangers, and what is the status of regulation?
Dangers and Regulation
How does kratom work and why is it considered dangerous? First, in small doses it serves as a stimulant, but at higher doses it give the user a similar high to opioids, and many practitioners of Asian traditional religions use it as a substitute for opium according to the Mayo Clinic. It has other side effects as well, which include:
- Dry Mouth
- Chills, nausea, vomiting.
- Changes in urine
- Liver damage
- Hallucinations and delusion
- Possible death
Proponents argue that these side effects are rare, just as they are with other supplements or prescription medications. However, there is one critical difference.
Since kratom is not a controlled substance, it is not standardized. Different blends and maturity may have different levels of the substance in it, and there is no standardized label in the United States to warn users of side effects and reveal additional ingredients, if any. When it is sold illegally, as is the case with many other drugs, it may not be what it is advertised to be, and may even be cut with other substances, including additional opioids.
These additional ingredients, along with the opioid properties already present, increase the risk of kratom addiction, and removal of the substance from a treatment regimen often results in withdrawal symptoms, according to the DEA.
Calls to poison control centers about the negative effects of kratom are also on the rise, and this may be due to misuse by users who are uniformed — another argument for regulation and standardization of labels.
The arguments for regulation actually span those who approve of kratom use and those who disparage its benefits. The reason is simple: those who disparage its properties want the benefits to be proven through blind studies and other common methods of pharmaceutical testing. Those who approve of kratom use want a clean, usable product that will provide benefits without the side effects that often come with illegal distribution.
The most recent issue with the FDA has been the discovery of heavy metals in various brands and forms of kratom, making them warn again about its use. This is yet another setback in the image of the supplement and those who manufacture and distribute it. On November 27, 2018, after testing 26 different varieties of kratom obtained by field investigators, the FDA found high levels of heavy metal in nearly all of them, and they warn that there may be more out there.
What does this mean to kratom? The problem may be in several places, from processing that introduces heavy metals to additives or packaging. The introduction of heavy metals could come from several places in the pharmaceutical supply chain. Where is the problem, and how serious is it? We simply don’t know yet because the industry largely flies under the radar and there has been little research conducted.
Debate on Both Sides
There’s a debate on both sides, both for and against kratom. Both sides have excellent points, and the answer probably lies somewhere in the middle, with a more regulated and standardized supplement that will benefit those who need it, but where side effects and dangers can be minimized.
The important thing is to be respectful on both sides, a practice advocated even by the American Kratom Association in their call for “Kratom Warriors.” If kratom indeed lives up to its medicinal claims, ways to safely introduce it to the market legally should be explored, reducing risk to users who choose to obtain it by skirting the law.
It is good for both sides to be challenged on what they believe. This is the only way to learn more about each other and move toward a place of compromise and mutual respect, something often lost in other political debates.
In the meantime, the debate over kratom and its use will continue. The most important thing is to keep our discussions real and look unemotionally at the facts — the only way to find a reasonable solution.