EILI WRIGHT, Health and Poverty Fellow—

In Ohio, opioid addiction is consistently at the forefront of the public safety agenda. In Licking County alone there were 42 unintentional overdose deaths in 2018, and the numbers are rapidly increasing. Various public health initiatives around the country work hard to find new ways to accommodate the issue, including sharps exchange locations where addicts can obtain clean needles, safe drug drop-offs at police stations and some solutions even going as far as Oregon’s decision to decriminalize heroin and other street drugs. 

One nontraditional solution that has shown promise, but is still highly dangerous and unresearched, is the potential of a substance called kratom that could help recovering addicts curb withdrawal symptoms, leading to a less painful rehabilitation.

Kratom is a substance originating in Southeastern Asia, specifically Indonesia. In recent years as kratom entered the U.S. and European market, it has become a widely popular substance due to the behavioral effects on those who ingest it. According to the American Kratom Association, “Kratom, or Mitragyna speciosa, is a tropical tree, part of the coffee family, with medicinal, stimulant and psychotropic properties.” It is not a mild substance and because of its opiate-like effects, even though it is less addictive than heroin or crack, it can still be addictive over long periods of time, resulting in many negative health consequences.

Despite the risk, on the American Kratom Association website there are multiple testimonies advocating for the use of kratom. There are articles from veterans arguing that it mitigates symptoms of PTSD, others vouching for its help with chronic injury pain, and there are many, many more. Not only do people use it for mental and physical health, but because kratom’s stimulant properties mimic very closely the effects of opioids—and isn’t as addictive—some believe it could be helpful due to its ability to curb withdrawal symptoms. 

The problem is, kratom is not a regulated substance. In 2016, the DEA temporarily listed kratom as a Schedule I drug, citing an immediate public safety risk. The DEA listed the reason as “the identity, purity levels, and quantity of these substances are uncertain and inconsistent.” Other drug examples listed in Schedule I are heroin, marijuana, and ecstasy. The DEA classifies drugs under Schedule I according to these qualifications: “those that have a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision.” The Food and Drug Administration has also not approved the use of kratom, and even warns consumers not to use it.  

In 2018, the FDA sent a warning letter to a company called The Kratom Spot, demanding them to stop the sale of their kratom or the FDA would begin legal action. The FDA cited their blog posts as untruthful and harmful due to the lack of understanding about the substance. The Kratom Spot’s blog posts claim positive outcomes from the use of kratom, listing long-term cures and solutions to various ailments.  “Many of our customers have reported that kratom has helped them quit the use of heroin and synthetic drugs. The mood elevation qualities of kratom reduces opiate withdrawal effects.” The FDA cited it as harmful because there is no evidence that kratom can fix illnesses, addictions, or mental health problems, and kratom is a very easy substance to manipulate. Some kratom suppliers have been shut down, but a quick Google search will show kratom capsules, powders, and patches widely available to the public without much evidence about where they came from. 

The big problem is the inconsistent legality and regulation of kratom. Even when the DEA listed kratom as a Schedule I drug, they received heavy backlash and decided to end the ban after a two-year span. In 2019, however, an article was published by the New York Times showing “that kratom had been found to be a cause of death by medical examiners or coroners in 91 out of 27,000 overdose deaths examined by the agency over an 18-month period ending in December 2017.” 

In 2021, kratom is still unregulated yet completely legal in the state of Ohio. There are stores made specifically for the sale of kratom right outside of Columbus, and even some right down the road from Denison that sell it over the counter. But there are still no rules about the purity of kratom or the quantity of other substances included in products sold to the public. It remains unapproved by the FDA and is even completely illegal in Ohio’s neighboring state, Indiana. All of this controversy begs the question, when will kratom be regulated in the United States, and what will the potential benefits be?