Kratom, an herbal supplement that was once a quiet member among the legion of botanical products sold in the United States, exploded onto the national scene in August 2016 when the Drug Enforcement Administration announced plans to classify it as a Schedule 1 controlled substance. As such, it would join heroin, LSD, ecstasy, marijuana, and other so-called recreational drugs as a substance with “a high potential for abuse and the potential to create severe psychological and/or physical dependence.”

The DEA withdrew its call to ban kratom, and instead asked for public comments on the product. The comment period closed Dec. 1.

We believe that a move to make kratom a Schedule 1 controlled substance is premature and shortsighted, from both the scientific and clinical perspective. It would make it nearly impossible for researchers to fully examine its safety and clinical uses.

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Walter C. Prozialeck: Kratom is the popular name for the leaves of Mitragyna speciosa, a tree native to Southeast Asia. Kratom leaves have been used for centuries as a mild stimulant, a painkiller, and a treatment for opioid addiction. Its leaves can be eaten raw, but more often they’re crushed and brewed as tea or turned into capsules, tablets, and liquids.

I recently published a review on the pharmacology of kratom in the Journal of the American Osteopathic Association. There is substantial evidence from animal and biochemical studies that kratom and its active constituents, such as mitragynine and 7-hydroxymitragynine, have beneficial pharmacologic effects. Primarily, researchers suspect it might provide pain relief similar to opioids, but with significantly less potential for addiction and for severe toxicities from overdose.

As might be expected with almost any botanical product, as the use of kratom in the US has grown, there have been increasing numbers of reports of adverse effects resulting from the use of purported “kratom” products.

The DEA based its decision to classify kratom as a Schedule 1 drug based largely on reports of adverse effects. According to the CDC, about 42 percent of kratom-related adverse events reported between 2010 and 2015 involved non-life-threatening symptoms that required some treatment. About 7 percent were classified as major and life-threatening. The DEA claims that kratom can lead to psychotic symptoms and psychological addiction, and reports that there have been 15 kratom-related deaths between 2014 and 2016.

In those fatal incidents, however, the kratom products were almost always either concentrated extracts or fortified with various substances or drugs, including mitragynines, opioids, or stimulants. Many of the users had confounding conditions, such as a history of drug addiction or the use of multiple drugs such as alcohol, opioids, or marijuana, aside from kratom or along with kratom. The bottom line: It is not at all clear that kratom itself was the cause of the problems.

In evaluating the effects of kratom, it is important to note that most information is based on personal reports by kratom users. Scientists who have systematically analyzed those reports have concluded that even though kratom can be addictive, the potential therapeutic benefits of kratom outweigh its risks.

After carefully evaluating the literature on kratom, I have concluded that when it is taken in pure herbal form at moderate doses (no more than 5 to 10 grams), pure leaf kratom is relatively benign in the vast majority of users. In addition, even though kratom itself is clearly addictive, it appears to be much safer than opioids.

That said, I don’t think it is appropriate for physicians to recommend kratom to their patients at this time. There are clearly issues regarding quality control and standardization of kratom products that need to be addressed. Questions about kratom can be addressed only through well-controlled clinical trials in humans.

My concern is that a move to Schedule 1 status would stifle this important research. It is my sincere hope that some sort of compromise can be developed so that quality standards for the production of kratom can be established without banning this product.

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Anita Gupta: I specialize in helping patients manage pain. More and more of my patients are asking me about alternatives to opioids, which are highly addictive and only about 30 percent effective at treating chronic pain.

After kratom was featured so prominently in the media, a number of my patients asked me about it. I believe in evidence-based medicine, so I did some research on kratom. The “evidence” was all over the place, and I had trouble finding solid, reliable information. At the same time, I know there is some value in anecdotal reports, of which there are many. Given what I had learned about kratom, I couldn’t in good conscience recommend it to my patients.

