Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Kratom: harmless herbal supplement or dangerous drug?

Dennis Wichern
Meds
August 17, 2018
Share
Tweet
Share

What is it?

Kratom is a powdered herbal supplement derived from the leaves of a tropical evergreen tree that is native to Southeast Asia and is usually taken orally but can also be brewed into teas.

It is commonly used by consumers as an alternative medicine to self-treat opioid addiction and chronic pain.  The leaves contain two compounds, mitragynine and 7-a-hydroxymitragyine, which interact with various receptors in the brain.

At low doses the drug acts similar to a stimulant; however, at higher doses more like an opioid.   

What’s the FDA’s view?

There are no FDA-approved uses for kratom and the agency has received concerning reports about the safety of kratom.

On February 6, 2018, FDA Commissioner Scott Gottlieb M.D. released a statement citing the agency’s scientific analysis and review of the 25 most prevalent compounds in kratom.  “From this analysis, the agency concluded that all of the compounds share the most structural similarities with controlled opioid analgesics, such as morphine derivatives.”

In the same statement, Dr. Gottlieb stated that the FDA had linked 44 deaths associated with kratom use and that there was “no reliable evidence to support the use of kratom as a treatment for opioid use disorder” and “Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids. There is no evidence to indicate that kratom is safe or effective for any medical use.”

And in May of this year the FDA issued warning letters to several kratom distributors for illegally selling kratom containing products with unproven claims about their ability to treat opioid addiction and withdrawal, pain, blood pressure, and cancer.

What About the CDC?

On February 20, 2018, the CDC issued a nationwide public warning advising consumers to avoid kratom due to a multi-state outbreak of Salmonella linked to the herbal supplement.  The outbreak ultimately affected 199 people in 41 states.

And in 2016, the CDCreported that between January 2010 and December 2015, U.S. poison centers received 660 calls related to kratom exposure.

How about the DEA?

On August 31, 2016, the DEA published a “notice of intent” in the Federal Register  “to temporarily schedule the opioids mitragynine and 7-hydroxymitragynine, which are the main active constituents of the plant Kratom, into schedule I pursuant to the temporary scheduling provisions of the Controlled Substances Act based on a finding by the DEA that the placement of these opioids into schedule I of the Controlled Substances Act is necessary to avoid an imminent hazard to the public safety.”

In support of their position, the DEA cited an increasing number of poison centers calls related to kratom, significant and increasing law enforcement seizures of the drug and numerous direct and indirect deaths relating to the substance.

Both the FDA and NIDA had no objection to DEA’s proposed action.

However, two months later DEA withdrew its “notice of intent” action against kratom after 51 U.S. Representatives asked DEA to delay its action to “provide ample time for public comment” while referring to the plant substance as an “internationally recognized herbal supplement.”  Eleven U.S. Senators wrote DEA a few days later and also asked for a delay “given the long reported history of kratom use, coupled with the public sentiments that it is a safe alternative to prescription opioids.”

ADVERTISEMENT

Is it legal?

Kratom is legal under federal law but illegal in the states of Alabama, Arkansas, Indiana, Vermont, Wisconsin and the District of Columbia.

It is also illegal in Thailand, Australia, Malaysia, and several European countries.

Standard dosage unit?

There are currently no established standards for safely producing kratom, no standard dosage unit or composition, and limited, if any clinical research along with hundreds of unknown foreign and Internet providers of the drug.

While the FDA continues to release red flag warnings about the drug, those that are self-medicating with kratom are risking their health and possibly their lives.

Dennis Wichern is a retired DEA agent.

Image credit: Shutterstock.com

Prev

Physicians must reclaim the medical record

August 16, 2018 Kevin 12
…
Next

Medical schools should improve long-term career counseling

August 17, 2018 Kevin 3
…

Tagged as: Emergency Medicine, Medications

Post navigation

< Previous Post
Physicians must reclaim the medical record
Next Post >
Medical schools should improve long-term career counseling

ADVERTISEMENT

More by Dennis Wichern

  • CBD: What is it? A former DEA agent explains.

    Dennis Wichern
  • Telemedicine should be easy. Here’s why it’s not.

    Dennis Wichern
  • How to avoid negative press and fines during the opioid crisis

    Dennis Wichern

Related Posts

  • How hospitals can impact generic drug companies

    Mark Kelley, MD
  • A drug problem in rural Georgia

    Ashish Advani, PharmD
  • Drug ads are a campaign against physician trust

    Judy Salz, MD
  • Crippling drug costs: the role of insurers

    Janice Boughton, MD
  • The complications of drug regulation

    Julie Craig, MD
  • Should drug use be decriminalized?

    Katya Korol and Sarah Fraser, MD

More in Meds

  • FDA delays could end vital treatment for rare disease patients

    G. van Londen, MD
  • Pharmacists are key to expanding Medicaid access to digital therapeutics

    Amanda Matter
  • How medicine repurposing enables value-based pain management and insomnia therapy

    Olumuyiwa Bamgbade, MD
  • Forced voicemail and diagnosis codes are endangering patient access to medications

    Arthur Lazarus, MD, MBA
  • From stigma to science: Rethinking the U.S. drug scheduling system

    Artin Asadipooya
  • How drugmakers manipulate your health from diagnosis to prescription

    Martha Rosenberg
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI is already replacing doctors—just not how you think

      Bhargav Raman, MD, MBA | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI is already replacing doctors—just not how you think

      Bhargav Raman, MD, MBA | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Kratom: harmless herbal supplement or dangerous drug?
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...