Kratom: Medicinal or Criminal

The U.S. Drug Enforcement Agency (DEA) moved earlier this year to list the herbal supplement kratom as a Schedule 1 drug under the Controlled Substances Act. This would place kratom alongside Heroin, LSD, Morphine, and Ice as substances that have a high potential for abuse and a risk to public health.

The ban, proposed to come into effect in October 2016 would make it illegal to purchase or possess kratom and would suddenly place the estimated 3-5 million regular users in the U.S. on the wrong side of the law.

Overwhelming disapproval to the proposed ban from the public and lawmakers saw the DEA suspend the listing and call for public comment on the pros and cons of kratom. Submissions closed on December 1 with over 100,000 comments received, mostly calling for more scientific research into the benefits of the herb.

Kratom is not an opioid, but instead belongs to the coffee family and produces a similar mild stimulating effect. The active molecules in kratom however, mitragynine and 7-hydroxymitragynine (7-HMG) bind to the same neuronal receptors as opioids like heroin, codeine, oxycodone, and morphine which leads the DEA to have concerns over the potential of addiction.

Millions of people use kratom for pain relief, anxiety, PTSD, depression, addiction to prescription painkillers, opioid addiction, period pain and even fibromyalgia. There are calls for kratom to be listed as a natural supplement under the Food, Drug and Cosmetic Act, joining other herbs such as St. Johns Wort and Valerian.

Kratom can be purchased at herbal supplement stores or sourced online. The leaves can be chewed but are quite bitter. Dried leaves can be boiled to make a sort of tea. The dried leaves are also powdered and added to tea or other liquids such as orange juice. The powder is often placed into capsules and taken this way.

The FDA started working with other US agencies to seize shipments of imported kratom in 2014, as the product was being marketed as a dietary supplement but had never been shown to be part of the US diet nor to be Generally Recognized as Safe.

As of May 2016, Alabama, Arkansas, Indiana, Tennessee, Vermont, and Wisconsin had made kratom illegal, and the US Army had forbidden soldiers from using it.

Description

Mitragyna speciosa Korth. (commonly known as kratom, also ketum), is a tropical evergreen tree in the coffee family (Rubiaceae) native to Southeast Asia in the Indochina and Malaysia phytochoria (botanical regions). M. speciosa is indigenous to Thailand, Indonesia, Malaysia, Myanmar, and Papua New Guinea.

In cultures where the plant grows, it has been used in traditional medicine. The leaves are chewed to relieve musculoskeletal pain, increase energy, appetite, and sexual desire in ways similar to that of coca.

The leaves or extracts from them are used to heal wounds and as a local anesthetic. Extracts and leaves have been used to treat coughs, diarrhea, and intestinal infections. Kratom is often used by workers in laborious or monotonous professions to stave off exhaustion as well as a mood enhancer and/or painkiller.

In 1836, kratom was reported to be used as an opium substitute in Malaysia. Kratom was also used as an opium substitute in Thailand in the nineteenth century.

Across Southeast Asia and especially in Thailand, in the 2010s a tea-based cocktail known as 4×100 became popular among some younger people. It is a mix of kratom leaves, cough syrup, Coca-Cola, and ice. As of 2012, use of the cocktail was a severe problem among youth in three provinces along the border with Malaysia.

Adverse Effects

Minor side effects may include nausea, vomiting, and constipation. More severe side effects may include seizure, addiction, and psychosis. Other side effects include high heart rate and blood pressure, liver toxicity, and trouble sleeping. When use is stopped withdrawal may occur.

When mixed with other substances, kratom use has resulted in death. In the United States, there were fifteen kratom-related deaths between 2014 and 2016, although in none was kratom the sole factor.

Regulation

As of 2015 there was a growing international concern about a possible threat to public health from kratom use. In some jurisdictions its sale and importation have been restricted, and a number of public health authorities have raised alerts. Sometimes the finished product is mixed into cocktails with other opioids.

United States

The FDA started working with other US agencies to seize shipments of imported kratom in 2014, as the product was being marketed as a dietary supplement but had never been shown to be part of the US diet nor to be Generally Recognized as Safe.

On 30 August 2016, the Drug Enforcement Administration (DEA) announced its intention to place the active materials in the kratom plant into Schedule I of the Controlled Substances Act. This drew strong protests among those using kratom to deal with chronic pain or wean themselves off opioids or alcohol.

A group of 51 members of the US House of Representatives and a group of 9 senators each sent letters to Acting DEA Administrator Chuck Rosenberg protesting the listing and around 140,000 people signed an online White House Petition protesting it.

In October 2016, the DEA withdrew its notice of intent while inviting public comments over a review period ending 1 December 2016.

As of May 2016, Alabama, Arkansas, Indiana, Tennessee, Vermont, and Wisconsin had made kratom illegal, and the US Army had forbidden soldiers from using it.

United Nations (UN)

As of January 2015 neither the plant nor its alkaloids were listed in any of the Schedules of the United Nations Drug Conventions.

Europe

In Europe as of 2011 the plant was controlled in Denmark, Latvia, Lithuania, Poland, Romania and Sweden.

ASEAN

As of 2013, kratom was listed by ASEAN in its annex of products that cannot be included in traditional medicines and health supplements that are traded across ASEAN nations.

Australia and New Zealand

As of January 2015 kratom was controlled as a narcotic in Australia and under the Medicines Amendment Regulations of New Zealand.

Thailand

Possession of kratom leaves is illegal in Thailand. In 1943, the government passed the Kratom Act 2486, which made planting the tree illegal. This was in response to a rise in its use when opium became very expensive. In 1979, kratom along with marijuana were placed in Category V of a five category classification of narcotics. Kratom accounted for less than 2% of arrests for narcotics between 1987 and 1992. The government considered legalizing kratom in 2004, 2009, and 2013.

Malaysia

The use of kratom leaves, known locally as ‘ketum’, is prohibited in Malaysia under Section 30 (3) Poisons Act 1952 and the user may be fined with a maximum amount of MYR 10,000 (USD 3,150) or up to 4 years imprisonment. Certain parties have urged the government to penalize the use of kratom under the Dangerous Drugs Act instead of the Poisons Act, which carry heavier penalties.

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