A sober look at kratom, a psychoactive plant that has many claimed benefits, and has also inspired a moral panic

Kratom (previously) is a plant that grows wild in Malaysia, Thailand, Indonesia, Myanmar, and Papua New Guinea, and is a relative of the coffee plant. For centuries, people have chewed or drunk teas brewed from its leaves for a mildly euphoric effect, and recently, the plant has come to the US, prompting many stories of incredible benefits in fighting opioid addiction and treating chronic pain, as well as some non-credible claims about curing cancer or producing morphine-like highs, as well as a moral panic that has led the FDA to (unsuccessfully) class it as a Schedule A narcotic, with no medical benefits.

The research on kratom is disappointingly thin, so it's hard to say empirically what's going on with people who ingest it. The plant is legal in most of the USA, and can be readily obtained at low costs over the internet, though many of the firms that sell the plant adulterate it with a range of substances, some of them dangerous in and of themselves. Kratom has been implicated in a smattering of overdose deaths, but it's not clear what the causal relationship is in these (as a remedy for addiction, it's possible that opioid overdosers had ingested kratom in a bid to help wean themselves off of their addictions).

As Emma Grey Ellis notes in her excellent Wired story, kratom is remarkable because it is a drug that sparked a moral panic that fizzled out. Unlike other drug-related panics that saw the possible therapeutic uses of drugs ignored in rush to prohibit them, the effort to ban kratom at the FDA died in the face of evidence about possible benefits from the substance, proffered by people who pointed out the lack of evidence for the supposed dangers of kratom use (this is reminiscent of the attempt by California authorities to ban salvia divinorum, a powerful psychedelic that was ably defended by the MAPS project, whose scientists made a compelling case for salvia's therapeutic uses, including helping people safely stop taking opioids).

Kratom's detractors are one problem, but its boosters are another. Hucksters sell kratom with a variety of unsubstantiated and dangerous claims, notably that it can cure cancer. Between this and the adulterants they add to their supply, taking kratom can be a crapshoot in which users have to take it on faith that they're getting a product that's safe and in a known dose.

Ellis hangs her Wired story off the personal journey of Faith Day, a recovered addict who credits kratom with helping her kick her habit. Day, having observed that Portland, OR, leads the nation in searches for "kratom," moved there and opened a boutique kratom dispensary, and began to advocate for regulation of kratom to make it a safe and reliable product. This has attracted much harassment and even death-threats from some kratom sellers and users.

So the DEA and FDA’s worries aren’t unwarranted. “They are rightly concerned about any substance that they have very little control over that patients and consumers are using to self-treat medical conditions,” the University of Florida's Grundmann says. “When you talk about withdrawal, depression, anxiety—that usually belongs in the hands of a medical professional.” Few seem to think that calls for a ban, though. “If we completely cut off any legal way for those consumers to get kratom, then we don’t have any oversight left.”

Instead, it might be more helpful to consider what kratom’s widespread use says about where our culture around drugs and medicine is now. “Many kratom users I’ve talked to don’t feel comfortable interacting with doctors, which is to their detriment,” the University of Rochester's Swogger says. “But we can’t pretend like the medicines we’re providing are getting to everyone. They’re not.” While not everyone who takes a kratom supplement has a story as dramatic as Day’s—from homeless substance abuser to business owner and mother—it’s clearly filling a need for millions of people. The need to regulate, but not ban, kratom use is already being acknowledged on the state level: The Kratom Consumer Protection Act has been passed in Arizona, Georgia, and Utah, and is pending in Oregon.

“If it was as dangerous as the media says, I don’t think that would be happening. Nobody’s passing a heroin consumer protection bill,” Day adds. “It’s just weird.” You probably know how Portland feels about weird. The place plans on keeping it.

Release the Kratom: Inside America's Hottest New Drug Culture [Emma Grey Ellis/Wired]

(Image: Clean Kratom Portland)