By Jennifer Margulis, Ph.D.
“It takes an option off the table for people who want to get off opiates and that’s unfortunate,” ethnobotanist Dennis McKenna, Ph.D., says. “The DEA decision was not made to benefit patients. People will die because of this ban.”
On August 30, 2016, the United States Drug Enforcement Administration (DEA) surprised botanists, herbalists, and natural medicine advocates when it issued a press release announcing the intention of classifying a plant called kratom (Mitragyna speciosa), and two of its active ingredients, mitragynine and 7-hydroxymitragynine, as Schedule 1 substances, beginning September 30, 2016.
The DEA’s ban on kratom, which is being instituted without public comment or stakeholder input, will for the next three years put kratom on par with dangerous and highly addictive drugs like heroin, ecstasy, and “bath salts.”
Since the DEA announcement, more than 123,000 people have signed an online petition asking the White House to stop the DEA from classifying kratom as a Schedule 1 substance.
What is kratom?
If you search YouTube you’ll find more than 37,500 videos about kratom. Thousands of Americans have tried it, and there is no question that the use of the plant has been growing in popularity in the United States. Still, kratom is not a household name for most of us. If you haven’t heard of it, kratom is used as a natural pain reliever as well as a non-pharmaceutical way to wean off of opioids. At low doses, kratom is considered a stimulant; at higher doses, a sedative.
Kratom is in the coffee family (Rubiaceae) and grows wild in marshy regions in Asia and the Pacific Rim, including Borneo, Malaysia, New Guinea, and Thailand. For several centuries in Thailand and South Asia, the plant’s leaves have been chewed for their energizing, calming, and euphoric effects. The very bitter leaves can also be ground up and eaten or drunk, smoked, brewed into tea, and made into an herbal extract. This YouTube guide, which has been watched by more than 50,000 viewers, recommends drinking kratom with orange juice.
Is kratom an “imminent hazard to public safety”?
The DEA claims to be classifying the kratom plant and its alkaloids, mitragynine and 7-hydroxymitragynine, as Schedule 1 substances “to avoid an imminent hazard to public safety,” explaining that kratom is “abused for its ability to produce opioid-like effects” and blaming the plant on 15 deaths between 2014 and 2016.
“It’s not as toxic as opiates per se,” insists Dennis McKenna, Ph.D., an ethnobotanist at the University of Minnesota. “There isn’t an imminent danger of public harm.”
McKenna, who did his postdoctoral research in the Laboratory of Clinical Pharmacology of the National Institute of Mental Health as well as in the Department of Neurology at Stanford University’s medical school, believes the kratom ban is a mistake.
“It takes an option off the table for people who want to get off opiates, and now that’s not available to them,” he tells me. “Ultimately it will have a bad effect.”
Gregory A. Smith, M.D., a pain management specialist based in Southern California and executive producer of the documentary American Addict, agrees. Smith has a handful of patients who have used kratom. He says they all have had a good response to it.
“There are people who are able to stop using opioids by taking it,” Smith explains. “It helps with addiction. I’m not going to say it’s the perfect solution, but I think there are a lot of good things about kratom and that it should be studied more. The worst thing they can do is fast track and ban it. I think it’s ridiculous.”
What about the deaths from kratom?
The DEA claims people are dying from kratom use. But kratom proponents point out that the DEA’s numbers speak for themselves. Fewer than eight people a year, in a country with a population of 318 million, have allegedly died from using kratom. (Compare that to the 250,000 people who die annually from medical errors or the 2,200 who die annually from alcohol.)
The full Notice of Intent issued by the DEA, filed with the Office of the Federal Register, further cites several kratom deaths in Sweden in a one-year period: “Deaths related to kratom exposure have been reported in the scientific literature beginning in 2009-2010, with a cluster of nine deaths in Sweden from use of the kratom product ‘Krypton,’” the document reads.
But even a cursory look at the scientific literature shows that the DEA assertion is missing a sentence. Postmortem reports revealed that these users tested positive for a mixture of mitragynine and a metabolite of tramadol, a prescription opioid. So the deaths that the DEA blames on kratom are actually the result of an adulterated nutritional supplement, not kratom alone.
Annual confirmed deaths from kratom use alone: 0
Annual deaths from kratom in combination with other substances: <8
Lethal drug overdoses in 2014: 47,055
Deaths related to prescription pain relievers in 2014: 18,893
It is true, however, that kratom can be dangerous, and even lethal, if mixed with other drugs. According to a January 2016 review of the pharmacology and toxicity of kratom, published in the International Journal of Legal Medicine, “Literature indicates that kratom is sometimes fatally mixed with carisoprodol, modafinil, propylhexedrine, Datura stramonium, fentanyl, diphenhydramine, caffeine, morphine, and/or O-desmethyltramadol (‘Krypton’).”
“The deaths associated with kratom are from poly-substance abuse,” says Kelly Devine, 44, who is the founder of Kratom United, a Facebook community that encourages grassroots activism to educate people about the benefits of kratom. Devine has been using the plant for almost two years. “It’s simply wrong to blame them on kratom.”
“It has literally saved her life.”
Devine tells me that she has herniated disks in her spine and bilateral sciatica after her car was hit by a drunk driver on the Washington, D.C. Beltway years ago. The pain has been so bad at times that she’s been unable to walk. “I can’t explain how chronic pain can literally drive a person mad,” Devine says, recalling a time when her legs buckled and she “dropped like a washcloth,” hitting the floor so hard she had to have surgery on her legs and use a wheelchair.
It was out of desperation—after trying to commit suicide to escape the pain—that Devine first tried kratom. She bought some from a store outside of Frankfort, Kentucky, mixed it with strawberry yogurt, and shot it down. It tasted terrible.
