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When money is scarce, Margo Burton and her husband will go without cigarettes. Sometimes her husband has to go weeks without using his cell phone.

But the loss she feels most acutely is when she runs out of an herbal supplement called kratom. She takes two teaspoons of it every three hours to control the debilitating pain caused by endometriosis.

“I need it so I’m not hurting, so I can be a good mother,” said Burton, a 31-year-old stay-at-home mom of a toddler in southeastern Missouri.

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So when she read this week’s news that the Drug Enforcement Administration will outlaw kratom for two years — putting it into the same legal category as heroin and LSD — she started sobbing. She could hardly talk as she woke her husband up to be consoled.

From the DEA’s perspective, kratom is a dangerous, life-threatening drug that is creating a “public health crisis.” But to daily kratom users like Burton, the drug is a lifeline. “A whole lot of people are going to go into a deep depression and commit suicide, or start back on dangerous drugs that cause them to OD,” Burton said.

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It’s easy to dismiss kratom users as herbal remedy enthusiasts, intent on using psychoactive plants however they like. But the DEA’s decision has revealed, instead, a hidden nationwide network of advocates, educators, and devotees who talk about discovering kratom the way some Christians talk of being born again.

Many use it to try to wean themselves off opioids. Others use it to manage the pain of autoimmune disorders or car accidents. Veterans use it to tamp down their post-traumatic disorder. Users recognize that an unregulated substance comes with certain risks, so they have banded together on the internet to vet kratom vendors and mentor new converts.

Now the community is ramping up to battle the DEA. At the center of that fight is Susan Ash, the founder and director of the American Kratom Association.

The Queen of Kratom

In 2008, Ash got so sick she couldn’t care for herself. It blindsided her. She had been working as a conservationist in Oregon, hiking through majestic tracts of forest as part of her work day, but she had to give it up and move back in with her parents in Norfolk, Va.

“The pain was excruciating,” she said. “It was in my joints, it would wake me up in the middle of the night, it would have me in the emergency room.”

Doctors thought it was fibromyalgia, and began to prescribe her heavy-duty opioids. But in 2010, she tested positive for Lyme disease. That was only part of her trouble, though: she soon found she was addicted to opioids, counting the hours until her next dose.

She had heard about kratom in a Lyme support group. She was suspicious at first, and didn’t want to have anything to do with the woman who made the suggestion. “I was frightened, really frightened,” she recalled. “I avoided her for a few weeks.”

But then Ash began to do some research.

She learned that kratom is the name of a tree with wide glossy leaves and yellow flowers, grown in the jungles of Southeast Asia. She learned also that it had been used for centuries by those who were experiencing opiate withdrawal.

Eventually, she called the woman back. “She had to walk me through this whole process, how to take it, who to buy from,” she said.

Much of the kratom consumed in the United States is grown in Indonesia and Malaysia, where the leaves are dried and ground into a powder. That, in turn, is compressed into 5-kilogram bricks and shipped to American vendors. Kratom is sold in smoke shops and sometimes even gas stations, but Ash and most kratom users buy it online.

It was kratom, Ash said, that allowed her to escape the opioid epidemic. She ended up in rehab in 2011, and was weaned off her pain pills with Suboxone, a medication that itself contains opioids and can be addictive. So, after eight months, against her doctor’s orders, she weaned herself off Suboxone with kratom.

“This is the plant that returned me to being a productive member of society again,” she said.

Many states, however, didn’t see it that way.

In 2013, Tennessee outlawed the selling and possession of kratom, and more states were headed in the same direction.

So, in 2014, Ash started the American Kratom Association to try to keep the substance legal. With kratom keeping her pain at bay, she said, she began flying from state to state, meeting with legislators and speaking at hearings. Over the course of three months this year, she visited six states to try to beat back proposed kratom bans.

The irony is that she agrees with some of the reasoning behind the crackdown.

Do-it-yourself regulators

Kratom worries physicians partially because opioid addicts are using it instead of seeking medical help.

But they also worry about it because what they think is kratom might not actually be kratom.

“Here’s the problem in the United States,” explained Dr. Edward Boyer, an emergency physician and toxicologist at Boston Children’s Hospital, who has done research on the substance. “If I walk up and buy a bag of kratom, I don’t know what’s in that. Is it kratom? Is it some plant matter to which an opioid has been added? There’s evidence that some unscrupulous businessmen have taken plants and sprayed hydrocodone on them.”

That’s because of the Dietary Supplement Health and Education Act of 1994, which prevents the Food and Drug Administration from regulating dietary supplements unless they are sold with packaging that claims they have medicinal benefits.

As more and more states have looked into banning kratom, the FDA has also been cracking down, outlawing its import and ordering the seizure of any batches that do make drug claims.

But, as FDA spokesperson Lyndsay Meyer told STAT in July, “We have very little power over supplements.”

And that’s something that Ash — suspicious as she is about government regulation — worries about.

“There is a problem with some rogue industry people out there putting things into kratom that may or may not be natural. You don’t want people to be nervous that it’s a huge widespread problem and never take kratom,” she said.

So some kratom users have formed a kind of do-it-yourself FDA, approving or denying certain kratom vendors, trying to make sure that the stuff they are putting into their bodies every day is safe.

The inspectors have little or no training in toxicology, chemistry, or medicine. They don’t have home laboratories. But what they do have is experience taking kratom. They are the administrators of one of the most popular online kratom communities, a closed Facebook group called Kratom (New and Current Users.)

“You have to be vetted by the admins of the group in order to advertise,” said Kathy Timinskis, a 66-year-old group administrator, who lives in Zimmerman, Minn.

To kratom sellers, the vetting process is worth it: the group has over 13,000 members.

“Once they start advertising in there, they’re going to get a lot of business,” said Margo Burton, the mother in Missouri, who is another administrator.

So the vendors agree to fill out the Facebook group’s application forms, send the administrators a copy of their business license, and send off samples to independent laboratories to be tested for contaminants such as salmonella and E. coli. The vendors then pass on those lab reports to the administrators of the group.

But they also need to send something else: samples of their products. Usually, vendors send 3 ounces of each of the three different strains.

“We’re kind of like the guinea pigs,” said Burton.

