An increasingly vocal online community of users say the ground-up plant is a valuable natural painkiller. But is it next in a line of sketchy legal highs?
In January, an Oklahoma City TV station warned viewers about kratom, a new drug said to be rapidly taking hold in the community.
"Users say it's the legal form of heroin, with hallucinogenic effects like LSD," reported KOKH-TV, Oklahoma City's Fox affiliate.
At low doses, kratom has a stimulant effect, the station reported, but users had begun taking "high doses, two to three pills at a time, several times a day" and were experiencing the opposite result—something comparable to taking "a fistful of very strong painkillers," according to an Oklahoma Bureau of Narcotics spokesman quoted in the report. Another source, identified as "a man on YouTube," apparently took "several of the pills" and said it felt like he had taken "40 to 60 milligrams of OxyContin."
Kratom, which is the ground-up leaf of a tree native to Southeast Asia and typically either consumed in capsule form or brewed into a tea, had already "sent one Oklahoma [sic] to the hospital," the station reported. State officials told KOKH they were concerned more residents would get sick, with kratom increasingly available in convenience stores, gas stations and, in particular, on the Internet.
Similar reports have aired on local newscasts across the country, telling viewers that kratom is dangerous and potentially addictive, frequently featuring local law enforcement officials or drug counselors comparing it to heroin and to recently trendy synthetic drugs like bath salts, K2, and Spice.
But an increasingly vocal online community of kratom users and vendors say it's a relatively harmless drug that's been safely used for centuries in the areas of the world where it's originally found.
Advocates say kratom's valuable as a natural painkiller, especially for patients suffering long-term discomfort from conditions like multiple sclerosis and fibromyalgia, and as an aide to those looking to fight addiction. It's also touted as an herbal treatment for anxiety and attention deficit disorder and, in lower doses, as a stimulant that avoids the jittery feeling caused by too much caffeine.
"The best way I can compare to it is kind of the feeling you get after you work out," said Phil Hackley, whose company Divinity Products sells kratom capsules as well as packaged teas and sweetened drinks containing kratom. Hackley told me he's long been in the food business, making and distributing products like salsa and barbecue sauce, and makes kratom products to the same quality standards as any other food.
"It wouldn't be so popular if it was a dangerous LSD-slash-heroin mixture of drugs that the media makes it out to be," he said. "It wouldn't be so popular throughout mainstream America."
Chemicals in kratom do, in fact, bond to opiate receptors in the brain, medical researchers have found, explaining why it's historically been used in Thailand both as a painkiller and as a treatment for addicts undergoing opiate withdrawal. At lower doses, it indeed acts as a stimulant and was historically used by Thai laborers looking "to increase work output," according to a 1988 paper in the Journal of Psychoactive Drugs.
More recently, it's been formally studied as an alternative to methadone in treating opiate addiction, with one study showing mitragynine, one of kratom's active ingredients, prevents withdrawal symptoms in lab rats.
A 2008 paper in the journal Addiction described a patient with chronic pain who successfully switched from injecting ground-up Dilaudid pills to drinking kratom tea, with minimal withdrawal symptoms. Ultimately, he suffered a seizure after taking kratom simultaneously with the wakefulness drug modafinil—the cause of the seizure wasn't clear, but he quit taking kratom afterward.
"He described a period of withdrawal considerably less intense but more protracted than that from prescription opioids," according to the paper. It's easy to find extensive anecdotal examples online of others using kratom to quit opiates, although Edward W. Boyer, a professor at the University of Massachusetts Medical School and one of the authors of the Addiction paper, cautions it can be habit-forming in its own right.
"It has opioid activity like any other opioid, and to suggest that it doesn't have any abuse liability would be irresponsible and scientifically incorrect," he told me.
As far as seizures, Dr. Boyer said there are a handful of reports in the toxicology literature each year of seizures in kratom users. "But what you don't know what the denominator is," he said, explaining it's not known how many people are using kratom nationwide. And doctors might not think to ask patients experiencing seizures if they've been using kratom, and patients with a history of drug abuse can be less than forthcoming about the substances they've ingested, he said.
The Food and Drug Administration has also warned about kratom, saying in a February notice that it considers kratom and kratom-based supplements to be adulterated food subject to seizure, based on a law requiring new supplement ingredients be shown to be reasonably expected to be safe. Ingredients marketed in the U.S before 1994 are exempt from the rule, but the FDA said it hasn't seen evidence kratom meets that requirement.
The FDA alert also cites a number of side effects the agency says have been associated with kratom, from respiratory depression to loss of libido to skin hyperpigmentation.
"While we may not be the quickest turtle in the race, we do have access to the same science as everyone else," said Dr. Daniel Fabricant, the FDA's director of dietary supplements.
"I don't know of any food that I eat that has opiate activity," he told me. "Certainly that troubles us." Despite the FDA's official policy, though, kratom remains widely available online and on store shelves; when asked about that discrepancy, Dr. Fabricant said he can't discuss ongoing cases.
Kratom's defenders say that, overall, fears about the herb are overblown--that kratom's simply the latest victim of drug war hysteria and the medical establishment's suspicion toward natural medicines.
Robert McMahan, whose company Coastal Kratom sells powdered kratom and capsules online, told me he initially learned of kratom while recovering from a serious injury.
