FDA Seeks Stricter Regulations as Kratom Abuse Increase
As the country continues to seek solutions for the growing opioid epidemic and the fatalities that it is piling up, a new issue is beginning to come under fire from regulators: kratom abuse. Kratom, which is derived from a plant that is native to Southeast Asia, has become increasingly popular in the United States due to its opioid like properties. A growing number of individuals use the drug either to ease the withdrawal symptoms of opioids or to abuse it as an alternative to drugs like heroin or prescription pain killers.
Recently the FDA released a statement citing the dangers of Kratom and claimed that it was currently working diligently to increase regulation of the drug. The statement cited 36 kratom-related deaths as the basis for a warning it provided insisting that the drug has no approved therapeutic uses or reliable evidence of efficacy as a treatment for opioid withdrawal and that its use comes with serious side effects including seizures, liver damage and possibly fatal overdose.
Of the 36 kratom-related deaths cited in the report, none of them appear to be solely related to kratom but instead included alongside the use of other drugs which combined to cause fatal overdoses. The FDA did cite a major concern however as kratom abuse continues to increase as regulation surrounding the dangerous substance is still somewhat undefined.
Staunch supporters of the therapeutic uses of the drug state that it is a viable herbal alternative to pharmaceuticals like opioid pain killers and benzodiazepines, claiming that strict regulation is more about preserving the interests of pharmaceutical companies than it is about public safety. However, these claims are dubious as an increasing number of serious negative implications from kratom abuse are coming to light. Issues such as a significant potential for abuse to serious physical withdrawal are becoming more apparent as the number of kratom users across the country continues to grow.
What is kratom?
Kratom is a naturally growing evergreen plant which is in the coffee family and is native to Southeast Asia including Thailand, Indonesia and Malaysia. It has been utilized in traditional local medicine for at least the past 200 years and most likely far longer than that for its opioid and stimulant like properties. However, it has become increasingly popular in the West over the past decade as a legal and easy to access alternative to other opioids such as heroin, oxycontin and fentanyl.
While kratom is not an opiate, it does have properties and effects which can be very similar, which is why many who are struggling with kratom abuse have struggled with opiate abuse in the past. The drug binds to the same receptors in the brain as opiates do, which is the reason why many users report pain relieving effects as well as the ability to ease the uncomfortable withdrawal symptoms associated with opiate withdrawal. The drug is also not typically tested for in conventional drug tests, which is why many users of the drug claim to use it. Particularly opiate addicts who know they are going to be drug tested regularly, the drug is popular as an untraceable alternative as in large doses it has very similar to effects of opiates like heroin, oxycodone or hydrocodone.
The fact that kratom is a relatively new substance in western culture means that until recently it was completely unregulated and universally legal. It began to grow in popularity along with other “new” drugs like synthetic marijuana and bath salts which were sold in smoke shops and gas stations and became known as an easily accessible and legal way to get high. Since then Kratom abuse has been steadily increasing across the country, and this has been compounded by the fact that the opiate epidemic across the country is such a massive issue.
There are some advocates of the drug, stating that kratom is a natural, safe and non-addictive way to help not only overcome opiate withdrawal and addiction, but also for other ailments such as chronic pain and even anxiety. The FDA however cites the fact that no scientific research has shown clinical evidence for this to be true, and many anecdotal stories about the drug seem to point to the fact that the drug is not only addictive but carries with it a significant risk of physical dependence and withdrawal symptoms, in fact there is a growing When combined with other substances like opiates or benzodiazepines, it may increase the risk of fatal overdose as well, which is why the FDA is making a strong push for significantly increased regulation of the drug because of the significant increase in kratom abuse across the country.
The dangers of kratom abuse
While kratom abuse is a relatively new issue that the country is facing, there are some very real concerns and dangers which are becoming quite apparent. Still, much of the more subtle and long-term effects of kratom abuse are still unknown. The Drug Enforcement Administration classifies kratom as a “drug of concern” however it is not federally regulated at this time. There are some state and local regulations on the drug in various parts of the country but for the most part it is still legal and quite easily accessible.