Kratom
Kratom capsules are sold in smoke shops and gas stations, or online. Joe Raedle/Getty Images

“If you’ve been taking it for as a long as I have, you know what it looks like and what it tastes like,” said Shannon Scatolini, a 40-year-old legal assistant from Corvallis, Mont., who has been taking kratom for over 12 years and who said she used it to wean herself off opioids.

Users describe the taste as earthy and bitter, and as Scatlonini said, it’s as fine as flour, so it’s easy to see if there is some kind of contaminant. Once, one of the inspectors found a shard of glass glittering in the green powder.

They did not warn their 13,000 followers about that producer, though.

“We just didn’t accept them,” said Scatolini, “and we didn’t allow them in our group.”

Scatolini and Burton say that none of them has ever gotten sick from the kratom they’ve tried, and they provided STAT with examples of reports from a Michigan laboratory showing that samples of kratom had been tested for bacteria, mold, and yeast.

For Burton, being one of the self-appointed watchdogs of the kratom community comes with an added bonus.

“I live check to check,” she said. “There were two times where I was about to run out, and then I got a vetted vendor sample and it held me over until we got a check and I could order more.”

On most mornings, if her daughter isn’t up yet, the first thing she does is go to the mason jar of kratom on her kitchen counter. She takes a drink of sweet iced tea from a cup that’s ready in the fridge, pours two teaspoons of the greenish powder into her mouth, and then washes it down with another gulp of tea.

It’s a method she calls “toss and wash.”

“Some people take capsules,” she said. “Some people parachute it: If you don’t have capsules, you wrap it up inside a tissue or a fruit roll up or a flattened candy in order to mask the taste.”

But those daily rituals will soon become a criminal offense.

Stocking up while it’s legal

“This is not a woulda coulda shouda,” said Russ Baer, a spokesperson for the DEA. “This is definitely going to happen as early as September 30, 2016, or shortly thereafter.”

The agency defended its action, saying it was aware of 15 kratom-related deaths worldwide between 2014 and 2016.

Kratom advocates, however, say these terrible effects are always caused in conjunction with other drugs — and they are hoping to hash that disagreement out in court.

“We’re in the process of hiring a federal lobbying firm, a PR firm, and an expert toxicologist [who] can challenge the DEA’s claims that there have been deaths tied to kratom,” said Ash. She is also looking for lawyers with experience fighting the DEA, as are some kratom vendors.

The ban on kratom will last two or three years, during which time the Department of Health and Human Services will determine whether kratom poses a threat to public health. If studies find that it does, kratom will remain illegal; if not, the ban will be lifted.

It has happened before: a drug called TFMPP, often thought of as a stand-in for ecstasy, was banned by the DEA in 2002, only to be legalized again two years later.

In the meantime, kratom users are scrambling to buy as much of the greenish powder as they can while it’s still legal.

“Everybody I know is stocking up right now, and the vendors are running out,” said Margo Burton.

Her mason jar has only a half-kilo of kratom left. That’s enough to last her a few weeks — and she dreads the day when she has to go back to taking opioids.

  • Yes, doctors and ERs have been notified. Perhaps Kratom will become a legal, regulated drug in the future- possibly the active ingredient will be made available through pharmaceutical companies. There is simply no way to regulate street drugs- no consistency in content, no consistency in species used, or purity. “Medical marijuana” is laughable- it is an unregulated street drug, and most doctors haven’t a clue about the species or hybrids available and THC/cannabidiol ratios content. With Kratom, there is even less info available.

    • Michael Whitworth M.D. want to know what’s laughable, it’s doctors like yourself who think that because you have that overrated piece of paper hanging on your wall that you are somehow smarter than everyone else and your opinion means more! First of all kratom is not a narcotic! Where did you read that kratom was a narcotic at a .gov.com website? Beyond laughable. You read a few articles or skewed medical journals and all of a sudden you think you are somehow an expert on the subject! That’s exactly the problem with you doctors!
      Most of you have book smarts to where you can regurgitate all the mumbo they taught you in med school but most M.D.’s don’t have much when it comes to common sense or what they call street smarts! What can you expect from a profession that has been indoctrinated by the quackery institution called The American Medical Association!
      You say the safety of this drug is speculative! Again, kratom is not a drug, what don’t you understand?
      Kratom, has been around for thousands of years and it is 100% safe! Go on youtube and check out the kratom forums!
      In the past week there are hundreds of people making video testimonies all saying the same things over & over!
      Kratom is 100% safe you blockhead M.D. I’ve been using kratom for over 3 years and it got me off of a 15 year methadone addiction! Kratom is in the coffee family, it’s safe, it’s natural, antioxidant and so many other things! It’s a miracle!
      Would you be happy if the government banned kratom & thousands of people died in the process! Would you be happy if the government spent billions of dollars on trial studies for nothing just to reassure you that it’s safe?
      Why should you even care? Your quackery of a profession has kept kratom secret all of these years and let thousand & thousands of people suffer & die from because of it’s suppression! Just like your quackery profession has suppressed & banned all of the other real treatments of natural cures for illnesses over the years! To be honest kratom users don’t give a damn what your opinion is on anything especially when you can’t even get the facts straight! As far as kratom becoming a drug, the people who use kratom use it because it isn’t a drug! Let’s Big Pharma get they hands on kratom and they will ruin it just like they ruin most everything else! And yes, kratom can be addictive but so can alcohol, tobacco, coffee & sex!
      This government was founded on freedom of choice and the freedom to choose whatever medicine I want to into my own body! Thomas Jefferson once said, If the people let the government decide what foods to eat or what medicines to take
      their bodies will soon be in a state as are the souls who live in a state of tyranny! The statistics of the health of Americans speak for themselves! Highest rates of cancer, heart disease, autism! The autism rate is thanks to the government mandate of vaccines in our children! I suppose you are a pro vaccine 100% even when the statistics say otherwise? There’s been over 3 billion dollars paid out from The Vaccine Compensation Fund since the mid 1980’s. The 3 billion dollars with a B. How in the Hell can vaccines be safe when so many people have died and been awarded billions! The vaccine makers have been putting all kinds of toxic chemicals in vaccines over the years including mercury! But ignorant doctors such as still refuse to admit the obvious and you still have no problem injecting little children with your poison! I know because I was poisoned by your quackery industry! You doctors are a disgrace to humanity and don’t have a backbone to stand on! You people work for an industry that doesn’t cure anything, you only treat! You people are barbarians without a conscience!
      The citizens of America are being held hostage on all fronts! There is a huge conspiracy against the health, freedom & the pursuit of happiness of the American citizens! The FDA, , the medical profession, the judicial system & law enforcement are all part of the conspiracy and they are criminals! One of these days there will be a backlash against this whole corrupt system and there will be hell to pay. People are going to look back in this era in horror!

