Some Call Kratom a Miracle Herb. But Its Safety Is Questionable

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Crushed Kratom powder from capsules sold as an herbal supplement to relieve pain and anxiety.  (Lindsey Moore/KQED)

Americans know the dangers of drugs like morphine and heroin. But what about a supplement that acts like an opiate which any kid can buy from a vending machine?

Kratom, an herb that's legal, abundant and potentially dangerous, is currently the subject of a debate over its risks and benefits. Usually the leaf, which comes from a tropical Southeast Asian tree, can be chewed, brewed or crushed into a bitter green powder. Often sold as pills, capsules or extracts, it acts like a stimulant when someone takes a small amount but has a sedative effect at a higher dosage.

People who have struggled with an opioid addiction swear kratom salvaged their health, livelihoods and relationships. But the federal Drug Enforcement Agency worries the substance carries the risk of physical dependency. The agency threatened to prohibit kratom in 2016, but advocates and lawmakers pushed back, and the ban never occurred. These days, the DEA lists it as a drug of concern.

Gold Bali is a strain of kratom sold at Bumble Bee Botanicals in San Francisco. (Lesley McClurg/KQED)

'Kratom Changed My Life'

Linda Kline, 33, sells kratom for a living. She says her store has given her a new purpose in life, and while she herself doesn't have an opioid dependency, she credits kratom with turning around her mental health.

"I went from feeling desperate and hopeless to finding an alternative where I had full control over how I felt," she said.

She used to be paralyzed by anxiety and panic attacks. When her insurance carrier threatened to cut her Prozac prescription, she felt desperate. A friend suggested kratom, so she picked some up at a smoke shop.

Her anxiety vanished.

“It almost feels like you’re having just a little glass of wine," Kline says. "It’s really relaxing. There's no melting of the walls."

The new habit cost about $6 a day, but Kline couldn't always find a quality supply. The Food and Drug Administration has recalled dozens of salmonella-tainted products sold online or in convenience stores. The agency has also found toxic heavy metals in kratom supplements.

Linda Kline is the owner of Bumble Bee Botanicals, a shop in San Francisco that sells kratom. (Lesley McClurg/KQED)

That’s one reason Kline started her own chic boutique, Bumble Bee Botanicals, devoted exclusively to kratom products. In a few weeks she'll open her fifth location in less than two years. The shops offer 15 different kratom strains at outlets in California, Idaho and Nevada. Her clients' reviews online claim kratom is a miraculous herb that relieves pain, quells anxiety, subdues depression and generally lifts spirits.

Potential Dangers

Reviews like that haunt Mateo Martinez.

“My brother believed the marketing of kratom, that it was a natural herbal supplement that could provide you with the same benefits of an opioid without the risks," he said.

Mateo's younger brother, Marco, struggled with an opioid addiction in high school. Mateo describes Marco as a charismatic, creative teen, passionate about video games, cartoons and anime. Marco got hooked on painkillers after his dentist pulled his wisdom teeth.

“He was using them in a way that wasn’t just for treating pain,” Mateo said.

Email receipts show Marco used bitcoin to buy Vicodin and fentanyl on the dark web.

Eventually Marco wanted to kick his addiction. Testimonials on YouTube and Reddit promised that kratom was the way out. Soon Marco was popping capsules multiple times a day.

During his freshman year at UC Davis, the 19-year-old started hyperventilating regularly. The incidents worsened, becoming seizure-like episodes ending in the emergency room. Each hospitalization, the doctors were stumped. No one thought to test for kratom.

Mateo theorizes that kratom had built up in his brother's body. Marco died in his UC Davis dorm in February 2018, late on a Sunday night. The toxicology report named kratom as the cause of death.

"I think kratom needs to come with a much more serious caution that it is not harmless," Mateo said. "I'm very heartbroken."

In a recent 18-month period, the federal Centers for Disease Control reported 90 kratom overdoses, although most involved a combination of substances.


Slim Science

“The data to support either the benefits or the harms for kratom is really, really poor," said C. Michael White, head of the Department of Pharmacy Practice at the University of Connecticut. "A lot of the information we have comes from single-case reports."

White says animal studies suggest kratom could be an effective pain reliever but that the collection of human data has only just begun. He says scientists need to conduct a lot more research before the appropriate level of regulation is clear. White recently argued in the American Journal of Health-System Pharmacy that the safest place for kratom is behind pharmacy counters, for adults only, but with no prescription required.

McClain Haddow, spokesperson for the American Kratom Association, agrees that the product should only be sold to people over the age of 18. "We would like vendors to register their product with the FDA and get a chemical analysis from a certified lab to insure the only ingredient is the naturally occurring alkaloid in the kratom plant," Haddow said. "Some manufacturers are spiking products with fentanyl, heroin or morphine to give users a high." 

Dr. Scott Steiger, deputy medical director of the opiate treatment outpatient program at Zuckerberg San Francisco General Hospital and Trauma Center, doesn't know how to advise patients who want to use kratom .

“I tell them I just don't know enough on the basis of science to tell them whether it's a great idea or not.”

The DEA describes kratom as an addictive substance that causes hallucinations, delusion and confusion.

“I have seen that people who use kratom end up having a very hard time stopping the use of it," said Steiger.

His patients report withdrawal symptoms like nausea, sweats, aches and pains, loose stool, tearing and dysphoria. There is growing concern about kratom’s effects on the heart and liver.

Steiger emphasizes that doctors have evidence-based treatments like buprenorphine and methadone to help people with an opioid addiction. He doesn't recommend self-medicating with kratom until more research is available.

"We just don't know enough about this chemical and the long-term use of it to know whether experimenting would lead to complications," Steiger said.