While many Americans see drugs like fentanyl and methamphetamine contributing to the drug crisis, another drug has recently emerged as a threat to public health: kratom.
This opioid-like substance has contributed to hundreds of overdoses, but is promoted as the next wonder drug by well-funded lobbyists. It’s heartening to see legislators already weighing their options, and Californians would be well-served by their representatives taking action to ban sales of kratom. But more must also be done by our leaders in Washington D.C., where this drug should be classified as a Schedule 1 substance to ban its sale.
According to the National Institute on Drug Abuse, kratom “commonly refers to an herbal substance that can produce opioid- and stimulant-like effects,” and “refers to both mitragyna speciosa, a tree native to Southeast Asia, and to products derived from its leaves that are marketed as herbal supplements.” Several states and D.C. have banned or regulated kratom, but for those that haven’t, it’s easily accessible — available to buy at gas stations or online.
Its use has only increased in the U.S. According to the National Survey on Drug Use and Health, the number of lifetime users increased from 4.5 million in 2021 to 4.9 million in 2022 — a 10% increase in one year. The number of past-month users, indicative of heavier use, increased by 26% over this same period. For context, in 2022, there were more past-month users of kratom than past-month users of illegally-made fentanyl and crack, combined.
Proponents claim kratom is a substitute for pain medications that manages their mental health issues and withdrawal symptoms.
These misconceptions are driving more interest, and the nascent, profit-driven kratom industry is only beginning to fan the flames of the problem. The industry is estimated to be worth $1.5 billion.
These sales are tolerated because kratom operates in a gray area, where it is neither legal nor technically illegal. The FDA has not approved kratom for any use — it is not approved as a drug product, a dietary supplement or a food additive. Despite this, the federal government has taken a hands-off approach and has not banned these products.
It is no surprise that kratom-related harms have grown. The Tampa Bay Times found there were 587 kratom-involved overdose deaths in Florida between January 2010 and June 2022. In 2022, there were 1,278 calls to poison control centers about kratom (compared to 372 in 2017 and only one in 2016). A 2023 report from the Congressional Research Service noted, “some kratom products intended for sale in the United States have been found to contain dangerous contaminants, such as salmonella and heavy metals.”
In 2018, the FDA issued a mandatory recall for certain kratom products after a company selling them refused a voluntary recall. This was the agency’s first-ever mandatory recall of contaminated food products. The DEA warned, “kratom consumption can lead to addiction.”
Yet the industry and its allies continue to downplay these harms. Just as we have seen with opioids, tobacco, alcohol and marijuana, the kratom industry will pursue profits at the expense of public health. The American Kratom Association is the lead group that has been quietly working throughout the country to legalize these products and prevent them from being banned. They routinely downplay the harms of kratom claiming they “are not aware of child or infant poisonings.” However, between 2020 and 2022, there were more than 200 calls to poison control centers about kratom poisonings among children younger than five.
Recognizing these harms and knowing that the industry and its allies cannot be trusted to act in good faith, policymakers must ban these products and classify them as Schedule 1 substances, meaning they have a high potential for abuse and no accepted medical use. According to the Mayo Clinic, “the effects of kratom have identified many safety concerns and no clear benefits.” As the DEA works to schedule kratom, states should also work to ban it.
The public is beginning to wake up to the harms of kratom, and more must be done to protect public health.
This piece originally ran in the Sacramento Bee.