      To put it bluntly, most M.D.’s are basically worthless and do more harm to their patients then they do good! Besides that most of you doctors are clueless, out of touch, insensitive & arrogant to boot! Most doctors wouldn’t know what’s best for their patients to save their own lives.

      Years ago I used to give prestige to your profession but there’s not much good I can say about your field at all… The past 10 years since I have been online I have learned the truth about your profession and it is not a pretty picture to say the least!

    • Kratom has been characterized in multiple experiments as a mu opioid receptor agonist, which makes it a narcotic. I don’t get my information from “forums” but from solid, proven sources, and the fact is that Kratom is absolutely not 100% safe as you contend. Simply because you may not have had any known side effects (yet) does not mean this drug is safe or effective for the US population. Your own experience is meaningless from the population standpoint, and that is why Kratom needs to be studied before the massive expansion of use occurs that is happening under the current Kratom drug dealer’s organization. It may be that Kratom or its alkaloids may have some benefit, but we also need to assure safety. Ephedra is a plant that was thought to be “safe” by those that used this stimulant until deaths began showing up in ERs. Kratom is no different- it is a street drug made from a herb just as was ephedra, that is now being banned, just as was ephedra. But Kratom may indeed have some benefits, including maintaining an addiction for drug addicts. Those taking Kratom have simply substituted one street drug for another. They are still addicted to drugs.

    • Most people understand that there is not enough funding of research for plant medicine or any non-mainstream treatment. Under our current medical-pharmaceutical system there will never be. However, I will continue using plant extracts as needed. I use oregano oil and berberine to stop recurrent SIBO, for instance. There is no reason for me to take that high priced antibiotic when these substances work equally well without the high cost and side effects. Remember, our original medicines came from nature. Have you ever considered how so many Civil War veterans lived after their injuries, including amputation when people in your field were proud of having hands that got crusty from their work? It killed women after childbirth, those filthy doctors back then, but on the battlefield they used silver compounds. If bandages were coated with silver today, there would be far less antibiotic resistant infection and all the manmade or should I say doctor made, troubles that follow what otherwise could have bern a successful treatment.

      Do you know that the FDA is trying to remove probiotics from the market so they can be patented and prescribed? As someone who lived through C. Diff-two consecutive rounds-post-abdominal surgery, I can say that S. Boulardii helped save my life. Having it available over the counter harms no one. It is just the greed of corporations that is driving this. These same corporations subsidized your medical school and you have yet to shake that off.

    • As to Earl’s comment, I have to agree. I would point out that you seem to be unable to tell those seeking relief from pain with those seeking to get high. That is quite a great shortcoming in an ER doctor. I know people who have worked in ERs for decades. You know very sick people come to the ER for help and addicts come for drugs. There is a huge difference between these people and their motivations. That is what you need to learn to address, although the policy at many hospitals seems to be to provide the addicts with small amounts of what they are after. Our society has done a terrible job in handling drug abuse in every way. That is not a reason to leave people disabled from pain. There are risks to every treatment, but the bottom line is the extent of the risk to be accepted is decided by the patient. Doctors must keep their moral compass. Kratom is obviously safer and a less abused substance than most. The actions of the population show that to be fact.

      Do we measure the amount of alkaloids in coffee? Do we require Starbucks to do so? We do put a proof on alcoholic beverages, but people drink the amount they want. Making a black market for Kratom makes a safe product dangerous. Now there will be monetary incentive to adulterate or counterfeit it.

    • My medical school was so long ago, I guarantee they received nothing from pharma. I was trained as a physician in pain medicine, not ER. There is simply no way for any physician to know if a person is suffering from chronic pain or psychiatric disturbance since there is a huge overlap. MRI and CTs and x-rays do not confirm chronic pain or that the person is a “legitimate” patient. Believing every patient that says they are in pain and need opioids for pain control is now a ticket to prison for doctors, so most will not go there any longer. Thousands of physicians have stopped prescribing opioids and many more will in the near future. Opioids are for many, the path to addiction/substance abuse/substance misuse/drug diversion..it is a continuum and patients fluctuate between one category and another over time. Kratom, as other botanicals, does deserve study. Many of the time honored herbal and supplement remedies have been shown to be ineffective when subjected to scientific examination and clinical trials, but we should examine all things going into our bodies, including prescription medications with the same scrutiny. I agree big pharma is potentially making a power play on several fronts, but also believe we should not prescribe, endorse, encourage the use, or sell herbals/botanicals unless there is at least level III studies available. Anecdotes are level V. Rat studies, cell studies, and petri dish observations are not considered at all in Evidence Based Medicine. For opioid addiction, most “rehab clinics”, 12 step programs, counseling, rapid detox, etc. do not work long term. The only long term successful method for opioid addiction is substitution with another opioid. Morphine was substituted for opium in the 1830s and 40s; heroin was substituted for morphine in the 1890s (and was advertised as being “non-addictive” in the absence of studies, much as Kratom is now). Methadone has been substituted for heroin since 1972. Kratom may indeed have some excellent properties, but it is being used as substitution therapy for heroin and prescription narcotics, just as methadone clinics and suboxone clinics in the US currently do the same. THAT is why Kratom is successful- it is one opioid substituting for another, and why it belongs under the jurisdiction of the DEA. It does deserve more study and may be a useful tool in the future.

    • I understand your train of thought. I have learned in the past about the progression of development ofopioid drugs and the struggle to fight addiction. It has been a very sad history. The problem I have with your idea of the DEA overseeing kratom is that it is an unrefined plant. I know of several other plants which have similar action, not in the poppy family. I could be making some legal tinctures and marketing them. The DEA seems exceptionally corrupt, exceptionally inept or a mixture of the two. I am fairly Libertarian and resent the practice of government protecting us from ourselves.

      I think the reason the action is being taking is that some are attempting to refine kratom for its active ingredients, making a drug. There have been outbreaks of overdoses across the country recently, perhaps it is the active ingredients from or some sort of strong extract, added to a street opioid. It may be fentanyl. I will always think that kratom, marijuana and herbal/plant medicines should not be reguled as schedule 1 drugs. That is obviously wrong. The ranking comes from long ago and makes no sense. It causes many problems. I, too, would prefer a legal, taxed product which has been tested and labelled for purity, type, strength, rtc, perhaps like the USP testing. No one in government is going to ask me or you, however.