But quite a few of them started taking it on their own. Their results have been all over the place. Some tell me that they feel better, have less pain, and don’t need to use opioids for pain control as much. Some say they feel a little bit different, but aren’t sure if kratom it is making much of a difference. Others say it didn’t do anything for them. That assessment is hard for me to decipher — it can be a genuine statement that kratom didn’t work or it can be a veiled way to obtain prescription opioids, which carry well-established benefits and risks.

Does kratom actually ease pain is a question that must be answered. But we also need to know what risks are related to using it, and whether it interacts with medications and other supplements.

The supplement field is largely unregulated. There have been reports of so-called herbal supplements for erectile dysfunction that were spiked with sildenafil, the active ingredient in Viagra. When you don’t know the provenance of kratom, there’s no way of knowing whether it eases pain because it is laced with opioids.

As an osteopathic physician, my primary focus is on wellness and prevention. If kratom has the potential to manage pain without causing a secondary disease like opioid addiction, I believe we should give it a chance — but not before rigorously studying it to fully understand its benefits and its risks.

Walter C. Prozialeck, PhD, is professor and chairman of the department of pharmacology at the Chicago College of Osteopathic Medicine at Midwestern University. Anita Gupta, DO, is an anesthesiologist and professor of pain medicine at Drexel University College of Medicine and currently co-chairs the Committee of Prescription Opioid Abuse of the American Society of Anesthesiologists.

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  • I have Fibromyalgia, IBS, Polyneuropathy, and Osteoarthritis. I have had multiple epidurals, trigger point injections, and Low Dose Naltrexone (LDN). Before the LDN, I was taking opiate medication; first it was Lortab, then Norco for more than two years. I had two days of excruciating pain when I weaned off the Narcotic in April 2016. The Fibromyalgia and Chronic Pain Blogs spoke of Medical Marijuana, offering different delivery methods, but I live in Virginia where Medical Marijuana is banned. Multiple times, the blog comments would also mention Kratom, and one blog comment mentioned a specific strain of Kratom. From April to October this year, I tried to accept the pain but quality of life was not worth living so I ordered Kratom online. When my package arrived, there was an additional Kratom package that contained the same ingredients but at a lower dosage. Being cautious, I chose the lower strength package to try. As a retired Healthcare worker for more than 30 years, I can say one capsule (on an empty stomach) provided 30-40% pain relief; also I had a mild to moderate increase in energy and couldn’t believe how my concentration improved. The one capsule lasted approximately 4-5 hours. And I didn’t take anymore in that 24 hour period, although the package states you can take 1-2 capsules and maximum dose is 4 capsules twice daily in a 24 hour period. I made a mistake one day and took one Kratom after breakfast and it didn’t provide any benefit. I have shared with my physician that I started Kratom on my own and it does provide some pain relief which helps to diminish suicidal ideation. On the outside of the package, it states Not For Sale To Minors. It also cautions to not take if you are pregnant, and do not use while operating a motor vehicle or heavy equipment. The package states that this product has not been evaluated by the Food and Drug Administration and is not intended to diagnose, treat, cure, or prevent disease. I believe the research needs to continue without the Drug and Environmental Protection Agency (DEA) creating hardships based on FDA recommendation. Note: Based on a recent article from a government source, the medication that is injected into the spinal column for Epidurals….it has not been FDA approved and has resulted in fatalities. Why hasn’t this medication been banned?

  • I have been using Kratom for pain relief for over three years with great results. I have found that when I started, i was using Kratom in pill form with little to no effects. I have found that Kratom needs to be heated in tea form to extract the working ingredients in the crushed leaves. Studies should be done and both method as I beleive this is the reason that your information is not consistent.

  • I just wonder what is known about the animal toxicology and human pharmacology or addiction liability of 7-hydroxymitragynine (known since the mid-1990s), apparently the most potent opioid in kratom. I guess nothing; caution is advised. Note that DEA proposes the scheduling of two mitragynine alkaloids and not ‘kratom’, which is the leaf or herbal preparation of the tree also called by the same name.

