Detractors have called it “herbal heroin.” Advocates call it a harmless natural alternative to addictive prescription drugs that improves mental wellbeing and restores a healthy, pain-free life without side-effects. What is the real story behind the upcoming federal ban on Kratom, a plant that is unfamiliar to most Americans?
The Kratom industry is a small niche herbal market, with most users discovering it via word-of-mouth online. The crushed leaves of the plant imported from South East Asia have been sold mostly through herbal stores and in some smoke shops as “incense.” It is often taken in small amounts (about 5 grams per dose) in powdered form or in capsules. Kratom is used for pain relief, as a mood stabilizer, to treat depression, substance abuse and opiate withdrawal symptoms, and historically has been used in Eastern medicine to treat diarrhea, cough, and fatigue.
After the FDA concluded Kratom had no medical value, thereby preventing it from being classified as a dietary supplement, the DEA decided that the rarely-used herbal remedy is an imminent threat to public health. The agency announced Kratom will be banned federally as a Schedule I substance (the most severe category for drugs with no accepted or safe medical use, which includes heroin, LSD, and marijuana) on Sept 30.*
The problem is, the DEA doesn’t have conclusive medical or scientific evidence that the Kratom plant is a grave risk to the American public, or that it definitively fits the description of a Schedule I substance. The notice of intent published by the DEA on the Federal Register attempts to explain how the agency came to the conclusion that Kratom is dangerous, but upon closer inspection, the resources provided suggest the agency doesn’t really understand exactly what Kratom is or how it is used. Deaths and calls to poison control centers were cited, but there is no viable information that Kratom was ever solely responsible for any overdoses or health problems.
Chuck Rosenberg, acting director of the DEA (who has recently called medical marijuana a “joke”) admits, “We may have gotten it wrong.” But, he says, it’s better to “err on the side of caution” in regards to public health.
There are over 130,000 Kratom users who disagree with the upcoming ban, represented in a petition to the White House. Thousands more have lashed back at the DEA by sharing their personal stories about Kratom’s positive effects all across social media outlets under hashtags #IAm Kratom and #KratomSavesLives. In a Streisand-effect moment, the DEA announcement brought Kratom users out into the open, and they are outspoken. Success stories are cropping up in the mainstream media faster than anyone anticipated.
“The response has been unexpected,” says DEA spokesman Melvin Patterson. The agency has received a deluge of phone calls from the public regarding this issue in the past few weeks.
Kratom advocates and users are asking that the emergency ban is halted, but they aren’t asking that the plant be available in every grocery store without oversight. The American Kratom Association (AKA) and the Botanical Education Alliance (BEA) have joined forces to demand an open forum for the public and medical experts to weigh the merit of the DEA’s report on Kratom, and whether or not it fits the criteria for a Schedule I substance. They are also demanding reasonable regulations – age limits, side-effects or warning labels on the product, and further scientific testing.
Grant Smith, Deputy Director of National Affairs with the Drug Policy Alliance, has thrown his support behind Kratom advocates. “I think we need to take a step back and look at the therapeutic potential that Kratom has with respect to it possibly serving as a replacement for more potent opioid medication as well as a way to manage pain,” Smith said. “There’s a lot of potential with Kratom, but a lot of that potential could be snuffed out if this emergency scheduling goes through.”
The Kratom plant does seem to be a promising substance that could be used medically to treat a number of ailments, including treatment-resistant depression. But a Schedule I substance will be difficult, if not impossible, to research and develop.
At Memorial Sloan Kettering Cancer Center, Susruta Majumdar is researching Kratom and its alkaloids.“What we are going after is a non-morphine-like opioid, which would still exhibit morphine-like analgesia, but would not be addictive,” he said.
Majumdar’s studies in mice have indicated that Kratom-based chemicals have fewer side-effects than opiates, and a lower addiction profile. Of the DEA ban, he told a reporter for the health publication STAT, “It does hurt me, there is no question.”
Andrew Kruegal of Columbia University, who is also researching the plant for its pain-killing effects without activating proteins that cause life-threatening side effects, says of the DEA ban, “I think it’s shortsighted, and I’m not pleased with it, because it’s certainly going to hinder our research to a dramatic degree.”
Normally, the rules of the Controlled Substances Act require that the Attorney General provide a hearing if requested by “any interested party” in which scientific and expert medical opinion, along with the experiences of the public, be considered so that risks and benefits can be weighed prior to scheduling. But the DEA invoked the emergency scheduling rules (under subsection h), created to stop new synthetic drugs from reaching the market (think bathsalts). This cuts short the rulemaking process and provides only 30 days notice – not enough time to gather a real panel of experts or receive a public hearing.
