Three times a day, every day, for around a year, Tim Weaver would slide a tablespoon of kratom into his mouth. He'd let the bitter, grassy flavor of the powder seep into his tongue, gulp a glass of water to swallow it, then gulp more to wash the fine particles from between his teeth. Within an hour, the panicky feelings and achiness that accompanied Weaver's opiate withdrawal would recede. "I was able live again and not just feel like I wanted to crumple up in a ball," Weaver said. And as time went on, he relied less and less on the plant until he didn't need to use kratom at all.
When he was 18, Weaver started abusing prescription painkillers after a routine wisdom tooth removal left him with too many pills. Friends in his hometown of Pittsfield, MA introduced him to oxycodone and Opana, a dwindling supply of those led to Percocet and heroin, and the gaps between doses over the next ten years forced Weaver to realize he needed to quit. Tapering off didn't work. Cold turkey only lasted so long before lingering, months-long withdrawal symptoms sent him running back. And like many opiate addicts, he was distrustful of prescription options like methadone, Suboxone, and benzodiazepines.
Since using kratom to withdraw four years ago, Weaver has slipped a few times. His latest lapse was almost a year ago, and he hasn't gone back to regular use. He's been holding down a job as the assistant manager of a liquor store, which allows him to explore his interest in craft beer and whiskey.
Weaver's story is echoed online, among people of all ages and backgrounds who congregate in forums to share stories about how they've overcome their opiate addictions with kratom, an obscure plant that grows naturally in Southeast Asia. In 2012, when Weaver was quitting, kratom was legal nationwide and easily purchased online or in smoke shops. But that's already changed. Actions by the FDA and a growing number of state-level bans are making kratom harder to buy, and harder for researchers to study. Already, these restrictions are curbing our chances of understanding what might be a powerful weapon in the fight against the US opiate epidemic.
In Southeast Asia where it grows, kratom leaves are usually chewed whole. The stuff bought online in the US arrives as a fine powder, ranging in color from tan to dark green. The bitter taste is akin to oversteeped green tea, and users who can't stomach knocking it back with water (the "toss-and-wash" method) often mix it with chocolate milk or brew it into a tea. Though described in 1897 by English botanist Henry Nicholas Ridley as a "substitute for opium," kratom didn't gain a foothold in the US until the early 2000s, when whispers of its usefulness for quitting opiates or treating chronic pain showed up on sites like Erowid and Bluelight—around the same time opiate prescriptions and opiate-related deaths began to skyrocket.
Kratom is unusual because it's a stimulant at low doses, and a sedative at higher ones. The effects are generally mild, producing a slight euphoria around 45 minutes after ingestion and lasting for three to four hours. Kratom isn't an opiate, but it acts on the brain's opiate receptors and shares opiates' primary side effects of nausea and constipation. Where an opiate overdose can mean coma and even death, too much kratom leads only to vomiting up the overlarge quantity of plant matter. "It's not a drug one would seek out to get very high or to have their mind expanded," Andrew Flint, a friend of Weaver's who introduced him to kratom, and himself uses it for chronic pain, said. "It's more of a maintenance drug for those of us who could use a little help." Anecdotal reports on Erowid support this assessment, as do my own experiences trying the drug. The effects are subtle and not that interesting in a recreational capacity. To date there are no known fatalities from kratom usage alone.
Like coffee or alcohol, kratom has the potential for dependence, though that often requires prolonged use at precipitously high doses. The majority of user reports on online forums suggest there are few if any withdrawal symptoms. And the pain-relieving properties and low abuse potential of kratom has been known since as early as 1974, when the UN Office on Drugs and Crime published a comprehensive review of kratom. Summarizing a study from 1972, the review states, "there were no addictive properties as may be found in morphine."
Kratom remains unscheduled by the DEA, but the FDA threw it into legal limbo in 2014 when the agency issued an import alert that allows kratom shipments to be detained and destroyed without inspection. Historically, once an FDA import alert is issued for a product, it's permanent.
There are no large-scale controlled trials of kratom's effects on humans, but the FDA alert claims that kratom can lead to a terrifying list of side effects including, "respiratory depression, nervousness, agitation, aggression, sleeplessness, hallucinations, delusions, tremors, loss of libido, constipation, skin hyperpigmentation, nausea, vomiting, and severe withdrawal signs and symptoms." After repeated requests, the FDA disclosed the evidence it had used to draw those conclusions. Among the documents is a 2012 joint review of the substance with the Department of Health and Human Services, which only lists human side effects as nausea, vomiting, and constipation.
Robert Mozelsky, a medical officer with the FDA's Division of Dietary Supplement Products, also shared 14 other studies as relevant to the agency's stance on kratom. Many of these studies were uncontrolled, and in one of them the author himself was a participant. The few case studies that reported serious side effects described them as "rare" or a "coincidence." Three of the studies describe the effects of plants in the mitragynine genus that are not actually kratom.
Also included was a July 18, 2013 email to Dr. Daniel Fabricant, director of the FDA's Division of Dietary Supplement Programs, from three trade organizations (The Council for Responsible Nutrition, Consumer Healthcare Products Association, and United Natural Products Alliance) asking the FDA to step in where the DEA wouldn't:
"Kratom is not currently scheduled under the Controlled Substances Act (CSA), and that process is not likely to happen quickly given the lengthy process required for adding substances to the CSA," the email reads. "Thus, FDA appears to be best positioned to address the issues presented by the marketing of this substance."
