A Review of the medicinal herb Kratom from our new side project TGN Herbalism
Debates are being sparked across the country over what, if anything, the government should do in response to the recent surge in popularity of the psychoactive herb known as kratom. Hailed by its proponents as a miracle drug, kratom is a tropical evergreen tree in the coffee family that grows in the rainforests of Southeast Asia. In the West, it is typically sold in the form of finely ground leaf powder, which is then brewed into tea or made into capsules. A typical dose can cost less than 50 cents. Kratom contains a medley of psychoactive and medicinal alkaloids, the primary effects of which include pain relief, muscle relaxation, and mild paradoxical stimulating/sedating effects on the central nervous system. Users claim it to be the most effective solution available for pain relief, without the severe side effects of opioid painkillers or even those of over-the-counter drugs like acetaminophen. Additionally, since its mechanism of action in the brain is somewhat similar to that of opioids, it has been widely used with great success for the treatment of opioid withdrawal. Many believe it holds the key to solving the opioid crisis, freeing addicts from the withdrawal symptoms that keep them stuck and providing a far less risky alternative to prescription painkillers for those who need them.
Despite this, many government agencies have expressed concern about kratom as a drug of abuse and have moved to ban it. In 2016, the United States DEA announced its intention to place kratom in Schedule I of the Controlled Substances Act, the same class as heroin and LSD. After a massive public and scholarly outcry, the DEA rescinded its plans. However, since then, many state government bodies have moved to ban the drug, and it is currently illegal in Alabama, Arkansas, Wisconsin, Vermont, Rhode Island, and Indiana. Furthermore, the FDA under Commissioner Scott Gottlieb has been pushing the DEA to act on a federal level. This has been accompanied by misleading and sensationalist claims, such as when the Ohio Board of Pharmacy said that most users are injecting the herb (which is impossible), or when the FDA released a list of “kratom deaths” in which every single individual minus one had another easily identifiable cause of death listed (the kratom in their system was coincidental). The misinformation, fear-mongering, and brash, hasty reactions calling for a flat-out ban are eerily reminiscent of the 20th century “reefer madness”; ironic considering that the US is just finally emerging from that misstep now. Stay tuned for more in-depth write-ups on the subject, but here’s the quick run-down on why the feds are dead wrong:
- Kratom isn’t a gateway to drugs — it’s a gateway to sobriety. People don’t use kratom to get high; more often they’re using kratom to stop getting high. If someone is looking to abuse a drug, kratom is not a very good option. It can only be taken orally, is very unpleasant to consume in excessive amounts, and produces effects that are mild and take time to set in. The vast majority of people using kratom, whether they’re using it to treat pain or addiction, are using it in order to get away from opioids. With that taken into account, why on earth would you ban it, unless you want those people back on opioids? Banning kratom would worsen the quality of life of millions of Americans, prevent patients from receiving a potential breakthrough treatment, and lead countless people back into opioid addiction — likely to result in their deaths.
- Kratom has a low, but not zero, dependence liability. Unlike prescription opioids or anti-anxiety medications, which can addict a user in 4 days, one has to take kratom non-stop throughout the day for months in order to become dependent on it. Dependency is more mild than that of anti-depressants, antipsychotics, or muscle relaxers (which are not controlled substances), let alone opioids or benzodiazepines. In fact, the most common treatment for opioid addiction in the US today is Suboxone, which is itself an opioid far more addictive than kratom. Withdrawal symptoms from kratom typically only include a runny nose, insomnia, diarrhea, and soreness. Compare to the absolute horror of opioid withdrawal, or to alcohol and benzodiazepine withdrawal which can often cause seizures, delirium, and even death. Also consider that the vast majority of those who are dependent on kratom were previously addicted to something that is infinitely more dangerous, whether under the supervision of a doctor or not.
- Kratom doesn’t cause users to be impaired, detached from reality, fiendish, strung-out, etc. Kratom has paradoxical stimulant effects which are often compared to those of coffee, but without the jitters. Compare to other pain medications and opioid replacement drugs, which are heavily intoxicating. Nobody is strung out because of kratom. Nobody lost their job or their family because of kratom. If anything, it’s the other way around.
- It is practically impossible to overdose on kratom. It’s possible in theory, sure — just like overdosing on THC. In practice, it’s not going to happen. Taking too large a dose generally only results in dizziness and vomiting at the worst — compare to Tylenol, which kills thousands in the US each year. However, more research needs to be done into what interactions between kratom and other drugs may exist, as these may (or may not) in rare cases be dangerous.