Smith says, “It’s time to give decision making authority [on drug scheduling] to an agency that’s grounded in science and health. The DEA has proven time and again that they really could care less about the science. They care about the politics and they care about preserving as much control as they can in this area.”
Speaking with Kratom’s users and its advocates, they just don’t seem like they ought to be penalized for self-treatment with an old Eastern herbal medicine. They don’t fit the typical profile of those seeking a high or some kind of intoxicant. They are pain patients, veterans, soccer moms, grandmothers, hippies, libertarians, lawyers, business-owners and retail workers. Many are middle-aged or senior citizens.
Responses about the effects of Kratom were fairly consistent – most said it’s a lot like a strong shot of espresso (Kratom is related to the coffee plant), though a few said it can have Tramadol-like effects. Users also self-report the potential for abuse to be similar to caffeine.
A recent survey of Kratom users found that it was overwhelmingly used to treat medical conditions, with only 2% reporting recreational use.
Most Kratom users and advocates say that Kratom provides a “mood lift,” rather than a “high.” The distinction between the two may seem minor, but there’s a key difference. If Kratom is proven to be of medical value, and not just used to get “high,” the DEA has a much harder case to make.
Erin, a 54-year-old Kratom user (who, like most people I spoke to, does not wish to share her full name, given the DEA’s announcement that she will be a criminal on Oct 1) has degenerative disc disease, spinal stenoisis, herniated discs and fibromyalgia. She describes the boost Kratom gave her after years of being prescribed opiates. “I discovered Kratom and ordered some capsules, and decided to wean myself off of the opiates. I thought this would be really an awful process but I discovered that Kratom did everything I needed for pain relief with none of the awful opiate side-effects. It took away the pain and gave me an energy boost I had not had in many years. It quickly became clear that trading the opiates for this benign plant leaf was not hard at all and in fact the Kratom was much, much better. Kratom gave me my life back.”
She described her life prior to Kratom, when she took the opiates prescribed to her by her neurologist, as unbearable. “I had gotten to the point where I pretty much lived in bed and could not work.” She now runs a company with her husband and keeps up with her grandchild, who she takes care of two days a week. “I take approximately 8-10 grams of Kratom a day. Sometimes less, never more. I have felt no tolerance issues or need for more.”
It appears that for those who have experience as pain patients, life became more manageable when they cut down on the prescription opiates, or quit pills altogether – as one would expect. If Kratom could assist them to get back to a place in their lives where they are more productive citizens, it’s almost pointless to argue about whether or not anyone is enjoying Kratom. And yet, whether or not someone out there might be using Kratom for a mood lift has caught the DEA’s attention.
Why is Kratom so effective? It has, unlike some other natural remedies, an agonist effect on the Mu opiate receptors in the brain. To some degree it affects serotonin reuptake. Even though it is not an opiate (not derived from the opium poppy), the Kratom leaves contain the alkaloids Mitragynine and 7-hydroxymitragynine, both active key ingredients that the DEA wishes to now classify as opioids.
Scientific studies have concluded Kratom does not cause respiratory depression or low blood pressure, two of the most dangerous effects of opiates. It also appears to have a natural ceiling effect – larger amounts of Kratom produce an antagonist effect on (kappa) opiate receptors. According to Kratom users, it is also very hard to take large doses of Kratom due to nausea and vomiting.
Studies on mice, rats, and dogs have not produced a single death.
Yet the DEA’s notice of intent relied on 15 deaths they claim were due to Kratom ingestion in the past two years, as well as 660 calls to poison control hotlines in the past five years.
In all 15 cases of deaths cited by the DEA, Kratom was mixed with other substances, or was coincidentally found during autopsy of a person with prior medical issues. Similar to studies that erroneously concluded heart attacks could be associated with marijuana use, the problem is that correlation and causation are not clearly defined. For instance, nine deaths in Sweden that have been brought to public attention as a result of a product marketed as “Krypton Kratom” appear to be due to adulteration. A much more dangerous byproduct of Tramadol called O-DMT, which is lethal when mixed with central nervous system depressants, was added to the powdered leaf in the Krypton brand. All of the deaths in Sweden tested positive for a variety of pharmaceutical drugs, sometimes in large amounts, mixed with O-DMT.
In the cases of calls to poison control, most of the symptoms reported were mild. Nausea, vomiting, and in some cases agitation and hallucinations. According to Kratom advocates and scientific studies, this does not represent the typical effects of ordinary medical Kratom use.
