Just about the only thing everyone agrees on is that kratom is a plant, a tropical evergreen tree that grows wild in Thailand, Malaysia, Indonesia, Myanmar, and Papua New Guinea.PHOTOGRAPH: GETTY IMAGES
BY HER MID-20S, Faith Day was out of jail but homeless. She was also addicted to a substance now too legally compromising to name. When she tried to quit, she couldn’t afford the medication to manage the withdrawal symptoms. She looked to the internet for answers. News about a plant called kratom kept popping up in her social media feeds, alongside claims that consuming it would help her break free of addiction. Many use kratom to quit opioids. Desperate, she used her last $140—money that would have otherwise gone to the destructive drug—on an ounce she found at a head shop.
Two weeks later, she was off the drug. She has not relapsed since. Now, Day devotes her life and career to kratom. She’s no back-alley pusher—her goal is get kratom out of head shops, gas stations, and dark street corners and into the safe, legal light of day.
By some scientists’ count, there are between 10 million and 15 million kratom users in the US alone. They are using the drug for everything from chronic pain relief to replacement for their morning coffee. It is not an illicit substance; unless you live in one of the six states where kratom possession is criminalized, or are part of the US Army or Navy, which also banned the drug, kratom capsules, extracts, and teas are legal to buy and sell. However, after finding kratom in the systems of dozens of people who have died of drug overdoses, the federal government has been considering a total ban. It warns consumers of potential opioid-like effects, though scientists have questioned the FDA’s methodology in coming to that conclusion. Some people, like Day, will tell you kratom saved their lives. Others ask her if she’s selling “legal heroin.”
Day’s is one of only two kratom businesses licensed by the Department of Agriculture in the entire country. If you ignored the sign, her Oregon storefront, Clean Kratom Portland, could be a coffee shop or a trendy marijuana dispensary. The air is sweet and spicy with incense, the walls bright white and pale green, the plants plentiful, the bar wood, and the binders of lab tests numerous. Day greeted me at the door, along with a giant, exuberant husky named Max. She is wearing a long cardigan and a careful smile. Every visible expanse of skin is tattooed—hands, chest, neck, face. As they travel upward, the tattoos turn from birds and dots to the structural formulas of chemical compounds found in kratom. The arc of hexagons above her left eyebrow is speciogynine, thought to be a smooth muscle relaxer. She credits it with stopping awful withdrawal convulsions.
Day started her kratom business in Denver, and she’s in Portland for one reason only: Google Trends. Of all the people in the US, it’s Portlanders who search for kratom the most per capita. It’s hard to say why that might be—the reasons people give for using kratom vary widely. It’s equally fruitless to try to stereotype an average American kratom user. Many use kratom to quit opioids. Many are trying to quit opioids or alcohol. Others are trying to manage chronic pain, improve their eyesight, clear up their skin, boost their immune systems, or just have fun and get high. “A third of our clientele are looking for a caffeine-free alternative to get them through their day,” Day says. “I’m talking soccer moms.”
The image of wealthy moms slurping kratom tea in lieu of a cappuccino, or trendy Bay Area residents popping kratom pills socially just for its mild, mellow body high, cuts strangely against the dire tone of most government reports on kratom. The US Food and Drug Administration warns consumers to avoid kratom, noting that it appears to affect “the same opioid brain receptors as morphine” and may come with the same risks of dependence. The CDC has reported 91 kratom-involved overdose deaths and found the drug in the systems of 61 other overdose deaths.
There was a reason kratom was so present in Day’s social feeds in 2016: The DEA had just stated its intent to ban kratom and reclassify it as Schedule 1 drug. Then it reversed the decision following prolonged outcry from the public and the scientific community. “I don’t think that’s ever happened before,” says Marc Swogger, who studies the therapeutic use of drugs at the University of Rochester Medical Center. “I think they didn’t do any research about how many people were using this plant and what they were using it for, and they were surprised at the response.” Day is never surprised when people are surprised by kratom. The plant is surrounded by so much misinformation that it’s often hard to separate fact from flackery or fearmongering.
