DEA Banning All Sales of Kratom

By Pat Anson, Editor

The U.S. Drug Enforcement Administration has announced plans to ban all sales of kratom, a popular herbal supplement increasingly being used as an alternative to opioids for relieving chronic pain.

The DEA filed notice in the federal register that it plans to classify two opioid-like chemicals in kratom as Schedule I drugs under the Controlled Substances Act – the same classification given to heroin, LSD and marijuana. Kratom is currently considered a food supplement, not a drug, but the move would effectively prohibit all sales of kratom, which comes from the leaves of a tree grown in southeast Asia.

The founder of the American Kratom Association told Pain News Network that her organization may go to court to block the DEA from carrying out its plan.

"This honestly was a complete and total shock for those of us involved in this issue," said Susan Ash. "We're weighing all of our options right now and one option of course is to seek a temporary restraining order."

The two main active ingredients in kratom, mitragynine and 7-hydroxymitragynine, act on the same receptors in the brain as opioids do, but are not currently approved as drugs.

The DEA said it needed to classify them temporarily as controlled substances “to avoid an imminent hazard to public safety.”

“Available information indicates that these opioid substances, constituents of the plant kratom, have a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision,” the DEA said.

“Consequently, kratom, which contains the main active constituents mitragynine and 7-hydroxymitragynine, is an increasingly popular drug of abuse and readily available on the recreational drug market in the United States. Attempted importations of kratom are routinely misdeclared and falsely labeled. This is similar to other attempts to import controlled substances or substances intended to mimic controlled substances.”

Although the DEA refers to mitragynine and 7-hydroxymitragynine as "opioids," they are actually alkaline compounds that are believed to act on natural opioid receptors in the brain.

"They're not opioids. An opioid is a synthetic version of the poppy plant, so that's just completely wrong," said Ash. "They are novel substances that I really don't think you can define, quite honestly. There's nothing else like them in medicine or nature."

Although illegal in a handful of states, kratom is widely available online and in health stores, where it is sold as dried or crushed leaves, powder, capsules, tablets, liquids and gum. Users tout kratom's pain relieving benefits, and say it also reduces stress, depression and cravings for other drugs.  Recent policies that discourage the prescribing of opioid pain medication have increased interest in kratom as an alternative treatment.

Ash is a recovering opioid addict who uses kratom as a deterrent.

"I have no cravings for narcotics. No part of me ever desires to put narcotics back into my body because of kratom. There is no need because it works so well and it eliminates cravings," said Ash, who used the addiction treatment drug Suboxone for about a year while in recovery.

"I went off of Suboxone using kratom. There is no way I would ever put myself back on Suboxone. But where do I go for help with pain now?" she asked.

Ash first had an inkling that the federal government was preparing to take broader action against kratom when the Centers for Disease Control and Prevention issued a report last month claiming that kratom was "an emerging public health threat." The CDC cited kratom-related calls to U.S. poison control centers, which jumped from 26 calls in 2010 to 263 in 2015.

"I'm sorry, but I don't consider 263 calls to poison control an emerging public health threat. I don't think anyone does," said Ash. 

Few Kratom Studies

Although kratom has been used medically for hundreds of years, few studies have been done on its safety or to see how it actually works.

“Mitragyna speciose (kratom) has a psychostimulant effect like coca and a depressive effect like opium and cannabis, which seem to be contradictory. It is also reported that it is weaker than morphine, has a milder withdrawal syndrome compared to opioids, and is less harmful than cocaine,” is how one study explained it.

The Food and Drug Administration has been trying unsuccessfully to stop the importation and sale of kratom.  Last year the FDA issued an import alert that allows the agency to seize kratom supplements without even physically examining them.

Earlier this month, FDA agents seized more than 100 cases of products labeled as kratom in Grover Beach, California. The products are distributed by Nature Therapeutics Inc. under the name Kratom Therapy.  The FDA said the company was illegally selling kratom products as drugs to treat various medical conditions.

“The FDA will continue to take aggressive enforcement action to safeguard the public from harmful drug products illegally marketed as treatments for which they have not been studied or approved,” said Melinda Plaisier, the FDA’s associate commissioner for regulatory affairs.

The DEA says the ban on kratom chemicals would take effect at the end of September. Earlier this month, the agency also said it would not change the classification of marijuana as a Schedule I controlled substance.

Chronic Pain Patients Discovering Alternative to Opioids

By Pat Anson, Editor

It comes with clever names like KChill, Liquid K, Green Sumatra and Green Joy.

An advocacy organization calls it “a natural botanical that’s improving health and wellness from coast to coast.”

The Food and Drug Administration calls it a “narcotic” that can cause aggression, hallucinations, delusions, and tremors.

What are they talking about and why such radically different views?

