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Kratom Risks - Rhetoric Or Real?

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Kratom, which made news frequently for all the wrong reasons last year, is back in the headlines.

According to the CDC's Morbidity and Mortality Weekly Report, released recently, "Kratom was determined by a medical examiner or coroner to be a cause of death in 11 states during July 2016 to June 2017 and in 27 states during July to December 2017 in overdose deaths".

During July 2016 to December 2017, 27,338 overdose deaths were reported, of which 152 (0.56%) of the cases tested positive for Kratom on postmortem toxicology. Kratom was found to be the cause of death in 91 (59.9%) of the 152 kratom-positive dead persons, including seven for whom Kratom was the only substance to test positive on postmortem toxicology, although the presence of additional substances cannot be ruled out, reveals the report.

The FDA has been warning consumers time and again about the risks linked to Kratom, and the recent CDC report only strengthens the concerns over its use.

What is Kratom?

Kratom is an herbal supplement, made from Mitragyna speciosa, a tropical evergreen tree, native to Southeast Asia. Most people take Kratom as a pill, capsule, or extract. Some people chew Kratom leaves or brew the dried or powdered leaves as a tea. Sometimes the leaves are smoked or eaten in food. (Source: NIH).

Kratom contains the alkaloid mitragynine, which is said to produce stimulant effects in low doses and some opioid-like effects at higher doses when consumed. It affects the same opioid brain receptors as morphine and appears to have properties that expose users to the risks of addiction, abuse, and dependence, according to the FDA.

This herbal supplement is touted as an alternative to treat pain in place of opioids and as a "cure" for heroin addiction and withdrawal symptoms. Kratom is available in various internet forums.

The growing use of Kratom

In recent years, the use of Kratom has been on the rise. According to the American Kratom Association (AKA), a pro-Kratom lobbyist group, nearly 5 million Americans consume Kratom.

Revenue from sales of Kratom in 2016 exceeded $1.13 billion from an estimated 10,000 Kratom vendors operating across the U.S., according to a report published in the Journal of Pediatrics and Pediatric Medicine.

Legal Status in the U.S.

In August 2016, the U.S. Drug Enforcement Administration (DEA) announced its decision to list Kratom as a Schedule I drug, i.e., the same category, under which Heroin, Marijuana, LSD, etc falls. Adding Kratom to the Schedule I list would have classified it as a drug with no currently accepted medical use and a high potential for abuse.

However, with many of the members of the public challenging the scheduling action, the Drug Enforcement Administration reversed its decision in October 2016.
But states like Wisconsin, Vermont, Tennessee, Indiana, Arkansas, and Alabama have banned the use of Kratom, and many more states are considering the ban of this herbal supplement.

Boon or Menace?

Proponents showcase success stories of Kratom users who claim that the herbal supplement has helped ease their neuropathic pain and alleviate their anxiety and depression. They also see it as an attractive choice to help get off opioids.

But on the other hand, with the FDA receiving concerning reports about the safety of Kratom, including deaths associated with its use, the regulatory agency is cautious on the use of Kratom. Based on scientific analyses, the FDA has declared the compounds found in Kratom as opioids, underscoring its potential for abuse.

Last February, an investigation into a multistate outbreak of Salmonella in which 199 people were infected, revealed that Kratom was the likely culprit as most of the infected people reported consuming the powder form of Kratom.

In May of 2018, the FDA pulled up some of the marketers and distributors of Kratom products for illegally selling unapproved Kratom-containing drug products with unproven claims about their ability to help in the treatment of opioid addiction and withdrawal. Some of the Kratom products were also found to contain disturbingly high levels of heavy metals.

Rebutting the CDC's report on Kratom being detected by medical examiners and coroners in 91 toxicology records, here is what the American Kratom Association has to say…

"The CDC data does not report whether the dead persons ingested pure, unadulterated Kratom in conjunction with dangerous substances or used an adulterated Kratom product. The National Institute on Drug Abuse (NIDA) has documented that polydrug use or adulterated Kratom product deaths are properly attributable to the toxicity of the multiplicity of co-consumed drugs or adulterants present whether intentionally consumed as a consequence of an individual's addiction or the result of unknowingly using a product adulterated with a toxic dose of a dangerous substance".

Conclusion

Kratom has been on DEA's list of drugs and chemicals of concern for several years. It is not yet regulated and has the potential to be mixed with other substances or adulterants, including fentanyl, heroin, and morphine by unscrupulous marketers, posing a significant risk to the consumers. So the FDA may be right in condemning the use of Kratom.

But a complete ban on Kratom may hinder access to it, and scientists will have a difficult time doing research on Kratom's therapeutic potential.

In sum, the debate on the risks and benefits of Kratom is here to stay...

For comments and feedback contact: editorial@rttnews.com

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