Four states—Vermont, Arkansas, Wisconsin, and Tennessee—have banned kratom outright or effectively done so by scheduling two of the leaf's key alkaloids, mitragygnine and 7-hydroxymirtrogynine. Vermont calls it a stimulant. Wisconsin and Tennessee list it as a cathinone, like bath salts and k2, which it is chemically unrelated to. Arkansas' ban hinges on the findings of an individual physician, Thomas Atkinson, who has published no research on kratom. And now more states are jumping on the bandwagon: North Carolina wants to consider it a controlled substance, New Jersey is proposing heavy fines and jail time for distributors and users, and New York wants to penalize stores caught selling it.
As a 24-year-old county clerk, David Carlucci noticed he was signing death warrants for people younger than he was who'd died of opiate overdoses. Now a New York State Senator, Carlucci says the counties he represents have seen over 230 overdose deaths in the past few years. Carlucci has introduced repositories and outpatient services, and he's pushed for greater availability of Naloxone, a drug that can prevent overdose victims from dying. Carlucci is also the sponsor of a bill attempting to ban the sale and distribution of kratom in New York. "We have an epidemic going on, and we have this unregulated substance where people are profiting off of people to try to cure their addiction when we have no data to really back it up," Carlucci said. In short, Carlucci wants to protect his community—from opiates, and from unregulated, poorly researched treatments.
Carlucci's bill seeks to prevent the sale of kratom by levying fines and revoking liquor and tobacco licenses, meaning it would disproportionately affect brick and mortar stores. But Yassir Raouli, the owner of Brooklyn Smoke, said that kratom isn't a source of revenue for his smoke shop. "We've probably had these capsules for at least three months, four months. So it's not a product that moves," Raouli said, pointing to a small jar. "It's just a product that you need to have, being a smoke shop." Regular users, like Flint, consider the kratom sold in stores to be "total crap." Flint prefers to buy his kratom from online distributors who, to his knowledge, are largely located on the West coast, well outside of New York State's legal jurisdiction.
Carlucci's bill could kill headshop kratom in New York overnight, but would do little to scare online vendors. Still, legislators like Carlucci, who feel a responsibility to turn back the tide of opiate addiction, have limited options without help from federal agencies. "What would be great is if the FDA regulated it," Carlucci said of kratom. "We really have to figure it out in terms of are we actually helping people or making the situation worse."
The pure plant form of kratom might show promise for addicts, but that's often not the version of the product reaching the hands of consumers, or making headlines. More than half of FDA user reports involved claims of unclean manufacturing processes or kratom tainted with everything from buprenorphine to rat poison. Because of the financial risks involved in selling it, kratom manufacturers tend to be either wide-eyed evangelists or abject scumbags. Some of the latter cut their products with the very opiates that kratom users are attempting to withdraw from, and unknowingly ingesting those filler chemicals has led to seizures and even death in some cases. Even unadulterated kratom capsules sold in head shops are often not the powdered leaf at all, but concentrated extracts of the plant's psychoactive chemicals—the hard liquor to kratom's beer—which can hasten dependence in users.
One FDA report describes a 33-year-old male who took a product claiming to be kratom and subsequently went to the hospital after experiencing four grand mal seizures. He was allergic to Tramadol, an opiate that has a history of showing up in laced kratom, but claims to have tested clean for drugs. "There's almost nothing known about drug interactions in kratom," Dr. Walter Prozialeck, Chairman of the Department of Pharmacology at Midwestern U, said. Unfortunately we're not likely to discover the answer any time soon. As Prozialeck puts it, "The FDA has made it hard for NIH to fund research on controversial drugs."
Even the most scrupulous of kratom sellers have difficulty navigating its legal grey area. Distributor Will McKenna* works with a vendor who supposedly contracts local Thai farmers and does high performance liquid chromatography testing to ensure purity. When McKenna receives shipments at his business* outside San Diego, he performs his own tests to check for heavy metal contamination. After back pain led him to Percocet, and Percocet led to addiction, he used kratom to withdraw and quit his job in IT to spread the gospel. He tries to sell the purest, safest kratom he can get. But it's hard to be completely certain: McKenna and his overseas vendor have never met and only correspond via email. "The reason he's been in business for such a long time is he completely stays away from the limelight," McKenna said. "He's a little paranoid, he has a lot to worry about."
McKenna marks his kratom as "not for human consumption" and ships it to customers, hoping those words will help him avoid FDA scrutiny.
Even if it were properly regulated, kratom isn't totally harmless, and it doesn't represent a magic bullet to the opiate epidemic. But at the very least it's a promising option—one at risk of being shoved aside without adequate research or discussion around regulation. "We're probably now just starting to see some sort of plateau in terms of opioid-related deaths, and that's a combination of everything from increased awareness to legislation to medication-assisted therapy to take home naloxone," Kavita Babu, a fellowship director in medical toxicology and associate professor in the Department of Emergency Medicine at UMass Memorial, said. "We should be exploring all options."
The overwhelming majority of anecdotal reports on kratom suggest it has clinical value, but they're just that—anecdotes. What everyone I spoke to agrees on is that we need more research to know for sure. Studies on mice, rats, and dogs also show that the component chemicals in kratom have promise, but controlled human trials are needed before it can be regulated and safely prescribed to patients. "If it's seen that it can help then that should be the case," Carlucci said of potentially prescribing kratom. Even McKenna, whose livelihood depends on his ability to sell kratom, thinks it should be regulated. He wants to see standards in place to keep the product safe and pure. Regulation would mean treatment without the fear of accidentally ingesting cadmium or rat poison.
Even if it's a long way off, Dr. Prozialeck speculates that kratom might eventually find a niche similar to medical marijuana. "It's a last resort for patients, and it can help patients, even though most docs will not recommend medical marijuana if they have access to it. Maybe kratom will evolve in the same way," he said, "But hopefully it would be with the FDA's blessing."
*names changed or omitted