Kratom use poses significant dangers

This past January, The New York Times published an article about a drug called kratom, which is used as both an opiate substitute and for opiate withdrawal (some substance abuse treatment programs in Florida use it). One Florida company that sells it is named Kavasutra; the owner of it previously sold synthetic marijuana (also known as K2, Space, or Spice) and continued to do so even after it was federally banned in 2012. He eventually served 10 months in jail for doing so.

The drug is also sold in other states in a variety of forms. A bar called Krave sells it in a non-alcoholic drink called Ketum to customers in North Carolina. VivaZen is a drink sold in Alabama gas stations and head shops—its maker claims that “it’s a plant” and that “VivaZen is non-habit forming.” Treatment providers and companies that sell it for recreation employ various marketing terms such as “safe, plant, natural” and “legal high.”

I first heard about kratom in September 2013. A new student had moved into the Rutgers Recovery House just before the start of school, and multiple residents called me throughout the Labor Day weekend to tell me that they thought he was high on opiates. I had him report to the Rutgers Counseling Center and we sent him to get drug tested. He passed. A few days later, multiple students called me again to tell me that the young man in question seemed high. I had him tested again. He passed.

Another male resident who had been clean from heroin for about 18 months pulled me aside and said he suspected the young man was using kratom. He told me that it was made from Thai leaves and it had effects that were similar to those from opiates. The lab that Rutgers used did not test for kratom, nor did any other lab in New Jersey that I contacted. A few months later, the young man tested positive for opiates, and before we sent him away to treatment, he admitted that he had been using kratom interchangeably with heroin for a few months.

Origins, properties

Kratom is made from leaves from the mitragyna speciose tree in Southeast Asia. It has been used by the natives of Southeast Asia for hundreds of years, but the first written description of it hails from Dutch botanist Pieter Korthals in 1839. It is a relative of the coffee tree, and it works as a stimulant in small doses and a sedative in larger ones.

The leaves from the tree contain more than 40 different chemical compounds. The one that scientists believe causes the euphoric effects is named mitragynine. Tests have confirmed that mitragynine content is strongest in trees that naturally grow in Southeast Asia, rather than ones that have been grown in greenhouses around the world.

Kratom users report euphoric sensations similar to those from opiates, without the same level of intensity. When they use it during opiate withdrawal, some users state that it lessens craving and pain. For those who use it just to get high or as an opiate substitute, the reported immediate side effects include insomnia, nausea, sweating, runny nose, constipation and a loss of appetite. Common kratom withdrawal effects are muscle aches, diarrhea, mood swings, delusions and hallucinations.

Kratom has been used in Thailand for centuries as both a recreational drug and as medicine. Natives near the border of Malaysia used it to treat coughs, diarrhea and muscle aches (heroin was similarly marketed in the United States in the late 1890s and early 1900s). The Kratom Act of 1943 made it illegal in Thailand. Use diminished but continued.

Kratom has seen a resurgence in Thailand in the 21st century, as it has become part of a popular drug cocktail called Yaba, which is used by young people and bandits. Yaba has four ingredients: kratom leaves, cola, cough syrup and boiling water. At an addiction conference that I keynoted in Southern Thailand last December, kratom and Yaba were among the main concerns brought up by doctors, therapists, nurses, military members, clergy, and the politicians who were in attendance.

Legal status

In addition to Thailand, kratom is currently banned in Malaysia, Myanmar, Finland, Poland, Lithuania and Australia. It is illegal in Indiana, Tennessee, Vermont and Wyoming. There are legislative proposals to ban it in Florida, New Jersey and a few other states.

One group that is fighting the banning of kratom is the American Kratom Association, a supposed consumer group that claims the substance is a better alternative to methadone and is also a “natural painkiller.” Another kratom advocate is the Botanical Legal Defense (BLD), which fights regulation of dietary supplements. The BLD claims that it defeated a kratom ban in Arizona.

The Food and Drug Administration (FDA) banned the import of kratom in 2014, but has not decided yet on a full-scale ban. Some Internet sites have claimed that there are FDA-approved clinical trials involving kratom, but I could not find evidence of that. Without a federal ban, the use of kratom will increase.

Frank L. Greenagel, Jr., MSW, LCSW, LCADAC, is an Adjunct Professor at the Rutgers University School of Social Work. He is also an instructor at the Rutgers Center of Alcohol Studies and a member of the Hazelden New York board of directors. He writes a blog at greeangel.com, and rejoined the Army in 2014 as a Behavioral Science Officer.