      If you are trained as a pain specialist, I don’t understand how you sneer when people speak of killing themselves from pain. It certainly happens. I remember a young, single mother of three who had been on an email list that I was a member of. She OD’d accidently on NSAIDs due to migraine. Pain would not be the cause of death listed on her death certificate, so it is difficult to quantify the number of people lost due to intractable pain and their giving up.

    • There should be a better method of regulation of Kratom to assure it (and its alkaloids and congeners) are safe and effective. The US does not need the heavy hand of government restricting every freedom we have remaining. But in the absence of self policing in the areas of herbals/botanicals/supplements that leaves the public subjected to charlatanism, it is necessary to have some constraints. I would favor another division of the FDA itself with its own standards that would require level III studies (not level I studies as are required for medication and biologics approvals) that would approve those substances regulated by such a division. Its charge would be to protect the ability of individuals to buy and sell approved herbs/botanicals/supplements/homeopathics/essential oils and bring about standards in content, and create a compendium to be made available to the general public identifying seller claims that are proven, disproven, or speculative.
      I do not sneer at those that die because of pain, since I have treated pain for decades. But there is a continuum of pain treatment/chemical dependency/substance abuse/ addiction/diversion. Most addicts will vehemently deny addiction, claiming they are misunderstood pain patients. This sad situation came about due to physician massive overprescribing of opioids in this country. I work to re-educate physicians throughout the land about the malevolent effects their prescribing is causing to the public, and work to bring about a reasonable rational level of opioid prescribing.

    • Thank you for getting to the point where you describe changes and improvements that you would like to see made to our system. I appreciate the time and effort of your comments. It must be horrible to see patients go from a painful condition to also being addicts. I watched too many of my peers die during high school and soon after. I still breaks my heart all these years later, 15 & 16 years going for liver biopsies because of the damage they had done themselves, then continuing until they die.

      I think kratom is different and very useful, unless it is adulterated or strong extract is made and added to the herb. I do not trust the government to decide what I should put in mouth until the point that it causes harm to others from criminal behavior. Then, the criminal behavior can be prosecuted if such a thing occurs.

      I know of several plant extracts, available to all, that are excellent antivirals. The same with antibiotics. I think it is my decision as to whether to use such products. I know my history. I understand the tinctures. They are not measured in such a way to be standardized like a pharmaceutical, but they are effective and safe enough for children. They won’t kill my gut bacteria and allow C. Diff.

      I have access to the German Commission E information on herbs. I use the U of Maryland database and Sloan Kettering Memorial sites, among others. Ihave had some pharmacy and pharmacology classes. I feel that herbs are safer than prescription drugs and with good reason. Our species has its entire history as a species on which to base the use of plants as medicine. No, all plants are not safe. Not every “safe” plant is safe for everyone. Please, try to read the comments of the many thoughtful people on this article who have benefitted from kratom. Compare their outcomes with what you have seen in your practice. I am not suggesting that you prescribe kratom to patients, just try to see the good it can do. Unfortunately, there are too many people who crave a high. That is something beyond my ability to address. The emptiness or neediness in humans which causes this is beyond me. Pain from illness and injury I do understand. I have only empathy for that. I have compassion for those who are addicts and their friends and families, but I choose to stay away from such problems. I have seen enough that it is best for me to stay away.

      As for marijuana testing, when the voters in my state, Montana, approved medical marijuana use, the growers/providers decided to set aside a certain percentage of their sale for studies on the plant and its strain by the university at Bozeman. Of course, just as that program was getting in gear, the legislature changed the law and limited it very much, against the will of the voters. The DEA even raided some growers in the state while it was “legal” in the state. It was very strange as I had heard about some corrupt sounding outfits which were left alone.

      I would wish that you would read up on low dose naltrexone use. Look at
      http://www.lowdosenaltrexone.org which features the results of the few privately funded studies and fewer other studies which have been done. Lowering own’s own innate opioids briefly during sleep can have profound benefits in a number of illnesses.

  • You are short sighted Dr, just like the dea. If kratom is just like heroin then why haven’t they set up a program to help with the huge influx of people who are going to be detoxing. Have the ER’s been notified, have there been any attempt to warn kratom users or you and the dea want the suffering and death. I almost thought you were half human but you are just a robot tool. How did you take the oath, silly you had your fingers crossed didn’t you. Btw most kratom users want regulation. We need it to be safe and organic with consistency. I hope one day you develope a heart instead of that lump of coal in your chest. 1 luv bro….peace

    • In the end, I am so thankful I am not stuck with a doctor like you. I have walked out of the ER when pressed to admit me. I can go to Mayo. I have three doctors locally willing to give me opioids if I need them in the future. I am fortunate to be able to wean myself off oxycodone without problems when I no longer needed it. You seem to savor your position of leaving people in pain, deciding that they are addicts when their pain is just not well treated.
      Do you get your patients to try acupuncture, PT, massage and try whatever may help them? I doubt it. You are part of the problem.

      It was John D. Rockefeller who used his wealth to make the “modern” medicine which you practice. Prior to that press to drive doctors to use synthetic drugs produced by increasing large companies that make fabulous investments, homeopathy, osteopathy, chiropratic and other modalities were equals to you who have you roots as blood-letting barbers and magic-seeking alchemists. John Kellogg was just starting out hawking whole grain cereals. It is way past time that more people seek out practitioners who deal with their diets, their life styles and treat their pain meaningfully. I truly hate doctors and vets. I have found some who are exceptional and I wish all those who have written here about their suffering could find the right people to help them get as healthy as they are able. I would be disabled or dead if I had you as a doctor. Instead, the neurologist told me how incredibly well I am doing for how sick I was, and, though I have worked very hard to get well, it is because of practitioners who listened and considered and perhaps took risks for me, that I am better and rely on diet (including supplements) and exercise to stay well now. They thought out of the box, went the extra distance and actually helped through some bizarre illnesses. Other doctors literally looked away when told my symptoms or gave me useless tests that may be “standard” but missed my problems. You all do it every day and charge us and keep us sick! So go sit and yawn at the mirror.