Kratom is an herbal medicine made from the leaves of the Mitragyna speciose tree that grows in southeast Asia. People in that part of the world have used kratom for centuries as a natural remedy to boost energy, relieve stress and treat addiction. In the United States, kratom is increasingly being used as a pain reliever – a “safer” option than opioid pain medication.

“For people with chronic pain who want complementary therapy or want to avoid the organ damage mainstream medications can cause, it's a great option,” said Suze Blood, a 43-year old Maine woman who suffers from rheumatoid arthritis, degenerative disc disease and fibromyalgia.

On the advice of a friend, Blood started using kratom three years ago as an alternative to opioid pain medication, which not only didn’t help her pain, but made her tired and depressed.

“My friend brought me some powdered kratom to try, and he mentioned how beneficial it had been for him and his brother in managing alcohol dependence. I also learned it helps with opioid withdrawals. A smaller amount will offer more energetic response, and larger (doses) more sedative qualities and lasts for hours,” said Blood.

Traditionally, kratom leaves were simply ground up to make tea or sometimes even smoked, but the leaves are now being used commercially to make a wide variety of tinctures, ointments, capsules and energy drinks.  Like marijuana, different strains of kratom do different things, and the internet is awash with testimonials about their benefits.

Red vein kratom helps people relax and has “an excellent ability to reduce pain,” according to the Kratom Trading Company, while white vein Kratom is used as a stimulant “to promote alertness, mental vigilance and wakefulness,” according to Kratom Online.  

Kratom is not classified as a controlled substance by the Drug Enforcement Administration, but is considered a dietary supplement regulated by the FDA. Supplements in the U.S. are held to far less regulatory standards than medications, but that hasn’t stopped a handful of states from making kratom illegal or the federal government from trying to get it off the market.

In January, FDA agents in Illinois confiscated nearly 90,000 bottles of a dietary supplement made with kratom called RelaKzpro, using a provision in the law that allows the agency to detain a supplement if it believes the product is adulterated or misbranded.  

Even though kratom has been used for hundreds of years, the FDA considers it a "new dietary supplement” for which there is inadequate information about its safety.

The FDA even issued an import alert last year that allows the agency to seize kratom supplements without even physically examining them.

These heavy-handed tactics haven’t stopped kratom products from becoming widely available online without a prescription. They are also sold in some health and convenience stores – where they are often discreetly kept hidden behind the counter.

Few studies have been done on the efficacy or safety of kratom. The leaves contain mitragynine and 7-hydroxymitragynine, alkaline compounds that are believed to reduce pain by activating natural opioid receptors in the brain. Researchers have trouble explaining exactly how kratom works without comparing it to other drugs, most of them illegal.

“Mitragyna speciose has a psychostimulant effect like coca and a depressive effect like opium and cannabis, which seem to be contradictory. It is also reported that it is weaker than morphine, has a milder withdrawal syndrome compared to opioids, and is less harmful than cocaine,” is how one study explained it.

An increasing number of pain patients – unable to get opioids or tired of their side-effects – are trying kratom.

“I used to need 1-3 Percocet a day, and now i take ZERO and feel better and have a clear mind,” is how one of our readers put it.

Others have learned kratom is not only useful for pain relief, but reduces their cravings for drugs and alcohol.

“People are so scared of the opioid epidemic right now, which I completely understand, I’m a recovering opioid addict myself,” says Susan Ash, who was diagnosed with late-stage Lyme disease in 2010. She took opioid pain medication for several years, wound up going to rehab, and now takes kratom capsules for pain relief.

“It does activate these opiate receptors, so it is very effective on pain,” says Ash, who founded the American Kratom Association. “The beauty of this plant is that it’s not something someone like me, who struggles with opioid addiction, craves. It’s not something that I take when I don’t need it. It’s not something that ever in my life made me feel impaired. And I’ve been taking this for several years.”

Ash says most members of her association use kratom for pain, depression or anxiety.

“Our numbers increased a lot when hydrocodone scheduling went into place. We got a lot of older women who sought us out, whose doctors cut them off,” said Ash, referring to the DEA’s rescheduling of hydrocodone in October 2014, which made the painkiller harder to obtain. She says the CDC’s new opioid prescribing guidelines are having a similar effect.

“As those restrictions are put in place and more doctors are scared and unwilling to prescribe opioids, the more people we get. There’s definitely a direct correlation,” Ash told Pain News Network.

Kratom is illegal in Vermont, Indiana, Tennessee, Arkansas and Wisconsin. Several other states are weighing similar legislation, including New York.

If past experience is any indicator, outlawing kratom is a whole lot easier than actually controlling it.

Thailand criminalized kratom in 1943 when its popularity interfered with the opium trade, which was then a major source of revenue for the Thai government. Over 70 years later, kratom use is still rampant in much of the country.