She expected to feel a high or a buzz, she says, but it never came. Instead, not even ten minutes after she ate it, she realized she wasn’t in as much pain. “It didn’t feel like something kicked in, the pain was just gone,” Devine explains. “I’m usually at a 7. I tried this, and I was at a 2.”
Martha McClain, Devine’s 70-year-old mother, tells me that she, too, has taken kratom a few times to help with back pain. It did help, she says, but the real benefit has been to her daughter.
“She was a walking zombie two years ago; she could not function,” McClain admits. “She would sleep for three or four days at a time. She was in constant pain. She couldn’t get off the sofa. She started taking kratom, and, without even trying to, she quit taking 12 [of 13] of her prescription medications. Now she’s clear-eyed, she’s functional—she takes care of me, the house, and the dogs. The thought of losing kratom terrifies me. It has literally saved her life.”
Nature’s solution to opioid addiction?
Susan Ash, who worked as a park ranger for the National Park Service and served as conservation director of Oregon Wild for two years, also says that kratom gave her back her life. Ash’s health problems started with a flu-like syndrome. She developed excruciating pain in her knees, hips, and elbows; she found herself sleeping for four or five days at a time, stumbling out of bed only to eat a bowl of cereal and use the bathroom, and then going back to sleep.
None of the doctors she consulted could tell her what was wrong.
Ash was diagnosed with fibromyalgia, a catchall medical condition categorized by chronic pain and fatigue believed to have no cure. Her doctor prescribed powerful and highly addictive opioid medication for the pain. When the prescription narcotics made her sleepy and unable to focus, the doctor gave her another prescription, Adderall—a combination of amphetamine and dextroamphetamine that is used for attention disorders. When the Adderall exacerbated the panic attacks she had had since she was a kid, the doctor added yet another drug to counter the anxiety.
“At one point in my life, I was on 13 medications,” Ash tells me. Her story of hundreds of visits to the doctor and piles of prescriptions sounds eerily similar to Devine’s: “A huge cocktail of medications that included three highly controlled and addictive substances.”
It was not until three years after the onset of symptoms that a test revealed that Ash had late-stage Lyme disease, most likely caused by a tick bite during her time in the woods. But by then, like more than 2.1 million other Americans, Ash was addicted to opioids.
In 2012, after her sister and brother-in-law sat her down and told her they felt it was no longer safe for her to be around their children, Ash entered a 45-day rehab. When she left, doctors prescribed her yet another narcotic [this time Subutex (buprenorphine)] to treat the opioid addiction, as well as to manage the ongoing pain. The doctor told her she would probably be on it for the rest of her life.
Ash was desperate to try something else. She had been treated with antibiotics, via a chest port, for the Lyme disease and was still battling chronic pain, fatigue, and chronic nausea—the effects of long-term antibiotic use. She had learned about kratom a few years before from a participant in an online Lyme disease support group. She had tried it a few times when her prescription medication ran out. Now she decided to quit the Subutex and use only the plant medicine. It worked. These days Ash takes red vein kratom for pain (one to three teaspoons a day, depending on her pain levels) and green vein kratom for fatigue (also about one to three teaspoons a day). In 2014 Ash founded a nonprofit, the American Kratom Association, to educate the public about the health benefits of kratom.
“When I was on the narcotics I was counting the minutes before I could take my next dose,” Ash says when I ask her if she finds kratom addictive. “This is completely different. It is nature’s solution to opioid addiction.”
“The DEA decision was not made to benefit patients.”
Jason Lee Erickson, 38, a part-time construction worker, actor, and model in Tampa, Florida, has also found kratom to be a gentler alternative to prescription drugs. Once Erickson started taking kratom, he was able to stop taking the oxycodone—an opioid pain medication—that his doctor had prescribed for muscle spasms.
“It’s been about a year now, and I haven’t touched another pill,” says Erickson, who served in the Airborne Corps of the United States military for four years and still has lasting pain in his legs from jumping out of airplanes. “It eliminated the pain, and I was able to work a normal day on it. It was crazy how well it worked.” He estimates he takes one to two teaspoons a day and says his wife also takes it to help with anxiety.
Dennis McKenna, the ethnobotanist from the University of Minnesota, thinks it is appropriate for the government to regulate the use of kratom to ensure that it is used safely. But, McKenna says, an outright ban makes little sense, and will have the inadvertent consequence of driving people back to using much more dangerous and addictive pharmaceutical drugs.
“It takes an option off the table for people who want to get off opiates and that’s unfortunate,” McKenna says. “The DEA decision was not made to benefit patients. People will die because of this ban.”
The petition to ask the White House not to classify kratom as a Schedule 1 substance can be found here.
Jennifer Margulis, Ph.D., is an award-winning science journalist and investigative reporter whose work has been published in the New York Times and the Washington Post, and featured on the cover of Smithsonian magazine. A Fulbright grantee, she has a bachelor’s degree from Cornell University, a master’s degree from the University of California at Berkeley, and a doctorate from Emory University. She is the author of Your Baby, Your Way: Taking Charge of Your Pregnancy, Childbirth, and Parenting Decisions for a Happier, Healthier Family (Scribner, 2015) and coauthor, with pediatrician and addiction specialist Dr. Paul Thomas, M.D., of The Vaccine-Friendly Plan: Dr. Paul’s Safe and Effective Approach to Immunity and Health—from Pregnancy Through Your Child’s Teen Years (Ballantine, 2016). Learn more at www.JenniferMargulis.net. Follow her on Facebook, Twitter, and Pinterest.