The dangers and potential of ‘natural’ opioid kratom

Given the opioid addiction crisis, it would seem preposterous that an opioid is legal for use in the United States and can be purchased at tea stores, convenience stores, over the internet and, yes, even from vending machines.

However, kratom is not your average opioid. The Drug Enforcement Agency found this out when it tried to ban the herb in 2016.

Public outcry from users and 51 congressmen around the country from both political parties was loud. The DEA has since dropped its attempt to ban kratom, although its use is banned in Alabama, Arkansas, Indiana, Tennessee, Vermont, Wisconsin and Louisiana.

More recently, on Nov. 14, 2017, the FDA issued a public warning about kratom, citing 36 deaths that the agency has attributed to kratom use.

Kratom lies at the intersection between natural product and drug of abuse, areas I have been been exploring as a clinical pharmacology researcher and a pharmacist for two decades. From ephedra for weight loss to MDMA (molly) for PTSD, experience has taught me that natural products are not always safe and that banned drugs may actually benefit some patients.

A popular plant

Thousands of people take kratom, which grows naturally in Thailand, Malaysia, Indonesia and Papua New Guinea, to relieve pain, believing a natural herb to be safe. However, we just do not know enough about the herb to deem it safe, or effective.

We do know that kratom has very mild pain-relieving effects and a slight stimulant effect. It brings a low risk of stopping breathing, the main risk of stronger opioids.

The opioid effects from kratom come from two potent chemicals, mitragynine and 7-hydroxymitragynine in kratom’s leaf. Mitragynine is the more prominent and has very mild opioid effects, while 7-hydroxymitragynine is 13 times more potent than morphine milligram for milligram.

But just because kratom is not as dangerous as heroin and fentanyl does not mean it is free of adverse effects. In fact, they are all highly addictive. Capsules of kratom in Albany, N.Y. in a Sept. 27, 2017 file photo, after the death of a young police officer in upstate New York was classified as a kartom overdose. AP Photo/Mary Esch

In an assessment of the 660 calls about kratom to United States poison control centers from 2010-2015, the major adverse effects included racing heartbeat, agitation or irritability, drowsiness, nausea and high blood pressure. The adverse effects were moderate or severe in 42 percent and 7 percent of people, respectively.

In addition, unlike prescription drugs, the quantities of the active ingredients in unregulated kratom products can change over time or can be adulterated with other products. In an assessment of several kratom products commercially sold in the Western world, the concentrations of 7-hydroxymitragynine were substantially higher than could be achieved naturally, which negates the safety benefits of using kratom versus other opioids.

Help for hard workers?

Kratom has been used widely in Southeast Asia for millennia, but it was banned in Thailand in 1943. Fans of the herb said the ban was due to politics, not health.

The ban hardly stopped its usage there. According to the 2008 national survey in Thailand, more than a million people reported using kratom. In several southern districts in Thailand, up to 70 percent of the male population reportedly uses kratom daily.