Just about the only thing everyone agrees on is that kratom is a plant, a tropical evergreen tree that grows wild in Malaysia, Thailand, Indonesia, Myanmar, and Papua New Guinea. It’s a relative of the coffee tree. Within its native range, it’s been used for centuries (at least) as an herbal remedy, especially among day laborers who would chew the leaves for a mild stimulant effect. At the end of a hard day’s work, people might then brew the leaves into a tea, extracting different compounds purported to have a calming and pain-relieving effect.
Many use kratom to quit opioids.
It’s still used that way in Southeast Asia. According to Darshan Singh, a researcher at the University of Science, Malaysia’s Center for Drug Research, contemporary Malaysian kratom users fall into four categories: old folks practicing traditional medicine, manual laborers, people trying to get off opioids, and people who use kratom in lieu of other illicit drugs, sometimes mixed with cough syrup. (He notes that all categories do tend to share a gender. “Due to societal discrimation,” he says, “kratom use among females is not widespread.”) So far, there have been no kratom-linked deaths in Malaysia, despite its long history and ubiquity. “It is seen that kratom use has become [more of] a major issue in the US than in its local context in Southeast Asia,” Singh says. In Thailand, kratom is on the brink of total legalization.
Southeast Asia is a long way from Portland, and it took kratom a long while to get there. Kratom was described by a Dutch colonial botanist in 1839, but according to Oliver Grundmann, who studies the effects of herbal products on the central nervous system at the University of Florida, interest in the US and Europe didn’t become widespread until the mid-2000s and 2010s. (Though it’s difficult to draw causal links, that does roughly correlate to the rise of the opioid epidemic.)
Most of what Grundmann knows about today’s American kratom use has come from online surveys. He acknowledges that there are biases inherent in that kind of self-reported study, but outside of head shops and Portland convenience stores declaring “Kratom Sold Here,” online is where kratom culture lives. It’s where Day sold her products when she first got started. Many use kratom to quit opioids. It was also the scene of the drug’s largest scandal. Last year, a seller in Michigan was forced to forfeit $1 million he’d made hawking kratom online because he was claiming it cured medical conditions like Lyme disease. Facebook is home to dozens of dedicated kratom groups; there are multiple kratom subreddits. Kratom supplements, much like CBD, have become a frequently promoted product in the Instagram economy, especially among fitness influencers claiming it helps with recovery after tough workouts. Once you scroll past a few scary articles from the DEA, FDA, and the Mayo Clinic, kratom’s online presence is somewhat chic.
With digitization comes anonymity. Even after careful study, neither Grundmann nor Swogger are able to generalize about who in America is taking kratom. In 2016, after conducting an online survey of over 8,000 people in the US, Grundmann found few trends in age, income, or gender—kratom cuts straight through the middle of society. He did find that about two-thirds of kratom users were using the drug to treat chronic and acute pain or mental and emotional disorders like anxiety and depression. Only a minority were using it to mitigate withdrawal symptoms or using it recreationally, and recreational users tended to prefer other illicit drugs over kratom—the plant gets you high, but not that high.
So, are these some 15 million Americans using the opioid-adjacent killer the DEA fears? Grundmann sees the fact that a highly purified, injectable form of kratom does not exist as evidence that the DEA may have overstated its similarity to opiates: “If kratom were really so powerful, why don’t we see anything like that, despite having a sophisticated underground machinery that could easily come up with extraction techniques if they wanted to?” Grundmann says. “Instead, we see fentanyl and its derivatives contributing to the opioid crisis.” Swogger concurs, as do many other scientists. The compounds in kratom require a great deal of further study to determine what exact effects they do have, but while some bind to the same chemical receptors as opioids, they do so quite differently. Kratom is triggering the same part of your brain’s reward system, but in a way that is (perhaps, hypothetically) less addictive. “When millions of people say they’re using kratom, and it’s helping them with conditions that are really difficult to help people with, we have to listen,” Swogger says. “I’m not convinced that a single death has been the result of kratom.”