    • It so happens the docs at Mayo are some of my friends and I know how cautious they are with opioids. Mayo docs have written some of the most damning articles about opioids, and do not offer them to almost anyone for pain. Most patients these days going to Mayo will have their opioids reduced or discontinued. I am also glad I don’t have to deal with a patient like you…you wouldn’t last 5 seconds in my practice. Just as patients can choose their doctors, we can also choose our patients- those that have no respect for the medical profession or for the efforts they have made over time to make medical treatment safe and effective do not deserve care from doctors. I am sure you can find your own brand of “care” that suits you better. And yes, we do employ acupuncture (an expensive bandaid that has short term benefits for pain), psychology (greater benefits for many chronic pain patients that have a huge psychological overlay), massage (works great short term), and prescribe supplements (those with Cochrane proven benefit for pain- there are only 4 that have been shown to actually work). Fortunately for the good of the country, opioid availability is rapidly shrinking, the suicide rate of chronic pain patients is no different than when on high dosage opioids, and functionality/pain actually improve on lower doses of opioids. The psychological dependence on opioids is huge in this country…we are turning the tide though, as more and more doctors lose their medical license for prescribing opioids, as some are jailed or brought up on criminal charges of Medicaid fraud for overprescribing opioids, other doctors are finally starting to “get it”. The availability of opioids is collapsing in the US and pain patients, that have been unwittingly addicted (chemically dependent) to opioids (even if they do not know it) are actually improving their level of pain and functionality when they are forced to reduce their level of consumption of opioids.

    • You say I would not last a minute at your clinic, yet you have no idea what physical problems I have, my background or anything about other than these comments. I will take that to mean that you have set your professional persona aside when commenting here, otherwise, you are kind of ridiculous. I have needed narcotics post abdominal surgery and at times recovering from that, given to me by my surgeon at Mayo, may I add. I have used acupuncture, which has helped me greatly to deal with pain. I am glad I can afford it. Fortunately, I don’t need your services. I pity those that do. That would be like being caught on fly paper. I still believe that kratom should stay legal. People will demand private testing without government interference. You and the government just like to control how much pain sick people must endure. You have a low opinion of those who aren’t doctors whatever criteria you use to feel so smug and superior. You’re the sick person. You need spiritual counselling. First, do no harm. Didn’t you swear to that? Does it have any meaning?

    • The reason you would not last 5 seconds in my clinic has nothing to do with your physical problems: it is because of the chip on the shoulder attitude and your fundamental belief that the medical profession is an evil empire. We have no tolerance for those that berate the physicians that have sacrificed their time and lives during extraordinarily difficult studies for up to a decade. Primum non nocere is more than a flippant adage bandied about as a punch line to use against doctors that are not sufficiently driveling in obsequiousness towards their patients that they would drug them into oblivion simply because the patient says they hurt. No, we have a much higher order implementation of that phrase, which includes protecting patients and society from charlatans hawking their latest unproven gadgets and nostrums to the masses. We believe in a hierarchy of evidence that rewards proof with implementation and education of patients while discouraging that which merely speculative or anecdotal since in many cases these turn out to be another way of defrauding the public at best and costing the lives of those that would be hoodwinked by flim flam artists. If something is worth using or advertising, it is worth proving. And no, this does not require a multimillion dollar budget nor backing of academia. It can be done within the office of an acupuncturist, a massage therapist, a naturopath, a chiropractor, or a homeopath if they take the time to understand fundamental scientific principles. I hold in great esteem those in alternative or complementary medicine that actually do take the time to study and prove the worth and safety of what they are selling to the public. They do this by conducting well accepted trial methods and do not stoop to the level of the con-man who claims “I did this and a patient got better” without examining the surrounding interrelationships between cause and effect. Some acupuncturists, chiropractors, and other alternative medicine practitioners have excellent scientific acumen. We in the medical field extoll those virtues. We deplore claims being made to sell supplements/botanicals/herbs that have no basis in factual scientific human studies or observations. We do not deny there are some drugs such as Kratom, that may have benefits, but just as other opioid narcotics are controlled, so shall Kratom be controlled, primarily because of the paucity of evidentiary science to support uncontrolled unlimited usage. What makes Kratom a street drug is that is has activity on the mu receptor (opioid narcotic effect), has no measure of potency, no guarantee of species or additives being used, has had no analysis of content, and no studies of either human effectiveness or safety. We do not deny Kratom may ultimately turn out to be a useful medicinal precursor or innate source of a new series of congeners. But we draw the line at widespread advertising and profiteering using a street narcotic without proven safety profile. You and I will have to agree to disagree on this and most other subjects. Best wishes in your understanding of healthcare that you employ.

    • There are a large set of doctors on whom the education has been wasted. They have a small number of diagnoses they use. Then there are the few thinking, engaged doctors. Clearly I have hit a nerve with you. I am most appreciative and respectful of the latter. The former I get the Hell away from before they kill me. You say that are part consumer safety advocate, consider me an informed consumer. There are professionals of all sorts whose services I would not pay for. I have high standards. When doctors whom you have respected leave you becoming increasingly ill for years and then you find someone who actually runs the right test, or like my facorite neurologist, identified my father as having supra nuclear palsy the minute he laid eyes on him, then you see a good doc in action. There are huge differences, unfortunately. It takes many skills and talents to vecome a goid doctor, getting through school and interning is a hard thing, but it doesn’t make a good doctor, just a doctor. Respect is earned and it goes both ways. It’s my body. I don’t subject it to just anyone! As you have written, doctors have caused at least one big problem-opiate addiction, as well as over-prescription of antibiotics leading to resistant bacteria, and who knows what other problems. I am picky too! I prefer a team when I have a big health problem including my naturopath and acupunturist and physical therapist, and a doctor who listens and really thinks and is well read since school and learning from patients’ experiences also.

  • So why not just smoke instant coffee? The reason is it reverses the antinociception of morphine and displaces tritiated naloxone….which means it makes pain worse. Therefore it does act on mu opioid receptors but not in the way you think it does: it actually reverses the effects of narcotics while at the same time displaces naloxone, characterizing it as a competitive mu opioid antagonist. http://www.ncbi.nlm.nih.gov/pubmed/?term=mu+opioid+receptor+coffee There is little scientific evidence tea has any significant effect on opioid receptors. Chocolate may have some intrinsic activity on enkephalin production in the brain but there is a higher affinity for cannabinoid receptors (marijuana) or amphetamine like effects than opioids. So go smoke some coca beans….. 🙂

    • You are very cruel to people who are suffering. You are no doctor. Any educated person knows it is cocoa beans, not coca which what gets refined to cocaine.