Just one of many scientific studies concludes: “To our knowledge, there are no well-defined studies of toxicity of MG [Mitrogynine] in humans, and in the case report of the identification of MG, among other substances, at autopsy, the medical examiner did not include mitragynine in the cause of death.”
Recent press has been favorable to Kratom advocates. The coffee example is often used in the media to explain what is otherwise a complex topic — our double standards about addiction and mood regulation. A coffee drinker may develop an addiction to coffee, and withdrawal can include physiological symptoms. Coffee makes people feel more productive and energetic, and sometimes people get a little bit of a “buzz” from their double shot in the morning. But as a society, we don’t find addiction itself to be immoral or dangerous. Rather, we judge substances based on the way that addiction affects a person’s quality of life. Because there are no dramatic life-ruining effects from drinking lots of coffee, we embrace it as part of our culture. As a society, we accept that it is even beneficial to alter our moods with mild psychoactive substances.
Because Kratom helps with some forms of treatment-resistant depression, due to its effects on serotonin in the brain, the ban has the ability to affect the quality of life of those suffering with mental health issues.
“I’ve never been high a day in my life,” says one Kratom user who has treatment-resistant depression (who also wishes to remain anonymous due to the upcoming ban). “I’ve suffered no side-effects except for a happy, healthy normal life. I’ll know my government thinks my being happy was a crime. It will all be so much worse this time. Come Sept 30, I’ll have to flush any Kratom I have down the toilet so as not to be in possession. When I do that, I’ll also flush my healthy, happy productive life down the toilet. My depression will return, with the added knowledge it all could be prevented … My biggest concern will be if I can reach for a bottle of water from bed because I won’t be able to leave it.”
“Making me a criminal, taking Kratom away from me and thousands others like me who use it therapeutically for pain, depression and even to kick addiction to actual drugs – we are all losers. There are no winners in this misguided and misinformed vindictive vendetta.”
While some advocates feel this was a conspiratorial move by pharmaceutical companies to eliminate a natural competitor, or a “vendetta” against former opiate users, it’s difficult to say exactly why Kratom was ever on the DEA’s radar in the first place. The agency has been under a lot of pressure to contain the opiate epidemic. Even if their intentions were good, they went into this ban blindly, disregarding scientific study and public opinion. The result is regulatory overreach, curtailing rights to protect the public from a threat that is vague at best, and that seems to concern no one but the DEA.
40,344 calls were made to poison control centers in 2016 for opiate exposures
An ex-heroin addict and current Kratom user, who also does not wish to use his real name, describes himself as having been “one of the worst kinds of addicts you can imagine.” He thinks the ban on Kratom is going to “literally” kill people. “I was utterly convinced I needed to shoot dope until I died, and paid zero attention to anyone trying to reach out to me with a better way. It’s so sad how tough it is to break through to many hardcore opioid addicts, and in the end only they can decide when they’ve had enough of that type of ‘life,’ if you can even call it that. But I am so grateful to get out of the game when I did … It is getting fucking brutal out there. Everyone I used to run with, including family members, who used with me, are either dead or in prison. All of them.”
He describes Kratom as “miles ahead” of methadone and suboxone.
A 32-year-old ex-professor who uses Kratom as part of her treatment for a rare form of leukemia, along with PCOS and migraines, shared her story with me. She receives home nursing care for a severe type of anemia caused by the leukemia and is in the hospital at least once a month. She agrees the DEA’s decision is counterproductive. “This is important. I have sat there in front of my doctors a few times crying about how difficult it was me to find alternative pain treatment all the while this ‘opiate epidemic’ is going on.”
“If [the government] is going to chase opiate users with pitchforks, they had damned well make alternative treatments more accessible. Making kratom illegal is a slap in the face.”
She shared with her doctors the benefits she receives from taking Kratom and received a positive response. Her medical team is supportive of whatever helps her with pain, as long as it doesn’t interfere with her other medications. “I was able to cut my Percocet dose in half. Now I only use it for breakthrough pain. All my doctors know I use [Kratom]. My home care nurse even introduced it to some other opiate-sensitive patients of hers and they love it.”
Lee, a Kratom user who worked in clinical research and drug development for 12 years, says, “It’s hard to find physicians that have strong opinions on kratom, in my experience, because it’s still relatively unknown in medicine. Pain management is a large part of palliative cancer care, and I am the only one at my early phase advanced cancer research group that even knows what Kratom is.”