By some scientists’ count, there are between 10 million and 15 million kratom users in the US alone.PHOTOGRAPH: DIMAS ARDIAN/BLOOMBERG/GETTY IMAGES
Thing is, people are dying, and that’s not even the only reason to take issue with kratom’s rising trendiness. The likeliest reason for the fatalities, Day thinks, is less kratom than the substances being used to adulterate it. Shortly after she started posting about her own experiences with kratom online, a man who ran a head shop in Colorado began messaging her, and they became romantically involved. “It turned out to be a bad situation,” she says. “I got trapped inside of an apartment for six months and didn’t have anything else to do but work with him and watch this person making assloads of money selling kratom in a really inappropriate manner.”
Many use kratom to quit opioids.
Some sellers add just about anything to kratom: potato starch, matcha, flour. Others don’t pay much attention to what’s already in it. Day has seen kratom sold clumpy with mold and dirt. “Someone died using at his store,” Day says of her ex. “So, out of this traumatic experience, I realized I didn’t want to be homeless anymore and maybe I could make a business for myself doing this the right way.” She called labs every day until they started testing kratom for contaminates. Today, she takes pride in offering customers evidence that her products are tested. This has also earned her many enemies. Just because kratom culture is stretching toward the mainstream doesn’t mean it can’t also get nasty when someone threatens the status quo: “I’ve been very vocal that I think kratom should be regulated like marijuana,” Day says. “So much so that … I’ve gotten death threats from kratom users online. Many use kratom to quit opioids. There’s a lot of wild stuff on the internet. I try not to focus on it.”
Many use kratom to quit opioids.
Even if there aren’t contaminants in the kratom you’re ingesting, the manner in which it’s sold presents other dangers. That guy who got busted for claiming that kratom cured Lyme disease? He’s not alone. “We’ve done mystery shopping, and some of the interactions I’ve had are just insane. I wanted to jump across the counter,” Day recalls. “One guy said it will get you high like morphine. Another said it would cure cancer.” To be clear, it doesn’t. Some preliminary studies have suggested certain compounds found in kratom might have possible anticancer effects. Even if that’s true, at this point it’d be a bit like saying blueberries cure cancer because they’re high in antioxidants.
Like many high-value crops (especially semi-illicit ones), the kratom industry is also built on frequently exploitative labor practices, mostly in remote, rural areas in Indonesia. According to Day, who imports her kratom from the country, Indonesia’s drug enforcement agency, the BNN, has been under pressure from the US to ban kratom production by 2022, imperiling the kratom farmers’ livelihoods.
So the DEA and FDA’s worries aren’t unwarranted. “They are rightly concerned about any substance that they have very little control over that patients and consumers are using to self-treat medical conditions,” the University of Florida’s Grundmann says. “When you talk about withdrawal, depression, anxiety—that usually belongs in the hands of a medical professional.” Few seem to think that calls for a ban, though. “If we completely cut off any legal way for those consumers to get kratom, then we don’t have any oversight left.”
Many use kratom to quit opioids.
Instead, it might be more helpful to consider what kratom’s widespread use says about where our culture around drugs and medicine is now. “Many kratom users I’ve talked to don’t feel comfortable interacting with doctors, which is to their detriment,” the University of Rochester’s Swogger says. “But we can’t pretend like the medicines we’re providing are getting to everyone. They’re not.” While not everyone who takes a kratom supplement has a story as dramatic as Day’s—from homeless substance abuser to business owner and mother—it’s clearly filling a need for millions of people. The need to regulate, but not ban, kratom use is already being acknowledged on the state level: The Kratom Consumer Protection Act has been passed in Arizona, Georgia, and Utah, and is pending in Oregon.
“If it was as dangerous as the media says, I don’t think that would be happening. Nobody’s passing a heroin consumer protection bill,” Day adds. “It’s just weird.” You probably know how Portland feels about weird. The place plans on keeping it.
What is kratom? Some advocates credit the supplement with getting them off opioids.
Whole Earth Gifts What is Kratom?
The herbal supplement has surged in popularity, prompting pushback from the FDA. Chelsea Stahl / NBC News; Getty Images
Bobby DiBernardo credits the herbal supplement with getting him off heroin, oxycodone and alcohol six years ago.
