Time to crack down?

The plant that’s been hailed as a potential treatment for opioid use disorder has also been behind a staggering 6,500% increase in poison center calls nationwide over the last decade and a half.

Kratom trees are native to parts of Southeast Asia, and their leaves have grabbed the attention of the global narcotics trade amid growing demand for pills, powders and concentrated liquids that can produce “opioid- and stimulant-like effects,” according to the National Institute on Drug Abuse (NIDA).

Like its sister drug, kava, kratom derivatives have been used as traditional medicine for centuries. But its mostly unregulated proliferation throughout the US has led to rampant misuse and a spike in severe side effects, as detailed in a new report from the Society for the Study of Addiction and the Medical College of Wisconsin.

Looking at data from America’s Poison Centers, the authors noted only 19 cases of general kratom exposures in 2010 compared to 1,242 cases in 2023.  

In 2010, none of those cases were associated with “severe outcomes” — marked by “life-threatening effects, significant residual disability or death” — and it wasn’t until 2012 that a severe outcome was even reported. 

But by 2023, those numbers had jumped to 158 cases. 

Kratom and the FDA don’t get along: The agency has not approved it for medical use, and it’s not currently scheduled under the US Controlled Substances Act. This has meant that individual states are left to set their own regulations — and many have chosen not to. 

Per lead study author Dr. Ryan Feldman, of the Medical College of Wisconsin, the states with no regulations “consistently had worse outcomes in this study than states that banned kratom use.”

“As kratom use rises, and concerns over kratom and its risks increase, legislatures across the country are debating the best ways to regulate its use,” he said.

Without enough solid study of the effects of widespread kratom use, policymakers aren’t always certain about the best path forward for their constituents. But scientists are starting to paint a clearer picture.

Feldman said emerging research shows that kratom can have some seriously scary side effects like seizures, irregular heart rhythms, liver damage and breathing problems. 

Data from his own study shows that “nearly 1 in 7 cases reported to a poison center with a single-substance kratom exposure were admitted to a hospital, and 1 in 16 were admitted to a critical care unit.” 

And if kratom is combined with other drugs, as his research shows it often is, “kratom’s tendency to interfere with metabolic pathways” can make the other drugs more dangerous.

Still, according to NIDA, which “supports and conducts research to evaluate potential medicinal uses for kratom and related chemical compounds,” deaths linked to kratom use remain very rare, and almost all cases “involved other drugs or contaminants.”

The FDA website says regular kratom users typically report using less than 6 grams of botanical kratom at a time, often to “self-treat conditions such as pain, coughing, diarrhea, anxiety and depression, opioid use disorder and opioid withdrawal.” 

Given the widespread devastation of the dual opioid and chronic pain epidemics, medical experts and researchers have been scrambling to find a safe alternative for pain management and opioid use disorder treatment. Sectors of the medical community only recently embraced kratom as a potential option.

The Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health found that, in 2021, around 1.7 million Americans age 12 and older had used kratom in some capacity.

Ultimately, Feldman is calling for better oversight, because — as his research shows — “the kratom problem is not going away anytime soon.”