Kratom: Miracle Plant or Dangerous Opioid?
In 2017, The U.S. Department of Health and Human Services declared the opioid crisis a public health emergency — and for good reason. Statistics show that an estimated 130 people die from an opioid overdose daily¹.
As a result, certain states have implemented laws that restrict the number of opioids prescribed to patients as well what kind of patients can obtain these drugs. States like California, Texas, and Washington require doctors to fill out substance abuse disorder assessments before prescribing opioids. These questionnaires are intended to evaluate the risk of a patient abusing their medication by asking questions about past alcohol and illegal drug use. Patients deemed “high-risk” would stand a much lower chance of getting prescription opioids.
The DEA has also been at the forefront of the opioid crisis — pushing doctors to prescribe fewer of these drugs.
In the war against opioids, chronic pain patients have become unintended victims. The medication they once relied on to manage their pain has now become much more difficult to obtain. In fact, many chronic pain patients can’t even discuss the possibility of opioid pain control with their doctors for fear of being labeled a “drug addict”.
So, what do they do when they can’t get adequate pain relief from their doctors?
They turn to alternative treatments — like Kratom.
With no FDA regulation, there is plenty of controversy surrounding Kratom. While some users think it’s a miracle plant, others believe it’s just another dangerous opioid.
What is Kratom?
Indigenous to Southeast Asia, the Phillippines, and Papua New Guinea, Mitragyna speciosa, or Kratom, is actually a tree belonging to the same family as the coffee bean. For hundreds of years, inhabitants of Southeast Asia have taken the fresh or dried leaves from the Kratom tree and consumed them — usually by making them into tea or chewing them up. This was particularly popular among laborers because ingesting the leaves helped improve their productivity and fend off fatigue.
In Thailand and Malaya, it was used as a cure for morphine dependence, and as a substitute for opium.
As most things do, kratom eventually made its way to the Western world — becoming especially popular in the US. It’s estimated that three to five million people in the US currently use kratom.
If you stop by your local head shop, you’ll probably find kratom being sold in some capacity — although most experienced kratom users prefer to buy it from cheaper online vendors.
Even though it’s technically a tree, the medicinal value of kratom lies in its leaves, and that’s usually what people are talking about when they reference kratom. Most of the time, users purchase ground-up kratom leaves and consume them in powder form.
There are a variety of reasons people why gravitate towards kratom — many of which extend beyond pain relief. In smaller doses (1–3 grams of powder), kratom can provide users with a stimulant effect, giving them the energy to go about their day.
In larger doses (4–8 grams), kratom can produce sedation and pain relief — similar to an opioid.
The effects can also depend on what strain of Kratom that is being used. The three most popular strains — green vein, red vein, and white vein — are each known for their own unique effects: the green and white veins are typically more energizing, while the red vein tends to induce sedation.
Those who use kratom for pain relief might buy a red vein strain, while those looking to increase their energy might buy a green or white strain.
Along with pain relief, kratom is also utilized to combat opiate withdrawal. People looking to kick their addiction often turn to kratom as the next “step-down”. Users on the internet boast success stories about how kratom helped them manage everything from heroin to alcohol withdrawals. For those who are addicted to opioids but also deal with chronic pain, kratom has become a popular choice because it addresses both issues.
Truthfully, the reasons that people use kratom are widespread: anything from the treatment of diarrhea to anxiety.
One of the drawbacks of the herbal remedy is that users must figure out their own treatment plan. They’ve got to figure out where to buy it (head shop or online vendor?), determine what strain to purchase, and then work out what dosage works best for them. The process typically involves a lot of trial and error.
Besides a scarce amount of medical studies, much of the information about the plant (and how it interacts with people) come from kratom users who post about their experiences online. The subreddit, r/kratom, has over fifty-thousand subscribers who regularly post news articles, questions and personal stories.
Why do people think kratom is dangerous? A glance at the FDA Smear Campaign
If you’ve heard anything about kratom in the past couple of years, it was probably related to how it almost got a nationwide ban in 2016.
In recent years, the FDA has firmly maintained the position that kratom is a dangerous opioid with highly addictive properties. In 2016, they pushed the DEA to classify two of the primary psychoactive components in kratom, mitragynine and 7-hydroxymitragynine as Schedule I drugs. This would not only make kratom illegal but place it on the same level as heroin and LSD.
A large public outcry from millions of kratom users forced the DEA to reconsider this plan, and instead, they decided that there wasn’t enough medical evidence to substantiate the FDA’s claims.