This lack of regulation is one of the biggest concerns for many experts. Because it is not technically approved by the FDA is it sold under the guise of being “incense” or other products which are marketed as not for human consumption meaning it is difficult to know exactly what is in the products. Another major concern is the fact that the growth is kratom abuse has led to an underground market for it, sold by drug dealers and sometimes cut with other unknown substances. The danger of kratom’s interaction with other drugs, specifically opiates, is likely what has led to the handful of kratom related deaths which have begun growing in frequency in recent years as the drug’s use continues to increase.
Because kratom and kratom abuse has not been studied extensively, these negative interactions with other drugs and substances are mostly unknown. Reports of negative interactions with opiates, benzodiazepines and even alcohol have been reported with effects ranging from seizures to fatal overdoses.
Some common side effects of kratom abuse:
- Facial flushing
- Excessive sweating
- Nausea and vomiting
- Liver damage
- Respiratory arrest
The final large concern for kratom abuse is related to its potential for dependence and addiction. Because it is not an opiate itself, many have made the claim that it does not have the same dangers of addiction and withdrawal that opiates do. However, recent evidence has been showing the opposite is true as many people are reporting not only a physical addiction but a mental and emotional dependence as well. The physical dependence specifically is reported to have withdrawal symptoms which are very similar in many ways to opiate withdrawal.
The FDA seeks more stringent regulations
The current issue that is allowing kratom abuse to continue to rise is its mostly unregulated and legal status across the country. Currently the drug is only illegal in 6 states: Alabama, Arkansas, Illinois, Indiana, Tennessee and Wisconsin. It is also illegal in a handful of cities in counties across the country due to local ordinances, however in much of the country it remains legal and easily accessible. It is also usually undetectable by standard drug test, which is another common reason why some people choose to abuse it over other more typical opiates.
Another reason why it is often abused is because of the misconception that it is a safe alternative to traditional opiates and opioids, allowing users to take it as a way to wean themselves off of drugs like heroin or prescription opiates. Many of these individuals however are eventually finding themselves struggling with kratom abuse, physical dependence and in some cases even serious medical complications.
This is why the FDA is pushing for more stringent regulation of the drug. Last year the DEA announced that it would use its emergency scheduling authority to classify kratom a schedule I drug, citing major concerns about public safety. This was brought about by the relatively quick increase in use and abuse of the drug, which brought about some anecdotal and documented dangers. However, this emergency ban on the substance was met with quite significant public backlash from those who claimed that it is a safe herbal alternative to many pharmaceuticals like opioid pain killers. This eventually led to the DEA withdrawing its emergency scheduling of kratom as illegal, claiming it intended to look for more expert and public comment on the matter before making a more permanent decision on the classification of the drug.
Since then the county has continued to see some serious complications from kratom abuse, which is what has led the FDA to again call for more stringent regulation of the drug. Because federal regulation has been lacking, many states and municipalities have since begun to take the matter into their own hands, banning the sale of the drug in their own jurisdictions. This has resulted in the drug being unavailable in small areas of the country, including a few states, however this process has been slow, and the sale of the drug is still unrestricted and legal in most states. This is why federal regulation is being called for so strongly, a federal law banning sale of the substance would make it illegal across the entire nation, removing the need for individual states to follow the long and drawn out process of banning the drugs themselves.
Treating kratom abuse
With its increase in popularity those who are seeking treatment for kratom abuse is becoming more common across the country as well. Substance abuse treatment facilities are seeing a significant number of patients who have found themselves physically and mentally addicted to the drug, which brings with it its own set of challenges. Primarily from a medical detox standpoint as the withdrawal symptoms associated with stopping the drug can vary wildly from patient to patient. Other difficulties include the fact that currently, the drug is so easily accessible to many, making it difficult to deter the purchase and use of the drug in a newly recovering person.
The good news is, many substance abuse treatment programs across the country have become a bit more familiar with the specific nature of kratom abuse and with the proper programs some kratom abusers have been able to successfully recover from their addiction. However, as with any substance abuse problem, successful treatment can often be lengthy and potentially expensive, which is why agencies like the DEA and FDA are hoping to increase legislation and regulation on the drug to hopefully reduce the number of kratom users in the future.