    • I wish you well with your health Sue. Many addicts can find help in 12 step programs or residential programs if they elect to forgo the usual suboxone/methadone routes.

    • You make poor assumptions. I am not a user of kratom. I am not an addict. I am fortunate to take low dose naltrexone for my problems, do yoga and other exercise and take supplements for my health problems. Having been in great pain, had multiple surgeries and fought my way back, I have compassion for those who can not find relief. I am very fortunate to have studied pharmocognosy in the ’80’s until now. I understand plant-based medicine. Kratom is so helpful to those who would be in endless pain without it. You are a jerk to not have feelings for them and think they are all addicts. So what if some were addicts and have rehabilitated themselves with kratom? That is an amazing transformation to have acheived. I have lost a number of fellow students to illicit drugs when I was in high school in the ’70’s. It is a miracle when someone overcomes addiction, or gets their life back from disabling pain. If you were a doctor, you would understand that.
      If you were a caring human being you would understand that and not troll those who are affected by this action making kratom into a very illegal substance.

    • I am happy you are taking a drug that is a treatment for addiction to opioids, alcohol dependency and for “fibromyalgia”. Show me the human studies on Kratom. Otherwise, it is just a street drug with no proven benefits and those using it are human guinea pigs. It is my hope the active ingredient, mirtragynine and other extracts may prove beneficial after being subjected to rigorous trials. However claiming Kratom is a safe “supplement” or is a “ounce of prevention” is irresponsibly labeling a drug that has no such proven safety or benefits. It is simply wishful thinking. Certainly anyone with a scientific or education in pharmocognosy would understand that.

  • Not only does kratom appear to a much better alternative to pharmaceutical narcotics it also has a host of other benefits including but not limited to: decreased fatigue, decreased anxiety, decreased depression, improved mood, better productivity, treatment for insomnia, treatment for RLS, improved blood sugar levels, and may even prevent cancer. Here is the link http://www.ncbi.nlm.nih.gov/pubmed/25081682?log$=activity

    Wait we can’t have anything that may prevent cancer. The hospitals and pharmaceutical companies will loose billions.

    • The study you cite was not Kratom- it was the active ingredient extracted from Kratom- the same process the pharmaceutical manufacturers use to create some of the pharmaceutical agents. And it does not cure cancer- it inhibits certain tumor cell growth in vitro- a far stretch from curing cancer in humans.

    • An ounce of prevention is worth a pound of cure! Many plants, especially as essential oils (frankincense, myrrh, sandalwood) cause apoptosis of cancer cells. Of course, if you look up the metabolic theories of Otto Warburg and his modern followers, you may find the “cure” to cancer.

      Kratom is a blessing to those in pain or who have become addicted. It is so wrong to put it on schedule 1. It is so drug companies can take the active ingredients and patent them, as the FDA is allowing to happen to many vitamins now. So corrupt! Make your own chemicals!

    • Apoptosis is a lab study of cells in culture. It has NOT been demonstrated in humans as an effect of Kratom, nor are there any scientific controlled studies to show Kratom has beneficial effects in treatment of human cancers. Such speculation can lead to unnecessary deaths of those that would buy into such nonsensical claims instead of engaging in those treatments that have been shown to be efficacious for the treatment of cancer. There is also NO evidence Kratom in any way prevents human cancer.

  • Kratom is a narcotic opioid, therefore using it is simply substituting one addiction for another. It is time the DEA moved to eliminate the illegal availability of this street drug.

    • So I guess people managing chronic pain are better off taking 60 mg of hydrocodone is a better option?. Get real dude! If you were in the same position as most kratom users you would use it too. And you should do some research on chronic pain, to live with pain is not living it’s dying.

    • Kratom, the narcotic street drug, will be illegal soon enough and all those using this street drug will need to find other alternatives. There are now 7 studies showing those patients that were taking high dose opioids and moved to low dosage or no narcotics had absolutely no increase in pain after stabilization. There is a place for opioids in chronic pain but the US population consumes 80% of all the opioids in the entire world (5% of the world population) and 97% of all hydrocodone in the world. Substituting Kratom is simply trading one narcotic for another. The problem is, the US population has a chemical dependency to opioid narcotics far greater than any other country in the world, with no lower pain scores or improved functionality to show for all those opioid narcotics. We have a giant bubble of a population that is functionally addicted to opioids, mistaking the pain from withdrawal from the opioids for pain relief of chronic pain from opioids. Approximately 4 out of every 5 patients in the US taking opioids for chronic pain are doing so as a maintenance of addiction, not pain relief. So, yes, Kratom should be illegal in the US.

    • There is absolutely no doubt that overprescribing by physicians contributed in the past and continues to contribute to the 18,500 deaths from prescription opioids, the 10,000 heroin deaths, and the 3 million addicted to opioids in this country.

    • Absolutely ludicrous Mr. Whitworth. Are you a real MD? I question your authenticity.

      Kratom acts on the mu-opioid receptors in the brain right? As does coffee (which this plant happens to be in the same family of Rubiaceae), chocolate and some teas.
      By this logic coffee, tea, and chocolate should also be taken off the streets.

      Perhaps you should apply to the DEA. You’d fit right in.

    • Do you really think that millions of people will simply lay down and die? You’re a more pathetic shill than I first expected. It must be fun to get paid by posting comments on the internet.

    • Lay down and die? lol….funny. Stopping a street drug does not cause people to “lay down and die” but it may help with their street drug addiction.

    • Well I have zero suboxone patients. My hope is that you can find more constructive ways out of your addiction than uncontrolled unassayed and potentially unsafe street drugs. I assume you read the article…..

    • Ok so removing it’s availability will solve anything? The way I see it this will only increase the desire for it. Many of the younger generation will be more intrigued to trying it. The other problem is once it goes to the “black market” it will be cut with other narcotics and so the users of kratom will not be getting the full benefits of kratom and in turn will start to become addicted to what ever it is cut with. Drug dealers know one thing for certain, the more potent their product is, the more money they can make on it. Secondly if making it illegal, why not make alcohol illegal? You should know as a M.D. that there is very few if any medical benefits to alcohol. The only real proven benefit to alcohol is to sterilize equipment and clean topical surfaces. Alcohol kills more people each year than almost all drugs combined if you take heroine out of the equation.

