UPDATE- 3/11/2015: After a successful petition by Change.org and the Botanical Legal Defense, the Broward County commission in Florida has voted to postpone a proposed ban on kratom until further research into the plant’s properties has been conducted.
In the past, kratom has been compared in the media to bath salts and synthetic marijuana. The ban on kratom was originally proposed by Commissioner Kristin Jacobs, who claimed that kratom also mimics the effects of illegal drugs. However, other council members disagreed, including fellow commissioner Stacy Ritter, who suggested kratom is being unfairly targeted by pharmaceutical companies that want to make kratom illegal because it competes with prescription drugs.
After completing the public hearing, the commission ruled there is no evidence that kratom poses a risk to human health or safety. They voted to postpone any decisions about a ban pending the completion of a study by the University of Mississippi that will examine kratom’s actions in the body, addiction potential, and any health risks.
ORIGINAL STORY: A recent Sun Sentinel article marked a potential turning point in the hysteria that has recently engulfed West Palm Beach, Boynton Beach, and nearby Florida towns regarding kratom. A herbal supplement that has risen in popularity, kratom is now offered at Florida kava bars, convenience stores, and gas stations [7]. The suicide of a 20-year-old Boynton Beach man, Ian Mautner, is promising to become a flashpoint for the issue of kratom’s safety and regulation after several news reports highlighted the fact that he was a kratom user, a factor his mother has argued led him to take his own life [7]. However, the most recent developments in the story indicate that Palm Beach County officials are backing away from an outright ban on kratom and may instead implement educational initiatives to teach consumers about kratom, its effects, and its potential risks [7]. The initiative would include warning labels on packages of kratom, partnerships with schools, and distributing information at community events and through social media.
Background
Kratom is one name for Mitragyna speciosa, a tree in the coffee family that is native to Thailand and parts of Malaysia and Indonesia. Used medicinally and socially in these regions, kratom is also called ithang, kakuam, and thom. The medicinal uses of kratom throughout history have included to relieve pain, ease anxiety and depression, provide energy and relief from fatigue, to treat diarrhea and IBS (irritable bowel syndrome), and to lessen opium withdrawal symptoms [8]. Kratom contains 28 identified alkaloids, including mitragynine and 7-hydroxymitragynine, which bind to the brain’s mu-opioid receptors; this may explain why kratom has been used to assist in withdrawal from opiates such as opium, which bind to the brain’s delta-opioid receptors [9]. While kratom can be mildly habituating, research studies as well as legions of fervent kratom supporters have suggested this potential is nowhere near that of prescription opiates, and may be gentler than the habituation associated with caffeine [3, 7].
Current controversy
Kratom is legal to sell in Florida and most of the United States, and some Florida kava bars have begun offering kratom on their menus. (However, despite some confusion on the part of West Palm Beach Post, kava is a totally different plant (Piper methysticum), and has much different uses in its native South Pacific: while kratom is usually mildly stimulating, not unlike coffee, kava has calming and muscle relaxing properties). Kratom has been freely available as a tincture, powder, or in capsule form in Florida stores for a number of years, and had not raised flags among authorities until the death this July of 20-year-old Ian Mautner of Boynton Beach, Florida.
Ian Mautner jumped to his death from the southwest 23rd street overpass onto Interstate 95 in Boynton Beach. An autopsy showed mitragynine (one compound in kratom) but also metabolites from several antidepressants in his system [5]. His mother has argued that Ian became addicted to kratom and the habit drove him to commit suicide, in an echo of the controversy surrounding the 2006 suicide of Brett Chidester, a Delaware teen whose parents stated his use of Salvia divinorum was a contributing factor in his death [2]. I would never want to belittle the tragedy of a parent losing their child, but I also see a sizable risk that Ian Mautner’s suicide could be used as the center for a campaign to unfairly ban kratom before taking the time to examine its likelihood as a factor in this young man’s death. Back in 2009, researchers such as Daniel Siebert came to the defense of Salvia divinorum to say that it has never been implicated in suidical ideation [10], but not before 33 states banned the herb [6]. Let’s look at the facts before we rush to do the same with kratom.
The facts are that kratom has not been clinically proven to be addictive, unlike most prescription opiates that many people are regularly prescribed by their own physicians. Furthermore, there is not the slightest evidence linking kratom to suidical ideation (thoughts of suicide). However, there is a well-known association between the use of antidepressants—which Ian Mautner had also been taking at the time of his death—and increased risk of suicidal thoughts or actions. In fact, the FDA requires manufacturers of antidepressants to include a warning box on their products because of just this risk [1]. Rather than rush to blame the exotic and unknown in a tragedy—such as kratom in this case, or Salvia divinorum in 2006—often it makes sense to remember the familiar can often be much more dangerous. No one blinks an eye at the use of alcohol and tobacco in the U.S., even though these drugs cause far more deaths per year than any traditional herb has in its entire history of use.
The Kratom Community Speaks Out
However, kratom still has a lot of support in the U.S. and around the world, from people who frequently testify that this unassuming Southeast Asian leaf has helped them manage chronic pain, anxiety, and kick addictions to strong prescription opiates they’d sometimes been dependent on for years [7]. Kratom supporters have argued that kratom is an effective and safe analgesic and anxiolytic, offers relief from diarrhea and IBS (irritable bowel syndrome), and provides many of the stimulating effects of caffeine for a longer duration and without the “caffeine crash”. Peter Isaacs, an employee at a local Florida kava bar, protests kratom’s comparison in the media to heroin and cocaine, stating that it is a herbal tonic similar to coffee in strength and effects [7].
