Kratom Users Panic as DEA Races to Make the Plant a Schedule 1 Drug

By Dorri Olds 09/19/16

If kratom becomes unavailable, users are scared they will have to return to prescription opioids or heroin to relieve their pain.

Kratom leaves
Has the DEA done its due research?

Hundreds of kratom users rushed the White House lawn in protest of what seems a grossly premature decision. October 1st is the looming date for the DEA to slap a Schedule I label onto the plant supplement. That will place it alongside controlled substances like heroin, LSD, peyote and ecstasy. Shouldn’t the DEA wait until it's done more research to understand whether this plant poses any serious threat?

Kratom (Mitragyna speciosa) comes from the leaves of a Southeast Asian tree that’s closely related to the coffee plant. It has been recognized as an analgesic and a remedy for opium withdrawal since the late 1800s. Unlike most substances, kratom acts as both an upper and a downer, depending on the dose. The stimulant effect occurs when taken in smaller amounts.

The American Kratom Association (AKA) and Botanical Education Alliance (BEA) stated in a press release that the purpose of the White House rally on September 13 was to call out the DEA for making a mockery of the opioid epidemic by pushing to ban this substance prematurely. They accused the DEA of using kratom as a scapegoat to divert pressure on the DEA for its inability to solve the current opiate crisis.

Fans of the plant supplement use it to treat pain and depression, and to kick opiates. As of now, some states have already banned kratom (Alabama, Arkansas, Indiana, Tennessee, Vermont, Wisconsin), while others are in the process of legislating against it (New York, North Carolina). If the DEA goes through with its emergency scheduling, the separate rulings for each state will become moot. The AKA, BEA and a multitude of users are angry enough to fight hard to keep it legal.

Those that rely on the medicinal qualities of the tropical tree blame the DEA for basing the ban on uninformed hysteria instead of empirical evidence. 

Susan Ash, founder and director of AKA, told me, “This is a very tragic situation. The AKA is fielding thousands of calls, Facebook messages, and emails from people all over the country who are afraid of going back to pharmaceutical drugs because they had unbearable negative side effects, or illicit drugs which will lead to even more deaths during this opiate epidemic.”

She said, “I am completely swamped. I have thousands of people afraid of relapse. People are explicitly telling us they are terrified of losing their quality of life or even their lives. We’re also fielding messages from people who have never been addicted to anything. They chose kratom as a safer, natural alternative to prescription drugs. These people feel they will no longer be able to be the productive members of society that kratom has enabled them to be.”

According to the press release, “[K]ratom has never been present alone in a single documented death and is about as habit-forming as the coffee to which it is related. By contrast, pharmaceutical drugs are one of the leading causes of death in this country, killing one American every 19 minutes. Prescription opiate pain killers account for more than 475,000 emergency room visits annually.”

Oliver Grundmann, PhD, a clinical associate professor at the University of Florida, agreed to speak with me. I asked, “Why are the DEA and FDA in such a hurry to categorize a seemingly harmless herbal painkiller as Schedule I?”

Grundmann said, “Over the past five years, according to CDC publications, the number of kratom hospital admissions has risen significantly—tenfold from 26 in 2010 to 263 in 2015.”

I queried Grundmann about the AKA and BEA assertion that kratom is not responsible for these hospitalizations. Their theory is that every one of those hospitalized had an adverse reaction due to a mixture of drugs in their system.

"I cannot speak to that. I do know that the DEA is relying on data the CDC published recently. The data from poison control center that indicates that there were increased reports of kratom use and kratom hospital admissions over the past five years, that those have gone up significantly with, I think, it was 660 calls or 660 cases related to kratom use over the past five years. That’s what the DEA is using as one of the main justifications for labeling kratom Schedule I.

“I have called for a sensible regulation of kratom products to ensure that people get kratom that is uncontaminated and does not contain other drugs, like opioids. People who use kratom to treat pain should be under a physician’s care as they withdraw from opioids.”

He also said, “Another sensible regulation would be to put kratom products behind the counter, requiring buyers to be counseled by a pharmacist before buying them. Putting it straight into Schedule I, however, will hinder any further research into kratom.”

Grundmann explained that the DEA has very little room for categorizing emerging potential health threats from substances. If the FDA doesn’t see a medical application for a drug, then the only Schedule that the DEA can recommend is Schedule I. 