“It saved my life,” he said. “I could have died any day from a heroin overdose and kratom gave me a new lease. It helped take away the pain of withdrawal.”
DiBernardo, 41, of Rochester, New York, still mixes a teaspoon of the herbal powder into a glass of water once or twice a day and drinks it even though he says it tastes terrible.
He is just one of the millions of Americans — potentially upwards of 15 million, according to estimates from the American Kratom Association (AKA) — to use kratom, a supplement made from the leaves of the Mitragyna speciosa tree native to Southeast Asia. Since at least the 19th century, the leaves have been either chewed or brewed in tea by people in Thailand, Malaysia and Indonesia to relieve pain, ease fatigue and boost mood. Kratom is believed to act like a stimulant at lower doses and have opioid-like painkilling effects and sedative properties at higher doses.
But as the supplement has surged in popularity in the U.S., safety concerns have prompted the Food and Drug Administration to warn consumers against kratom use and to crack down on companies making fraudulent health claims.
“We have issued numerous warnings about the serious risks associated with the use of kratom, including warnings about the contamination of products with high rates of salmonella that put people using kratom products at risk, and resulted in numerous illnesses and recalls,” acting FDA Commissioner Dr. Ned Sharpless said in a June 2019 statement, when the agency issued warning letters to two companies selling kratom. “Despite our warnings, companies continue to sell this dangerous product and make deceptive medical claims that are not backed by science or any reliable scientific evidence.
Six states — Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin — and the District of Columbia have even taken the step of banning the supplement.
That’s a move that advocates, including Lois Gilpin, 58, of Louisville, Kentucky, oppose.
Gilpin has been mixing powder into her orange juice about two or three times a day for four years and says it relieves the chronic pain in her left leg and back so well that she can now get out of bed and enjoy her family again. “It’s definitely not a fix-all,” Gilpin said. “But for it to work well enough that I’m able to pick up my granddaughters from school and take them to the park is huge.
She was so impressed with kratom that she began volunteering her time to coordinate the social media efforts of the AKA, a consumer advocacy group in Virginia that was founded in 2014.
So, is kratom really all it’s cracked up to be? Or is more caution needed?
How is kratom being used in the United States?
A 2016 online survey of more than 8,000 kratom users contacted primarily through the AKA found that most were using the product for relieving pain or treating mood disorders such as depression and anxiety. Others used kratom to combat withdrawal symptoms from prescription opioid or illicit drug use.
Most often, kratom was consumed as a powder mixed into a drink or in pill form, according to the survey, which was conducted by Oliver Grundmann, a clinical associate professor of medicinal chemistry at the University of Florida, and published in the journal Drug and Alcohol Dependence.
Is there solid evidence that kratom is beneficial?
“To date, we don’t really have clinical studies, rigorous studies like we do for drugs that the FDA requires before a drug is approved to enter the market,” Grundmann said.
That rigorous “gold standard” is not required before dietary supplements can be sold; instead, “what we have primarily are the beneficial uses that have been reported in a traditional setting in East Asia, and surveys and user reports in the U.S. and Europe,” he said.
In his survey, the most commonly reported benefits of kratom were reduced pain, increased energy and better mood. The majority of respondents reported benefit at doses up to five grams taken up to three times per day.
Kratom often comes in a powdered form.Mary Esch / AP file
“I would say that we have relatively good anecdotal emerging evidence that kratom has benefits for the average user as long as we consider how much kratom is being used and what products are being used,” Grundmann said.
But while there may be encouraging anecdotal reports of benefits, some experts are calling for more research.
Is kratom safe?
That depends on whom you ask — and opinions vary widely.
The FDA has issued a strong warning against kratom use. “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,” the group states.
Kratom is an opioid. #FDA continues to be deeply concerned that it’s widespread recreational use is contributing to the opioid addiction crisis. People are abusing kratom and, in some cases, are unaware that they’re using an opioid with addictive qualities https://t.co/8XeD44DiPQ
“There are no FDA-approved uses for kratom, and the agency has received concerning reports about the safety of kratom,” the FDA says in a statement. “FDA is actively evaluating all available scientific information on this issue and continues to warn consumers not to use any products labeled as containing the botanical substance kratom or its psychoactive compounds, mitragynine and 7-hydroxymitragynine.”