- While the alkaloids in kratom do bind to the brain’s opioid receptors, the mechanism of action is very different from that of opioids. The FDA’s claims otherwise are based on a computer simulation and not actual studies (which contradict them) — in other words, junk science. Kratom also affects a number of other sites in the brain, such as serotonin and noradrenalin receptors, which results in a wide variety of effects including reduced inflammation, blood pressure, and anxiety. Opioids of abuse are selective full agonists of the mu-opioid receptors, which means they specifically seek out that receptor type and fully activate its signalling to other parts of the brain. Kratom, on the other hand, acts as a partial agonist, which results in a more mild effect. The only other partial mu-opioid agonist available on the market is buprenorphine (Suboxone). As a result of this, both buprenorphine and kratom are unable to cause fatal overdose, as there is a “ceiling” to the level of effects that can be achieved with increasing dosages.
- However, there is another major difference that makes kratom unique from buprenorphine/Suboxone and all opioids. The mu-opioid receptor has two different signalling pathways, which result in differing effects. The first one, the G-protein pathway, is responsible for most of the desired effects of opioids — mainly relief from pain, anxiety, and certain gastrointestinal disturbances, as well as slight euphoria. The beta-arrestin pathway, on the other hand, is responsible for the severity of the side effects of opioids — constipation, dizziness, sedation, cognitive impairment, an extremely powerful reinforcing effect, strong addiction with hellish withdrawal symptoms, and, most importantly, respiratory depression — the cause of death in opioid overdose. Opioid drugs, and even buprenorphine/Suboxone, activate both of these pathways indiscriminately. Kratom, on the other hand, only activates the G-protein pathway, and thus does not produce strong euphoric effects or result in severe addiction.
- The War on Drugs has been a colossal and deadly failure. Use of controlled substances has skyrocketed since the Controlled Substances Act took effect in 1971. Billions, if not trillions of dollars wasted, millions of people thrown in prison, and innumerable lives ruined, only for it to have the opposite of the intended effect. Crack epidemic, meth epidemic, opioid epidemic — it’s abundantly clear that this does not work! We should not be expanding the War on Drugs, but rather looking towards alternative ways to deal with the drug problem in this country — and kratom is one of those alternatives.
- If kratom gets banned, further research into its uses and risk profile will not be able to occur. The government’s argument is that there’s a lack of clinical trials proving that kratom is any safer than opioids in humans, or that it works to treat any condition. They fail to take into consideration that there is no research proving the opposite either. The absence of evidence is not the evidence of absence, and banning the substance would make it impossible for such evidence to ever arise. This is similar to the case of cannabis, where it took decades for its actual medicinal potential to be uncovered due to draconian laws. If these bureaucrats were unbiased, why would they not wait for the research to be done? Based on this, it seems they’re not actually interested in the research — they’re just using this as an argumentative tactic.
- Pharmaceutical companies are aware of kratom’s potential and are scared of it cutting into their profits. Under the new Commissioner, Scott Gottlieb, the FDA has been pushing strongly against kratom, advising the DEA to place it in Schedule I. Mr. Gottlieb was previously on the board of the Big Pharma giant GlaxoSmithKline, which acquired two patents for alkaloids derived from kratom. These patents clearly described its low abuse potential, favorable side effect profile, and medicinal applications. Now Mr. Gottlieb wants to claim it’s the opposite, and has even gone as far as to encourage Americans on Twitter who take kratom to switch to the highly-addictive prescription opioid Suboxone instead! These corporations make tens of billions of dollars per year off of people who are addicted to their opioid drugs, funnel massive amounts of money into lobbying the federal government, and have a revolving door between their board rooms and executive positions in bureaucratic agencies tasked with regulating their very industry. In light of all the evidence, there is no alternative explanation that makes sense as to why the government wants to ban kratom — their claims fly in the face of everything we know about the herb, as well as reason and common sense.
Millions of Americans, including this author, have had their lives transformed by kratom. If you’d like to help fight the government’s efforts to ban this gift from Mother Nature, please visit the website of the American Kratom Association and consider making a donation to support their research, lobbying, and awareness efforts. If you have a story regarding kratom or any thoughts you’d like to share, by all means do so in the comments below.