"Basically, in 2005, I was working on a roof on a home that is two stories, " he said. "Long story short, I fell off the roof [and] landed right on the concrete."
He spent a couple of weeks in the intensive care unit, and wouldn't walk again for another year, he said. He was given various prescription painkillers, but ultimately doctors cut him off, leaving him with flulike withdrawal symptoms and lingering pain.
"I started researching alternative pain treatments, and somehow I ran across kratom," he said. When he tried it, he found it treated his pain at least as well as the hydrocodone-based drugs he had been prescribed and helped lift him out of a lingering depression.
"I felt like, 'I'm gonna conquer this; this, too, shall pass,'" he said. "[Later,] after completely being healed, I almost felt it was my calling to spread, because nobody I'd talked to had heard about this herb."
McMahan said that, not being a doctor, he doesn't formally advocate using kratom to treat any particular disease. But, he said, he regularly hears from customers successfully using it for a variety of ailments. He gets frustrated with news reports that only focus on the dangers of kratom, he said.
"I felt like, 'I'm gonna conquer this; this, too, shall pass. [Later,] after completely being healed, I almost felt it was my calling to spread, because nobody I'd talked to had heard about this herb."
"I get so angry when I see the negative, and there's no positive whatsoever, and it's always one-sided, and it really irks," he said, comparing the media portrayals to "21st Century reefer madness."
Unlike 1930s marijuana users, though, today's kratom users and vendors are able to use the Internet to organize in response to what they call alarmist reporting and to fight various state and local efforts to ban the substance.
When the Vermont legislature planned last year to include kratom in a bill banning a variety of substances, advocates were able to rally to the herb's defense, with Bill Lockwood, the owner of online kratom store Major Kratom, testifying and presenting testimonials from pain patients and other kratom users. "They were interested in what we had to say," Lockwood told me.
"They were interested in what kratom did, and they also countered by asking the representatives from the state toxicity lab [who advocated the ban] what was bad about kratom."
Ultimately, the bill banned 7-hydroxy-mitragynine, a chemical extracted from kratom, but made no mention of the leaf itself. Many kratom advocates distinguish between pure kratom leaf and "extracts" that contain heightened levels of the plant's active ingredients.
"They've made 100-times extracts," said Enoch. "People who really need it are saying, 'What the hell are you doing?'"
Lockwood and legislators he spoke with believe the law as passed places the leaf in the clear; by contrast, he said, Vermont law separately bans both cocaine and the coca leaf from which it's extracted.
"They agreed that the high-potency extracts were causing the problem and were the subject of abuse," once digitally connected advocates were able to explain the difference between the products, said Enoch.
And after KOKH, the Oklahoma City Fox affiliate, ran its initial report about kratom, the station received "a pile of viewer emails" from users and supporters of the substance and ran a second report including their arguments alongside those from state officials looking to ban kratom.
Similarly, when Forbes contributor David DiSalvo wrote a column many saw as critical of kratom, he received numerous comments and emails from its supporters and, as a result, agreed to try using it himself. His final review was favorable.
"My overall comment on Kratom is that it's a lot like good coffee, but with a more even, long-lasting energy effect, and a much more pleasant 'finish,'" he wrote. And as far as withdrawal, he experienced fewer symptoms than he would abandoning caffeine, he wrote.
"Having now experienced the product myself for a number of weeks, I can see no reason why it should be banned, or on what basis such a product would be banned if people can walk into a typical coffee shop and buy an enormous cup of an addictive substance that's arguably more potent than any kratom available anywhere," DiSalvo wrote.
Even before it was used to rally kratom's defenders, the Web was instrumental in the plant's rise in popularity.
"Probably the only reason it's being used in the U.S is because of the Internet," said Lockwood.
A 2007 paper by Dr. Boyer and others in the American Journal of Addiction documented a rapid rise in mentions of kratom on Drugbuyers.com, a forum then popular among purchasers of prescription opiates through grey market online pharmacies.
When those pharmacies were shut down in 2006, a number of their customers switched to using kratom, Dr. Boyer said.
Today, numerous online forums, including a Subreddit, are devoted to kratom, letting users discuss different strains, vendors and dosing options and warning newcomers away from the concentrated extracts and impure products they say are sold at gas stations and head shops.
"They put all kinds of things on them," said Enoch. "They put half-naked women on Mylar packaging."
Unscrupulous kratom vendors have been found to lace their products with other opioid drugs to boost their efficacy. One blend, marketed as Krypton, was found to contain an additional opiate related to tramadol and blamed for at least nine fatal overdoses in Sweden. In another case, cited by Dr. Boyer, a patient in Colorado suffered ill effects after taking kratom that had been laced with hydrocodone.
"So the person was actually treating their opioid addiction with outright opioid," Dr. Boyer said.
In the absence of clear regulation, web forums and groups like the Kratom Association, which maintains a list of certified sellers, have effectively taken on the role of steering consumers to reliable suppliers.
"There's a lot of forums – there's kratomforum.com," said McMahan. "There's a huge, open discussion of just about any vendor out there."
And, despite the warnings by the FDA and state regulators, there's a steady supply of new vendors and of customers who swear by the plant, he said.
"People [are] getting on these fibromyalgia forums and MS forums and talking about how it's saved their life," he said.