What Is Kratom? Why Has the DEA Wanted to Ban It?

October 12, 2016

Editor's note: This story was originally published by WebMD on September 19. It was updated on October 12, with the DEA withdrawing its intent to ban kratom and establishing a public comment period.

Advocates say the herb kratom offers relief from pain, depression, and anxiety. Scientists say it may hold the key to treating chronic pain and may even be a tool to combat addiction to opioid medications.

But the Drug Enforcement Administration (DEA) was initially moving to ban its sale as of Sept. 30, citing an "imminent hazard to public safety." The DEA in August announced it would make kratom a Schedule 1 drug -- the same as heroin, LSD, marijuana, and ecstasy.

The decision was delayed after members of Congress urged the DEA to delay the ban and give the public a chance to comment.

The DEA has withdrawn its intent to make kratom a Schedule 1 drug and established a public comment period through Dec. 1, according to a preliminary document available on the Federal Register website and set to be published on Oct. 13.

The DEA "has received numerous comments from members of the public challenging the scheduling action and requesting that the agency consider those comments and accompanying information before taking further action," Chuck Rosenberg, acting administrator, wrote in the preliminary document.

The DEA also has asked the FDA to speed up a previously requested scientific and medical evaluation of kratom and a scheduling recommendation.

The agency says kratom has a high potential for abuse and no current medical use. But its announcement sparked outrage. Opponents rallied in front of the White House against the ban, and more than 142,000 people signed a petition asking the federal government to reconsider.

Some research scientists were among those pushing to reverse the decision, saying a ban will harm their ability to study whether kratom can help treat pain and addiction. In the meantime, users rushed to buy the supplement before it became illegal.

Groups opposing the ban applauded the DEA's action.

"Everyone needs to understand that this is just the beginning of the fight and much more work remains to be done," says a joint statement issued by the American Kratom Association and the Botanical Education Alliance. "We cannot and will not rest until the cloud created by the DEA is completely removed."

Here's what we know about kratom.

How Kratom Works

In mice, kratom targets a part of the brain that responds to drugs like morphine, codeine, and fentanyl, according to a study published earlier this month by Susruta Majumdar, PhD, a researcher at Memorial Sloan Kettering Cancer Center in New York. These types of drugs are called opioids.

Majumdar's study found that unlike morphine, a synthetic compound derived from kratom (Mitragynine pseudoindoxyl) does not lead to harmful side effects like slowed breathing -- called respiratory depression -- constipation, and physical dependence. Since most deaths from opioid overdose are because of respiratory depression, he believes kratom merits further study to see if some of its compounds can be harnessed for medical benefits that are potentially less addictive.

"I'm not a kratom advocate," Majumdar says. "I'm not going to say it is a solution for everything, but there is early promise and scheduling is premature in my humble opinion."

Kratom remains poorly understood, says Edward W. Boyer, MD, PhD, a professor of emergency medicine at the University of Massachusetts Medical School. He knows of a case where a man successfully treated his opioid withdrawal with kratom.

"Most people with opioid withdrawal have abdominal pain, diarrhea, dysphoria.

This guy really only had a runny nose, and that is pretty remarkable," Boyer says. "I'm not willing to say [kratom] is great for everyone. I'm just ready to say that is pretty interesting and it should probably be studied more in a controlled way."

Walter C. Prozialeck, PhD, chair of the department of pharmacology at Midwestern University in Illinois, analyzed about 100 studies on kratom. He says one major question remains: How addictive is kratom?

Anecdotal reports suggest it is less addictive than opioids, but he says many companies in the U.S. advertise it as a legal high. Several Southeast Asian countries have outlawed it because of addiction concerns.

Prozialeck's review also found that in almost every case of reported kratom side effects, there were other things involved, like other drugs or health conditions. And since it's been sold as an herbal supplement, kratom hasn't received the same amount of governmental oversight as an approved drug.

"So we go from no regulation at all to a total ban. It seems like there could be some middle ground somewhere," Prozialeck says.

Given all these questions, Prozialeck says doctors aren't likely to recommend kratom to patients. But he says many in the scientific community do support more research on the drug, especially given the nation's opioid epidemic.

"If it lived up to its billing, some of the compounds in kratom could be useful at least as the basis for the development of better drugs that would treat pain without the addictive benefit of opioids. That would be an amazing advance in pain management," Prozialeck says. "But nobody knows how research will turn out. It could be a dead end. The biggest negative of the DEA ban is it will stifle any research in this area."

What's Next?

DEA spokesman Russ Baer says there is no discussion within the agency to reverse the scheduling decision. But the decision is temporary, and the agency has up to 3 years to convince the FDA to make kratom a Schedule I drug permanently. During that time, if research warrants, the decision could be reconsidered.

Baer says the DEA has reversed a scheduling decision once in 2004, on a drug called TFMPP, which is used as a legal alternative to ecstasy.

SOURCES:

Edward W. Boyer, MD, PhD, University of Massachusetts Medical School, Worcester, MA.

Walter C. Prozialeck, PhD, Midwestern University, Downers Grove, IL.

Saruta Majumdar, PhD, Memorial Sloan-Kettering Cancer Center, New York.

Petition.whitehouse.gov: "Please do not make Kratom a Schedule I Substance."

Boyer, E., Addiction, June 2008.

Prozialeck, W. The Journal of the American Osteopathic Association, December 2012.

Majumdar, S. Journal of Medicinal Chemistry, Sept. 2, 2016.

Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, July 29, 2016 "Notes from the Field: Kratom (Mitragyna speciosa) Exposures Reported to Poison Centers — United States, 2010–2015.

U.S. Drug Enforcement Administration, Drugs of Abuse: A DEA resource guide and "DEA Announces Intent to Schedule Kratom."

Russ Baer, spokesman, DEA.

Huffington Post: "Congress Calls Out DEA For Unilateral Move To Expand The War On Drugs."

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....