  • My fiance has been uaing kratom for quit sometime for his back aches, toothpain and other physical work related pain. He also uses it to help him focus more and be more awake instead of drinking energy drinks. I am manic depressive bipolar w/social anxiety. Instead of taking pills(which change me) I have decided to take kratom myself. It helps alot. It evens out my mood to where I dont have anxiety, I dont have deppression and I Defiently feel normal. Kratom has defiently changed my life.

  • I believe extracts and ultra enhanced kratom should be pulled off the market. Regular plain leaf kratom is my only alternative for pain and I’ve gotten off my antidepressant and use this instead. Now, that’s a reason they want it banned. The pharmaceutical companies are going to lose money. That’s the real reason for the ban. And since marijuana is becoming more and more legal, they need to replace it. DEA can’t have a job without drugs and private banks and jails can’t make profit without felons. Did you know that JPMORGAN Morgan make 150 million off a triple life sentsnce. Each life sentence earn 50 million dollars for the prison industrial complex. It’s fucking disgusting this country.

    • Hi Nathan:
      I am using kratom for pain and depression. What strain are you using for depression? I’ve tried a few strains and find that Dharma Bali, Bali and Indo help with pain and depression, but I would like to narrow it down to just one strain. Thanks.

  • I have experience with every opiate and opiod in the book, The patients that told Anita Gupta that they dont feel anything or cant tell if they do are full it,they are lying 100%. Its part of the addiction to clinge to the pain killers. I personally have and know of many individuals who have used kratom to stop taking Suboxone and Methadone, aswell as Herion. But if you can get pain killers from the doc that are covered by insurance, even if you dont take them you can sell them. So it takes a strong individual who is ready to change their life to go from that to having to pay for kratom out of pocket.

    • I agree. 9 months ago I used Kratom to get off of 15 years of Methadone use and opiates before that. I was ready to move on to my next chapter of my life without the horrible addiction of methadone. If I didn’t have kratom I wouldn’t had made it through the withdrawal period of 3+ weeks. I took 4-5 grams 4 times a day and was laid up a little from the withdrawals but I’m happy to say u have been opiate free for 9 months. Kratom changed my life.
      I agree I think the patients that said they got no effects from Kratom just wanted to keep their meds so they can sell them. At one point of my life I would have done the same. Also many of ther kratom companies mix regular tea and other things to cut it to make more profit. I order all my kratom from Major Kratom. It’s a very reputable company with an excellent product. I swear I’m not a spokesperson for them I’m actually just being honest. I have tried several other companies and the quality of the kratom is nothing compared to Major Kratom. If anything should be off the market it should be methadone. The worst drug in the world if you ask me.

  • Totally agree with the usage of the Kratom. When taken in a natural form with minor dosage … it really works well for the pain, anxiety, and energy. The one concern is towards it over usage for addiction just like opiates.
    http://kratomguides.com

  • I believe , from all the testamonials, I would like to see research, and allow people to use this as a way to relieve pain, anxiety, and get good facts on positive and negative aspects of this plant, befor making it a scheduled drug, which it is not ,. It’s a plant, a tree, much like coffee,. Alot of people have benefited greatly, and their quality of live changed to the point , they would be desperate, to find a non narcotic pain med , to replace it,. All I have seen , about this Plant Kratom, is all for the good, and we’ll being, of patients, who,s lives were all but over, as far a a good quality life.,. Please do the research, befor destroying lives ,. It’s been around for thousands of years,. It,s a God given plant, that has helped people through many potential life threatening issues,.

    • Yes regulate it and all vendors have to go through FDA standards anyways, so they don’t have much to do. Go look to see if there have been any death is in Thailand, Indonesian, or Malaysia. When there hasn’t been deaths in the countries it’s naturaly grown, then you know the DEA is just making up excuses to get it banned. It’s all a political money issue.

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