Kratom controversy

Southeast Asian plant creates a stir over its legality, health benefit

(Enterprise photo — Aaron Cerbone)

Nine thousand miles away from the rain forests of Thailand, Indonesia and Myanmar where it is harvested, a leafy plant in the coffee family called kratom is the subject of a debate sprouting in Tupper Lake. This is the latest branch of a debate growing here and throughout the U.S.: Should kratom remain legal?

Despite being illegal in Australia, Sweden and Poland — as well as countries where it is grown, including Thailand, Malaysia and Myanmar — kratom is legal in the U.S.

Though the Southeast Asian plant has long been used by native residents of Thailand, Indonesia and Myanmar, it only recently found a market in the U.S. over the last decade or so. It has quickly amassed a dedicated community of thousands of users, a Food and Drug Administration investigation and an announcement last year from the Drug Enforcement Agency that it intended to reclassify kratom as a Schedule I drug, alongside heroin, LSD and marijuana. That announcement was then withdrawn after two months of public outcry.

The DEA withdrew its announcement to schedule kratom after receiving 23,236 comments on a public forum with a majority opposing the action, 120,000 signatures on a “We The People” petition and hundreds protesting in front of the White House.

Though the DEA pulled its notice of intent to expedite a scientific and medical FDA evaluation of kratom, the thought of reclassification still looms large over the kratom community. So when Franklin County Coroner Shawn Stuart ruled in his Sept. 12 report that the death of Tupper Lake police Sgt. Matthew Dana was a hemorrhagic pulmonary adema caused by an overdose of mitragynine, the active ingredient in kratom, Tupper Lake was thrust into the center of attention for a nationwide community of users who passionately defend the plant’s legality.

Kratom powder is used for pain relief, bodybuilding and relieving opioid addiction, and is often mixed with hot water to make a tea. (Enterprise photo — Lou Reuter)

While most other cases of kratom-related deaths involved other drugs, toxicology tests on Dana showed no other substances in his system, only an unusually high amount of the Red Vein Maeng Da strain of kratom.

In days following the release of the report, hundreds of comments poured onto the Enterprise Facebook page, plus a few by email and phone, claiming that overdosing on kratom is impossible and the plant would induce vomiting before fatal levels could be introduced into the bloodstream. Stuart and the medical examiner he worked with both defend the report.

“His level was so high and that was the only thing that we found. It’s very hard to turn your back on that, particularly since the level was just absolutely astronomical,” local medical examiner Dr. C. Francis Varga said. “If I didn’t sign him out like that, I couldn’t sign him out at all.”

No one is yet saying publicly why Dana was taking kratom. He was a respected member of the police force’s narcotics division and a fitness enthusiast known for his health-focused decisions.

The people who use kratom are as varied as the reasons they use it: Some are fitness buffs trying to “push through the pain,” some are war veterans using kratom for post-surgery pain relief in lieu of taking opioid-based medication, some are college stoners looking for a new kind of “high,” but the most vocal users are heroin and opioid addicts who use kratom to ease themselves off the hard stuff.

Kratom extracts like these are concentrated amounts of the plant’s active ingredients which can be hundreds of times more potent than the regular powder. Currently, these products are unregulated by the FDA and are considered botanical specimens. (Enterprise photo — Aaron Cerbone)

Despite the irony of taking a psychoactive leaf to quit doing psychoactive drugs, this group is particularly concerned with the legality of the plant because they say it is a much more desirable method of kicking opioid addiction than others on the market.

Army veteran Steve Pechacek of Gent, New York, recently quit prescription medications after he finished 44 surgeries reconstructing his legs from an injury sustained in Korea in the 1980s. He quit after previous surgeries because the pain relief was not worth the toll prescription medication was taking on his life. However, the intense withdrawal from morphine dependency kept him house-bound and vomiting daily for a month. When he switched to kratom, he said he was able to live without pain and without opioid medication.

“I don’t want this to become illegal because it is an herb,” Pechacek said. “It is a ground up leaf; it is not processed in any way; it’s not altered in any way. I get it in ground up form and I make my own capsules. I take two capsules a day and it keeps me pain free and it keeps my PTSD in check. I don’t have to take big pharma’s morphine and everything else they had me on.”