“The DEA follows what the FDA is indicating,” Grundmann said. “There is currently no medically approved value or indication for the use of kratom.”

So I asked, “Is the reason that kratom research will be halted once it’s labeled Schedule I because the FDA will fear it is too dangerous to conduct any further tests on humans?”

He answered, “Yes, exactly. The case reports that are scientifically published are very few and rudimentary, and most involved a combination of drugs. It wasn’t kratom itself that caused toxicity or led to a fatality. But the DEA is taking an unusual approach in that they’re not seeking public opinion or from the scientific community before scheduling it.”

It was beginning to seem clear why the coffee family plant users were so upset. Their view is that Mitragyna speciosa needs to be researched thoroughly before deciding it’s harmful. With the government now calling it dangerous, the ban will extinguish further exploration.

Is the AKA and BEA correct in accusing the government of knee-jerk reactions to pressure about the opioid epidemic? I asked Grundmann, “Does the DEA believe that by taking a harsh stance on kratom, Americans will feel safer?”

“The DEA wants to ensure public safety, but putting kratom in Schedule I may cause a similar problem that happened with marijuana. It might push users into an illegal, or gray area, and then it becomes a law enforcement issue. There are components in kratom which act on opioid receptors. The DEA says it may lead to toxic effects and that’s why it should be categorized as Schedule I unless there is a proven medical indication for it.”

The AKA facts page says it is not an opiate. Grundmann said that while it does seem to act on opioid receptors, that doesn’t mean it should be lumped into the opiate category without further studies. The leaves contain alkaloids that interact with opiate receptors similarly to endorphins or opium. Caffeine users get a lift that is similar to amphetamine, their heart palpitates and some may get headaches, yet we don’t say "That’s it! The coffee plant must be speed, so we’ll ban it."

To be sure that Grundmann was not biased, I asked if he is a kratom user. His response? “I don’t have any personal interest in kratom. I have never used it but I have read the literature, I have published on this topic with graduate students together who are working with law enforcement who have seen kratom in their district’s crime maps. I worked on conducting an anonymous survey among kratom users to evaluate the profile of the average kratom user, who is mainly a middle-aged person, often a woman, who suffers from chronic pain. It’s a very different user profile for kratom than for many other drugs.”

Grundmann said, “I only have anecdotal information because that’s what the survey was intended to do—to get a more detailed picture of who’s taking kratom and for what reasons. I can only hypothesize that people who are taking kratom are taking it not to abuse it, but in order to seek relief from pain that may not be adequately controlled with other currently available medications. That survey has not yet been conducted. I am about to submit it to the institution review boards to get approval for it, so that survey is likely to start in October or November.”

If the DEA goes forward with the Schedule I categorization, kratom users will have to look for an alternative. I questioned Grundmann if he felt that the logical conclusion would be that kratom users will then turn to Vicodin, OxyContin, Percocet, hydrocodone and heroin?

It’s not surprising that Grundmann, the director of graduate programs in pharmaceutical and medical chemistry and clinical toxicology, did not hypothesize on what may happen. His answer instead, was based on what he knows already. “I recommend that kratom users don’t quit cold turkey when the ban becomes effective. Now is the time to talk with their physicians and find alternatives. There are less addictive opioids, such as Tramadol, that are not as potent as hydrocodone and the others you mentioned, so that may be a feasible alternative. Although it might not resolve all of the issues or it might not be as effective in treating all symptoms, due to kratom’s unique pharmacological effects, there may still be a helpful alternative.”

And what are kratom’s unique effects? According to Grundmann, “In animal studies or case reports, we see a stimulatory effect at low concentrations, which might account for some of kratom’s mood-elevating effects. People suffering from depression or anxiety disorders might benefit from low doses. At higher doses of kratom, we see the pain-relieving effect.”

According to PR Newswire on Wednesday, the White House was presented with a 120,000-signature petition to stop the DEA’s rush to ban the “coffee-like herb.” We’ll keep you updated on the developments.

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Dorri Olds is an award-winning writer whose work has appeared in many publications including The New York Times, Marie Claire, Woman’s Day and several book anthologies. Find Dorri on Twitter, Facebook, and LinkedIn.