    • Alcohol and cigarettes have always been used by the street drug users to justify the continuation of street drugs. Indeed alcohol kills 88,000 in the US, cigarettes 490,000 in the US, but these are regulated by the government and taxes are collected to help pay for the massive increase in health care costs associated with their use. Kratom is partially a victim of its own success, with massive increases in usage over the past 5 years, but also an unfortunate victim of the war on opioids. I personally believe it has some usefulness, and should remain available but taxed. The problem with Kratom is that it IS an opioid and just another mans Norco, yet the purity of Kratom, is in no way guaranteed any more than heroin. Several species are being sold as Kratom, and it is now being laced with other deadly drugs just as is heroin. We also lack safety studies on the species- most of the claims of miraculous powers of the drug are based on extrapolation from the petri dish or on anecdotes rather than any science, and there may be malevolent effects that have not been appreciated due to the lack of controlled studies. Should it be legalized? Perhaps….it does hold potential, but the timing of the drug’s explosion of usage in the US is just poor. The DEA, DOJ, FDA, CDC, US Congress, state medical boards, state attorney generals, state legislatures, and local governments are all working in conjunction to reduce the out of control opioid prescribing and use in the US, and are unwilling to see their efforts thwarted by the massive increase in another opioid street drug usage. Perhaps during the ensuing two years we can look at the drug’s properties in European studies to see if it has merit as a medicinal drug rather than a street drug.

    • Never in my life have a seen a doctor be so uninformed and callous. Thousands of years of use in Thailand is not enough information for this man. Kratom is not classified as an opioid by the scientists who are studying it. It is considered a novel substance that does not fit into any category we have. Regardless, you seem to think we are all too stupid to make the decision for ourselves what plants we consume. There are many people who object to synthetic medicine and only want to use natural remedies. It is their RIGHT to manage their life with supplements and botanicals and never consult a doctor in their life if that’s what they want. I’m sorry Dr, but you are crazy to say the government should be able to tell me I can’t consume a plant that helps me. I can’t wait until you watch us win this fight because we are not backing down and we now have congress on our side!

    • An ounce of prevention is worth a pound of cure! Many plants, especially as essential oils (frankincense, myrrh, sandalwood) cause apoptosis of cancer cells. Of course, if you look up the metabolic theories of Otto Warburg and his modern followers, you may find the “cure” to cancer.

      Kratom is a blessing to those in pain or who have become addicted. It is so wrong to put it on schedule 1. It is so drug companies can take the active ingredients and patent them, as the FDA is allowing to happen to many vitamins now. So corrupt! Make your own chemicals!

  • Kratom is the closest thing to a miracle plant I have ever known. It treats so many maladies, makes you feel good, and has hardly any side affects. In my 51 years of life I have never seen such a nefarious action taken from my country on its people.

  • It is often the naivete or denial of the public that requires the DEA to take action. Kratom IS an opioid. It is a mu opioid agonist, just as is morphine, heroin, hydrocodone, methadone, etc. The fact that the suppliers of the drug fail to tell people they are simply substituting one opioid narcotic for another is one of the main problems with “natural” products and supplements. The suppliers lie to the public about what they are actually selling. The users are effectively substituting one addiction for another.
    Evidence Kratom is an opioid narcotic: http://www.ncbi.nlm.nih.gov/pubmed/27556704, http://www.ncbi.nlm.nih.gov/pubmed/23846544, http://www.ncbi.nlm.nih.gov/pubmed/23206666, http://www.ncbi.nlm.nih.gov/pubmed/18482427

    • It’s an opioid, but a safe opioid that doesn’t destroy lives. So what exactly is your problem?

    • There is no such thing as a “safe opioid”. This is something frequently claimed by prescription painkiller addicts and some heroin addicts- that it is “safe”

    • Cheese is known to affect your opiod receptors like a narcotic, too. Kratom can not be abused like a sythethic drug. It can not cause over dose unless taken foolishly with other intoxicants. There are people who sniff glue and gasoline, should we ban those substances so total idiots are protected from their own destructive actions?

      You must be a sadist. You enjoy the suffering of others, “doctor”

    • Several overdoses in the literature from Kratom including deaths and one in my local ER. Yes, it is a street drug. It is no more a “supplement” than opium is a supplement. It deserves study and regulation- exactly what is happening despite the protests of the Kratom Clan. Doesn’t matter what you think, how much you protest, or what label you place on this street drug- the DEA IS planning to shut down availability and in cooperation with local and state law enforcement, will now jail those selling or caught with the drug illegally. It is a drug that does deserve more study, and if found in human studies to be safe and effective, then perhaps take it off Schedule I in 2-3 years.

    • I remember when a small number of people died of kombucha back in the ’80’s and the great hoopla then. Back then, that worried me, too, but I have seen enough of the scare tactics. I think there will be a new pain killer approved by the FDA soon. I doubt it will be safer than any other prescription or OTC drug. How many tylenol ODs or liver damage patients have you seen in your ER (if you actually are an ER doc)? Or those hemorrhaging internally from NSAIDS? Let alone the recent deaths from posdibly fentanyl contamined heroin? Many, many times more than kratom.
      Kratom is an herb, not a refined drug. There is no comparison of the risk of using such an herb to refined or synthesized narcotics.

    • Nonsensical speculation on the safety of Kratom. Do we know it does not contribute to later development of Alzheimer’s disease or hypothyroidism or any number of neurological diseases? No. Because it hasn’t been studied. NSAIDs, in the latest estimates do cause death, but it is estimated to be 2,000 per year. Supplements, that are also unregulated “herbs” also cause thousands of deaths per year because the manufacturers have been shown by the FDA to be adulterating the supplements with prescription NSAIDs, sometimes as many as 6 different NSAIDs. Of course supplements are not labeled as such. Kratom is not only unlabeled as to its content, subspecies, purity, but has not been assayed at all, anywhere, by anyone. I do not know what is in the street drug Kratom and neither do you since it is not regulated, controlled, or assayed. It is imported. No one checks or guarantees the purity or safety of the drug.