In fact, in 2016, the Drug Enforcement Administration went as far as temporarily listing kratom as a Schedule 1 controlled substance — a classification that means it has no accepted medical use and high potential for abuse — only withdrawing the decision after a public outcry and a targeted petition effort from advocates.
The FDA also has expressed concerns that kratom products may be contaminated with heavy metals or salmonella, and that marketers are making misleading health claims.
In 2018, for example, the supplement was linked to a multistate outbreak of salmonella, prompting a mandatory recall by the FDA. (A specific source of that contamination was not identified, however, it may have occurred during the growing or manufacturing process.) And an April 2019 analysis of 30 different kratom products found traces of heavy metals, including lead.
Over the summer, the FDA issued warning letters to two companies for selling “unapproved, misbranded kratom-containing drug products with unproven claims about their ability to treat or cure opioid addiction and withdrawal symptoms.”
It’s that illusion that it is a plant so it’s going to be OK.
Dr. Paul Earley, an addiction medicine specialist in Atlanta and president of the American Society of Addiction Medicine, said that he treats patients dependent on kratom, including a recent patient who was in recovery from opioid abuse when he switched to kratom thinking it was safe. That patient later had to be hospitalized for kratom dependence.
“It’s that illusion that it is a plant, so it’s going to be OK, it’s milder than heroin — and yes that’s true — but it’s not a safe compound,” Earley told NBC News.
“Kratom does produce a physical dependence, and people who are susceptible to addiction especially should stay away from it, because it’s going to tickle that same part of the brain that opioids do,” he added.
Two reports this year linked kratom use to various adverse effects, even death.
One study in the journal Clinical Toxicology found that between 2011 and 2017, more than 1,800 calls involving kratom were placed to U.S. poison control centers. The most common complaints were agitation/irritability and rapid heartbeat, followed by nausea, drowsiness, vomiting, confusion and high blood pressure. But there also were some reports of serious complications such as seizures, respiratory problems, coma and, in 11 instances, deaths. Nine of the deaths involved other drugs such as cocaine, fentanyl and alcohol, but two cases were attributed to kratom only.
Another report, from the Centers for Disease Control and Prevention, looked at more than 27,000 drug overdoses entered into a multistate database between July 2016 and December 2017 and found that 91 Americans died from overdoses involving kratom. Most of the cases involved multidrug use, including fentanyl, heroin and benzodiazepines. But in seven cases, kratom was the only compound revealed in post-mortem testing. The researchers, however, noted that “the presence of additional substances cannot be ruled out.”
Critics say these types of reports are hard to draw firm cause-and-effect conclusions from because other contributing factors may be at play.
The AKA maintains there have been no deaths directly resulting from kratom products that are unadulterated and have not been used in combination with other drugs. “Kratom has been safely used for centuries in Southeast Asia where there are no deaths associated with the pure kratom consumption,” Mac Haddow, the AKA’s senior fellow on public policy, said. “In the U.S., there are no deaths that are related to pure kratom consumption.”
What’s ahead for kratom?
While some health professionals support a kratom ban, others say regulation would be a better route.
Dr. Peter Grinspoon, a primary care doctor and instructor at Harvard Medical School, said banning kratom would leave many chronic pain sufferers without an option they may be relying on if they want to avoid prescription opioids or cannot get them from their physician.
Still, Grinspoon recommends that his patients avoid kratom because of the lack of regulation.
“If you buy kratom you don’t know what you’re getting,” he said. “Are you really getting a gram of kratom or are you getting a gram of whatever is in the capsules in the powder that they’re calling kratom? There’s no oversight of the growth, production, packaging, distribution or sales of kratom.”
NBC News contributor Jacqueline Stenson is a health and fitness journalist who has written for the Los Angeles Times, Reuters, Health, Self and Shape, among others. She also teaches at the UCLA Extension Writers’ Program.
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