After his 2012 article in Forbes comparing kratom to bath salts and other synthetic drugs drew wide criticism [3], David di Salvo published an in-depth “field report”-style article on his month-long self experiment with kratom. Di Salvo’s goal was to see how daily use of a kratom supplement affected him, especially to see if he experienced any habituation or withdrawal from kratom[4]. Since advocates of a kratom ban often argue that kratom carries a high risk of addicition, this part of di Salvo’s experiment was especially important. Over a period of a few weeks, di Salvo took kratom from several brands sourced online at a daily dose of about 3 grams.
He writes of feeling two tiers of effects: at the first tier, he experienced a stimulation similar to that of coffee, but lasting 4-5 hours; he reported feeling alert, but never so stimulated that he couldn’t concentrate. At the second tier came a pleasant relaxation that never increased enough to be considered sedation and did not cause drowsiness [4]. I would add that this contrasts with many prescription anti-anxiety medications, which are known to cause drowsiness. And as for the withdrawal symptoms he steeled himself for after stopping his kratom use at the end of the experiment? “I can tell you without hyperbole that getting off coffee is a far worse experience than getting off kratom,” di Salvo wrote. Other than a bit of morning tiredness for a day or so afterward, he experienced no noticeable withdrawal symptoms after ceasing kratom—and this in contrast to the grogginess, irritability, and crushing headaches di Salvo attests he experiences after ceasing to use coffee [4].
These whole dried kratom leaves are made into a stimulating tea not unlike coffee, but purportedly with smoother, longer-lasting effects.
From Calls for a Ban to Education
Fortunately, it seems as if the groundswell of support for kratom in Florida and nationwide may be turning the tide against this latest outbreak of hysteria. Officials in Palm Beach County who were earlier considering a kratom ban have shifted their focus to a program of educating residents in the area about kratom so they can make educated choices [7]. Jeff Kradel, Executive Director of the Palm Beach County Substance Awareness Coalition, made the point earlier this year that the kratom products being sold in convenience stores, gas stations and kava bars are of different potencies and purities and that many companies do not place adequate labeling on their products. “You really don’t know what you are going to get,” said Kradel [7]. Angie Francalancia, a representative of the Purple Lotus Kava Bar, also supported the education proposal as a chance to spread real information about kratom, which she maintains is no more addictive than a cup of coffee (and possibly less, as discusssed above). “For many people it offers an alternative kind of experience [to] alcohol,” said Francalancia, referring to kratom’s relaxing effects at higher doses [7].
Before passing the measure, officials heard testimony from Linda Mautner, mother of the 20-year-old Ian Mautner whose death in July became a rallying point for opponents of kratom. Supporters and distributors of kratom also spoke in defense of kratom, with some arguing kratom has made a positive difference in the lives of those recovering from opiate addiction. Some also suggested kratom could have a future role in recovery clinics treating opiate withdrawal and addiction [7]. The new education initiative, for which the commission set aside $25,000, would partner with schools and share information at community events and via social media aimed at teaching people about kratom, its active ingredients, how it works, and what the potential health risks are. Palm Beach County officials passed a related measure requiring warning labels to be placed on kratom products for sale in stores and in kava bars that offer kratom. The measure would also discourage businesses from selling kratom to persons under 21 years of age. It remains to be seen what the exact wording on these kratom warning labels will be, but so far this initiative offers hope that we have learned from the hysteria. I remain optimistic that we are moving in the direction of education and useful regulation of kratom, rather than toward a ban that would deny so many people a herbal medicine that has made a net positive difference in their lives.
REFERENCES
1. “Antidepressant Use in Children, Adolescents, and Adults”. Food and Drug Administration: Drug Safety and Availability. Last modified August 12th, 2010. http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm096273.htm.
2. “Brett’s Law.” Wikipedia. Last modified February 20th, 2014. http://en.wikipedia.org/wiki/Brett%27s_law.
3. Di Salvo, David. “Is Kratom the new “bath salts” or just an organic pain reliever with euphoric effects?” Forbes Magazine Online. Accessed December 10th, 2014. http://www.forbes.com/sites/daviddisalvo/2012/09/22/is-kratom-the-new-bath-salts-or-just-an-organic-pain-reliever-with-euphoric-effects/.
4. Ibid. “The Results of My Kratom Experiment”. The Daily Brain. Accessed December 5th, 2014. http://www.daviddisalvo.org/the-daily-brain/2013/4/5/results-of-my-kratom-experiment.html.
5. LaGrone, Katie. “Kratom craze: what lab tests reveal about the controversial plant.” West Palm Beach TV. Last modified December 4th, 2014. http://www.wptv.com/news/local-news/investigations/kratom-craze-what-lab-tests-reveal-about-the-controversial-plant.
6. “Legal Status of Salvia divinorum”. Wikipedia. Last modified October 15th, 2014. http://en.wikipedia.org/wiki/Legal_status_of_Salvia_divinorum.
7. Parker, Terri. “Palm Beach County Commission Votes to Put Kratom Warning Labels in Stores, Kava Bars”. West Palm Beach Post.com. Accessed December 3rd, 2014.
8. Ratsch, Christian. 1998. The Encyclopedia of Psychoactive Plants: Ethnopharmacology and Its Applications. Rochester, NY: Park Street Press.
9. Said, I.M., N. Chee Chung, and P. J. Houghton. 1991. “Ursolic Acid from Mitragyna speciosa.” Planta Medica 57: 398.
10. Sullum, Jacob. December 2009. “The Salvia Ban Wagon”. Reason.com. http://reason.com/archives/2009/11/19/the-salvia-ban-wagon/singlepage.
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