    • Here is my question to you Dr. What should someone like me do? I suffer from osteo arthritis and have been to many pain clinics and after building a tolerance I got off the opioids. I remained drug and alcohol free for about a year but I couldn’t consistently work due to the pain. Now I am back to work with the help of kratom and I am a chef. My job requires me to be on my feet for long periods of time. I do not have the option of office or desk work. I have to make a living and I can’t get disability benefit nor do I want them. It is just not enough money. I do not want to get on opioids or THC. I am upset because I don’t want to go backwards. I absolutely need to make a living and I also suffer from extreme panic attacks. I have tried accu puncture and chiropractics also. I am very nervous because I thought I found a way. I am not asking you to sound like a smart ass I just am scared.

    • I very much sympathize with Marlo’s plight. If Kratom works for a person, then understanding what little we actually know about the chemistry of the drug should allow your doctor to fashion a combination of medications that should bring significant relief. These may include supplements or supplements in combination with medications such as tramadol to enhance the effectiveness. It is my hope the US government will allow longitudinal Schedule I clinical trials on the medication so we can begin to understand potency variations, assay the purity, the clinical effectiveness and the long term side effects. I may petition myself to engage in one of these trials as a prescriber since I am not convinced Kratom is not helpful. I believe it is- but just as we did not know the potentially life threatening cardiac and renal effects of NSAIDs until they had been on the market for 50 years, we need to understand the potential effects of Kratom and its variants prior to wholesale approving it at this time. Do I believe it has potential? You betcha! But we have to prove it, and hopefully you can be in one of the trials.

    • Thankfully, you admit that people need pain relief when they have conditions causing pain. We may agree that we need improvement in pain control. You are ignoring the commenters here who write that kratom has been life changing in the most positive way. Plant based medicine has been used since there have been animals on Earth. I am all in for checking any long-term effects, good or bad of all plant medicines. In the current data available, which is slim in this country, most herbs are shown to have multiple benefits with the occassional downside of allergies. That is a fact. As to purity, yes, there can be problems, but read the article. The group mentioned tests products and advises against use of substandard products. Many of us realize that we can not rely on the FDA or our doctors. Look at the newer blood thinners as an example. They can cause bleeding in some and have no antidote. The patient bleeds out and get transfusions. If they do not die from blood loss, the donated blood begins to clot and they improve. We are guinea pigs for experimental and expensive drugs. Our safer, older proven drugs are expensive as generics are limited and not prescribed as often. Television is full of drug ads which are replaced by ads for class-action suits against those same drugs. It is crazy! Kratom has been used for longer than anyone can remember. There are other opiate-containing plants used as pain killers OTC in other countries, but no one can patent them, unless the drug companies succeed in getting the FDA to allow them to patent naturally occuring substances. There is one form of B-6 which is being taken off the market as a supplement and being patented by one company. Next will be fish oil and then many others. I want freedom. I have healed in large part due to supplements and diet and exercise. Sneer at LDN, but for those with an autoimmune condition, it can be a lifesaver. Certainly it beats having your immune system impaired so you get cancer. I had to watch my mother die that way. I have seen others suffer similar fates. As far as I am concerned, even with the progress in medicine, we are still in the Dark Ages of medicine, too close to the barbers and alchemists. I will laud a skilled herbalist any day!

    • I am no fan of the pharmaceutical manufacturers that are financially raping the American public while offering the rest of the world the same medications at a steeply discounted price. We pay 3 times as much as Canada for the same medications by the same manufacturers that have no government subsidies. My problem with Kratom is that it is a psychoactive drug with very little known about it, and due to the group in this article has massively expanded its use in the US, which of course they are doing for profit, just like pharmaceutical manufacturers. However they do nothing to certify purity, source, lack of adulterants, fund no studies of long term effects, neither collect nor publish scientific data about the drug’s side effects, and are in effect promoting a street drug on the basis “it has been used for a long time”. If this group had done some of the above things, the DEA might not have taken the steps it has to protect the American public. The scheduling of Kratom as a controlled substance is a profound setback for those that willy nilly promoted or used this street drug, but it is not a death knoll. Kratom does deserve study. But just because it is a herb does not mean that it is not a drug. Many “herbs” and flowers are regulated by prescription or control on growing or importation. Consider the opium poppy. Anyway, we need more study and it is my hope we can perform these studies before the wholesale release of the psychoactive street drug Kratom is approved for use in the US.

  • Thank you for this reasoned, balanced article on the travesty of DEA’s heavy-handed attempt to shut down the sales and consumption of kratom in the USA. I have been following the kratom movement for 4 years and using it myself as a substitute for coffee.

    I know Susan Ash and work with her to prevent the suffering that a closure of kratom sales and importation would cause. I have met Shannon Scatolini and Susan and can attest to their passion, energy, and warm humanity, despite dealing with diagnosed serious illnesses with the help of kratom.

    Despite its ragtag unregulated appearance, the vendors do a fantstic job at bringing a clean and safe product to millions of American consumers. I have taken many samples and never gotten sick from contaminants. The best vendors have their product tested before selling to the public. When dealing with the bulk powdered kratom, additives are easily visible and there is no financial incentive to add them.

    When the medical/pharmaceutical industry has nothing but synthetic palliatives for chronic diseases, is it any wonder that the public would go looking for traditional herbal treatments to find relief? That is the story that is not being told. I have written so many articles for Natural News and ILoveKratom.com, telling the stories of those who couldn’t function on MD-prescribed drugs, but returned to work and family with the help of this very complex herb.

    If we want to end veterans’ suicides or end the addiction epidemic, kratom can do the job. I’ve watched the successes and told their stories. It doesn’t need to be turned into a single ingredient pharmaceutical drug. It works gently and surprisingly well right now to tame PTSD and smooth the path to recovery from addiction, at great savings to the nation.

    When an herb does a better job at returning the sick to the ability to work and lead a normal, happy life — after all prescription alternatives have been tried and failed — shouldn’t patients have the right to use the herb? From what I’ve seen and experienced in the kratom community, I believe an accommodation should be made because for millions of us, pharmaceuticals cannot compare to the feeling of relief and normality this plant provides.

    Thanks, again, for a more intelligent discussion of a topic that has received too much scorn and sensational coverage.

    • I completely agree. They have no sympathy for anyone I am not buying their excuse of the reason why they are doing this. I would respect them more if they just told the truth as to why they are making it a schedule I narcotic. Money and power.

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