Kratom’s effects differ based on dosage and strain. Small doses stimulate while large doses sedate.

Weightlifters who use kratom before a workout report feeling focused and energized as the pain-relieving plant helps them push their routine further. This effect makes kratom a part of everyday life for chronic pain sufferers or people recovering from injuries and surgeries. People addicted to opioids find the plant satisfies their cravings with less serious side effects, risks and withdrawal symptoms.

Kratom, a Southeast Asian plant in the coffee family, is currently under investigation by the Food and Drug Administration after the Drug Enforcement Agency considered reclassifying it as a Schedule I drug. (Enterprise photo — Aaron Cerbone)

This is because kratom is not an opioid. Its active ingredient, mitragynine, binds to delta opioid receptors in the brain, whereas heroin or prescription medications bind to mu opioid receptors.

Recreational users say kratom produces a euphoric state, calming the body while maintaining clarity of mind. Despite these opioid-like effects, the usual dose is compared more to a couple of cups of coffee than to heroin.

Kratom is not without its side effects. In high doses, the plant has been known to cause vomiting, hospitalization and slight respiratory depression.

University of Florida medicinal chemistry professor Christopher McCurdy has been studying kratom for years now. In studies using morphine-addicted mice, he replaced the rodents’ opioids with massive amounts of kratom. The mice all survived with no observable side effects. The studies did also reveal the abuse liabilities of 7-hydroxymitragynine, the most potent alkaloid in kratom, as mice became addicted to the alkaloid.

This potential for abuse was at the heart of the DEA’s intent to reschedule the plant, along with it not having any accepted medical use and a lack of accepted safety for use under medical supervision.

A sign in front of the former Saranac Lake head shop Grateful Toad advertises for an event in October 2015 when free samples of kratom were given out by the Imperial company. In 2016, the Grateful Toad was fined $12,000 for selling mislabeled kratom, and the shop was shut down later that year. (Enterprise photo — Morgan Ryan)

Currently, the two most common heroin treatment options, methadone and buprenorphine, have many side effects, brutal withdrawal symptoms and are themselves both opioids. The DEA classifies them as having the “potential for abuse.”

This was not the first time kratom has made news in the Adirondacks. In 2016, Saranac Lake head shop the Grateful Toad was issued a $12,000 state fine for selling mislabeled kratom. The shop closed later that year. The kratom sold in head shops around the country is not always just the leaf, and since it is not regulated by the FDA, it is not labeled as such.

Synthetic kratom, much like synthetic marijuana, contains additional ingredients, can be hundreds of times more potent and in some cases can result in death. When kratom manufacturers mix in other drugs, including opiates, it can be deadly. Without proper labeling, it is impossible to tell if the pills or powders sold at head shops and gas stations are pure or mixed up with other drugs.

“When you start making concentrates five, 100, 200, 500 times stronger than the original leaf, you can’t produce a steady amount,” Lance Dyer said. “You don’t have people taking this kind of extract for a scientific study. It’s not out there.”

In 2010, a team of Swedish forensic physicians reported that the brand Krypton killed nine people in one year because it had been combined with the mu opioid O-desmethyltramadol.

Currently, the FDA is conducting an investigation into kratom, with no deadline set for its findings. Its research will be used by the DEA when it again considers where kratom should fall on the drug spectrum and may play a role in regulating the industry. With extracts delivering concentrated amounts of kratom’s active ingredients, synthetics mixing kratom with other drugs and a lack of packaging and content regulation by the FDA, it is difficult to tell what is actually in a package of kratom bought from a store or online.

“It is a completely buyer-beware marketplace,” McCurdy wrote in an email. “We have analyzed several (but not all) products in the marketplace, some are good, some appear to be adulterated.”

Kratom is currently banned in six U.S. states: Alabama, Arkansas, Florida, Indiana, Wisconsin and Tennessee. In San Diego, California, and Jerseyville, Illinois, local ordinances ban the sale of kratom.

It is unclear what position the DEA will take after the FDA’s findings are released, but kratom advocates are as vocal as ever about their view of the plant they say is important to their everyday lives.


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