Unfortunately for the kratom community, the FDA hasn’t stopped their attack. FDA Commissioner, Scott Gottlieb, released a statement in 2018, detailing the dangers of kratom:
Further, as the scientific data and adverse event reports have clearly revealed, compounds in kratom make it so it isn’t just a plant — it’s an opioid. And it’s an opioid that’s associated with novel risks because of the variability in how it’s being formulated, sold and used recreationally and by those who are seeking to self-medicate for pain or who use kratom to treat opioid withdrawal symptoms. — Scott Gottlieb, M.D., Press Release, 2018
Scott Gottlieb’s concerns do actually hold some weight here. There isn’t any regulation of kratom, and buying from head shops or online vendors does present users with a certain amount of risk. They can’t be sure that the kratom they’re purchasing hasn’t been laced with another substance, nor can they tell how concentrated of a dose they’re getting. All they can hope for is that the vendor they’re buying from is reputable and careful.
That being said, not all of Scott Gottlieb’s claims add up. In the same press release, Gottlieb mentions that there is a record of 44 kratom-related deaths:
Now, I’d like to share more information about the tragic reports we have received of additional deaths involving the use of kratom. Looking at the information we have received — including academic research, poison control data, medical examiner reports, social science research and adverse event reports — we now have 44 reported deaths associated with the use of kratom. — Scott Gottlieb, Press Release, 2018
A closer look at these 44 deaths by the Huffington Post showed that 43 out of 44 of these deaths weren’t really caused by kratom. The deceased just happened to have kratom in their system at the time.
In the 44 people the FDA mentions, they included a teenager who hung himself, a fatal gunshot wound, and plenty of drug overdoses where kratom was only one of many drugs ingested at the time of death. (There is one incident out of 44 where kratom was the only substance in the body, but besides that, no information is known.)
Despite their adamant position against kratom, the FDA’s actual medical evidence doesn’t measure up. They’re not educating people about kratom — they’re spreading misinformation.
Why do people think kratom is a miracle plant? A look at the success stories
In another portion of the press release, Scott Gottlieb goes as far to say:
We have been especially concerned about the use of kratom to treat opioid withdrawal symptoms, as there is no reliable evidence to support the use of kratom as a treatment for opioid use disorder and significant safety issues exist. — Scott Gottlieb, Press Release, 2018
Although Gottlieb would probably argue that anecdotal evidence isn’t “reliable”, I don’t think the experiences of millions of people should be discounted.
On howtoquitheroin.com, anonymous users have the opportunity to share their kratom testimonials:
”I’ve utilized kratom to for my chronic pain for a couple years now. I have R.A. and bulging discs in my back, yet am able to function well day-to-day without a single rx pain med. Side effects are minimal, and I’m able to take less, or none at all, on my low pain days- with zero withdrawal symptoms. (Like caffeine, some people do have some wd, and some don’t.) Let that sink in. Real, effective relief from chronic pain, with minimal side effects and dependence. AND it helps people stop using pain pills, heroin, and more. Kratom saves lives.” — SB (female)
“kratom is a literal miracle plant, I never touched another painkiller again after drinking the tea once, never went back. I took it for several years as a replacement for painkillers for back, helped immensely, took me a week of tapering down to quit completely and not think about it when I stopped, take it only when I have pain now, basically a cup of the tea (not powder) in the morning and that’s it. I have had it help people get off of every drug you can imagine, including alcohol.” — YS (female)
“Kratom has changed my life. Since discovering this plant I have been able to wake up and go about my day as normal. My anxiety was terrible but kratom puts me at ease.” — BN (male)
Even if the FDA refuses to admit it, kratom is helping people. It is changing lives. It is giving people pain relief. It is helping them manage opiate withdrawals. It might not be a “miracle plant” in all cases, but in a time when the dangers of opioid addiction are surfacing, kratom might be an alternative treatment to methadone or buprenorphine.
However, there are some concerns about kratom’s own nature as an opioid. Columbia University chemist, Andrew Kruegel, sets the record straight:
“They [FDA] don’t have to do this to claim that kratom is an opioid, because it is…but the question is whether it’s an atypical opioid, which is my preferred terminology. Does it have a better side-effect profile than the classical opioid drugs like morphine that we use every day? That’s the key question here.” — Kruegel, Huffington Post
The term “opioid” has become a trigger word for a lot of people lately, but we’ve got to remember that opioids do serve a purpose. If kratom can serve that purpose more effectively — with fewer side effects than morphine or oxycodone — shouldn’t we utilize it?
There is no easy answer
To answer the question posed, kratom is neither a deadly opioid nor a miracle plant. It, like any medication, has its drawbacks. It shouldn’t be treated like it’s completely harmless — because it’s not.
As an opioid, it does have addictive qualities. People who choose to use it should do so with caution. It is also, during this time, unregulated and scarcely studied. Not all sources that supply kratom can be trusted, and the long-term effects of this plant on body systems are still relatively unknown.
That being said, the millions of individuals who use kratom are proof that this plant has the capacity to help people. What we can hope for, in the future, is that legitimate medical studies — not FDA smear campaigns — will give us a clearer picture of how kratom fits into the world of modern medicine.
¹From the NCHS, National Vital Statistics System. Estimates for 2017 and 2018 are based on provisional data.