Lee is also a pain patient, with both a spinal injury, spinal stenosis and degenerative spinal disease. Like most spinal injury patients, hydrocodone was prescribed. Compared to hydrocodone, Lee describes Kratom as “mild” but still effective for pain. “As a chronic pain patient, I would selfishly want kratom regulated how Kava is, so that the ease of access from vendors would be as simple as possible for me. However, as a medical professional, I would like to see it as a Schedule IV or OTC medication. I don’t believe that it meets the same threshold as other schedule II or III medications.”
Further, the Kratom ban will negatively affect field workers in Bali who rely on cultivating and exporting the plant for their livelihoods.
Last week I received an email from a Kratom user I interviewed who told me that I should dig deeper into how this is going to affect veterans. Several videos have been released by veterans who use Kratom to deal with pain from war injuries, or PTSD and depression. The organization Soldiers for Change has added its support against the Kratom ban.
Andrew Turner is one veteran who has found himself at the center of the advocacy movement for Kratom. He became well-known after releasing self-taped videos about his conditions. He was present at the march for Kratom in Washington D.C., among a group of hundreds with “Kratom Saves Lives” signs in front of the White House, telling their stories into a loudspeaker before a cluster of media cameras.
In a video addressed to Mr. Rosenberg, acting director of the DEA, Turner says, “I’m a veteran. I suffer from combat-related disabilities. I deal with pretty chronic pain. I have PTSD. It isn’t an easy thing to manage. For a long time, I’ve worked with doctors in the DOD and the VA to manage my symptoms. Several years ago I found a plant called Kratom … it turned out with just a little each morning, I was able to stop taking prescription opiates. I’ve stopped taking my SSRIs. I very rarely have anxiety or depression anymore.”
Turner continues: “Mr. Rosenberg … has also sent a message to the media that says the public has no reason to comment. I served a little over nine years honorably in the Navy. I served in the Middle East. I served and worked at Guantanamo, went eye to eye with some pretty bad people, one of whom took the use of my functional right hand in a violent attack on me. I earned my right to comment. That’s what I remember the First Amendment being about, when I rose my right hand – the right hand I can’t even use anymore – I said I will protect the Constitution against all enemies foreign and domestic … You’re taking away my first amendment rights and taking away my ability to take Kratom for the next two years at least.”
Susan Ash of the AKA has been fighting Kratom bans on the state level for years. She has also used Kratom to treat chronic Lyme disease. The AKA has hired a Washington D.C. law firm, a PR firm (the Hastings Group) and lobbyists. The cost of this battle is upward of $650,000, and the organization heavily relies on small donations from the public. Ash has been central in recruiting the support of some members of Congress to delay the ban and request a fair hearing.
Susan Ash speaking at the March for Kratom in Washington D.C.
Last week, a “Dear Colleague” letter was issued by Rep. Mark Pocan (WI) and Rep. Matt Salmon (AZ), which asked for other representatives to delay the ban on Kratom and address the issue of regulatory overreach by the DEA in the legislature.
The “Dear Colleague” letter was signed by over 46 members of Congress. This issue can finally be addressed in the legislature because of the tireless efforts of regular Kratom users and advocates who rallied together, wrote thousands of letters and placed phone calls to their representatives all over the country.
While the public is divided over a controversial presidential election, Kratom advocates have placed political beliefs aside in order to push for representation on a common cause that directly affects their health and wellbeing. There’s a very real chance they may succeed in obtaining a hearing, and perhaps even delay or temporarily halt the upcoming ban, just using their voices and speaking directly to those in positions of power.
Even if Kratom is scheduled as expected, the efforts of advocates on this issue are a reminder that regulatory agencies do need input from the public to do their jobs effectively. The US political system can be flexible, it can be accessed, and it can be utilized to watch the watchdogs. Regardless of the outcome, a new community has formed around this little controversial plant, and it won’t just slip away quietly.
The AKA has published a National Call to Action with information on how the public can help by signing petitions, making donations or contacting representatives.
*The Sept 30 deadline is the earliest date at which Kratom could be scheduled. If the scheduling is delayed, there will be 24 hours notice on the Federal Register.
Update 10/12/16: The DEA has withdrawn its notice of intent for the emergency scheduling of Kratom due to public pressure. It is noted that the Internet was an important factor, as it brought together public opinions on this issue and helped advocates organize. Many calls directly to the DEA from the public were taken seriously. A period of public comment will commence, and the FDA has been asked to look into the issue of regulation and scheduling suggestions based on scientific information. This should take place before Dec 1 2016.