Kratom, a tropical tree native to Southeast Asia whose leaves contain psychoactive (mind-altering) opioid compounds, has seen an increase in popularity within the U.S. over the last several years. A variety of products derived from its leaves have become readily available to consumers, including specialty teas, tablets, capsules, gum, and smokable items.
Kratom is a consumer product that can be purchased in specialty cafes, gas stations and online. There are no FDA-approved kratom products, but despite this, kratom is seeing growing use for the self-medication of pain, opioid withdrawal, anxiety, and depression, often being marketed for these purposes despite the fact that no scientific evidence shows kratom to be safe or effective for treating these concerns. Notably, kratom does not show up on many standard drug screening tests, further incentivizing its popularity among recreational and self-medicating users alike.
An analysis of the National Poison Data System by the Centers for Disease Control and Prevention found that, between 2010 and 2015, calls related to kratom increased ten-fold, with 7.4% of those calls related to life-threatening cases. In 2014, the FDA banned the import of kratom, following measures taken by Thailand and Malaysia (countries where kratom natively grows) who banned kratom in the face of nationwide epidemics. A handful of states across the U.S. are now banning kratom altogether.
At best, there is no scientific consensus on kratom, and academics have agreed that more research into kratom is necessary. At worst, the National Institute for Drug Abuse declared kratom an emerging drug of abuse, noting that kratom interacts with opioid receptors in the brain producing sedation, pleasure, and decreased pain, especially when a large amount of the plant is consumed.
In fact, the FDA conducted a Public Health Assessment on kratom, employing 3-D models to study kratom’s chemical makeup, finding that a majority of the compounds within kratom closely resemble those found within opioid analgesics. Findings such as these have led the FDA to closely monitor kratom products, which they fear could follow the path the opioid epidemic took, as members of the general public may believe kratom to be safe because it is a plant and a naturally growing substance.
Currently there is little regulation for kratom. The DEA announced its intention to schedule kratom as a Schedule I controlled substance in mid-2016, but withdrew its plan due to pressures from the public and from Congress.
In addition to concerns over adverse effects, kratom may also be responsible for a wave of salmonella infections. According to the FDA, as of April, eight manufacturers of kratom products have had to recall dozens of kratom products due to positive salmonella test results across 37 different products, which have been linked to 132 salmonella infections across 38 states, hospitalizing 38 individuals.
Health effects of kratom include nausea, itching, sweating, dry mouth, constipation and increased urination. Adverse effects of kratom include muscle aches, insomnia, irritability, hostility, aggression, emotional changes, psychosis, respiratory depression, and addiction.
