Kratom is a tree that grows in southeast Asia, its leaves contain at least two psychoactive alkaloids. These alkaloids are mitragynine and 7-HO-mitragynine. Mitragynine has the highest concentration in the plant of any of its alkaloids. 7-HO-Mitragynine is an oxidized derivative and active metabolite of mitragynine. This plant drug has been used for hundreds, if not thousands of years, in their native environment. Kratom was first used in the US when Vietnam veterans brought the product back home. It didn’t became popular until around 2010. The reason for a sudden explosion in popularity, reaching up to 15 million users yearly(1), in the US is multifaceted. Number one, the drug is enjoyable, it causes euphoria, pain relief, and sedative effects. Number two, it is very effective at treating opioid withdrawal and can therefore be a tool for people wanting to quit classical opioids and opiates.(2) There are many ways to ingest this product. The most common way is to either make a tea out of the raw powder, or eat the raw powder. Anecdotally, most people I know who use the drug, take it in capsule form, or dump the powder into their mouth and wash it down quickly. There are also various forms of extracts and tablets.
Across most of the United States, the distribution, manufacturing, and possession of the drug are legal activities. Kratom products can be found in most vape stores and headshops across the US. Some states even have a variety of products being sold at gas stations. Kratom being available in gas stations was strangely a point of contention with one of the senators. Oddly enough he didn’t think to mention that alcohol and tobacco are available in those establishments as well. Arkansas is one of six states in the country where it is an illegal substance. It resides in schedule 1 of the controlled substances act. A senator named Justin Boyd put forth a study proposal about the kratom consumer protection act (KCPA), and what it would mean for Arkansans if it were passed. I, a long time kratom user and pharmacology researcher, reached out to senator Boyd to ask about the progress. He invited me to come share my opinion on the drug at a hearing hosted in a building just behind the state capitol. I gladly accepted his offer and began working on a presentation.
I had no idea what to expect from this hearing. I was pleased to see that multiple PhD’s would be speaking on the drug and the KCPA. Two researchers from Johns Hopkins university, The senior fellow on public policy from the American Kratom Association, and one of the world’s leading Kratom researchers from the University of Florida, were all present to defend kratom. I let out a sigh of relief upon seeing these people on the roster. Patterns displayed by lawmakers surrounding drug policy, and discussions about the policies themselves had jaded me. I didn’t know what to expect, but I found it more likely that it would be a horror show of anti-drug rhetoric and nonsense. Gladly, that is not what happened, for the most part.
There was one unsurprising thing that took place at the hearing. The Arkansas Department of Health was clearly against passing the KCPA in Arkansas. They didn’t explicitly say this, however. Instead, they spent about 25 minutes speaking in hypotheticals and misleading the senators on the current state of Kratom literature. Luckily, one senator saw through this and made a comment about how many times the words if and possibly were uttered. This was the direction the department of health was expected to take. They did something very similar during multiple public hearings about medicalizing cannabis in the state. They also pulled the same stunt with tianeptine.
I’m not sure if the speeches with the many scientists at the hearing were planned or if it just happened to synergize effectively. Dr. Chris McCurdy from the university of Florida exclusively focused on the chemistry and pharmacology of the plant. He also showed pictures of the only established kratom farm in the US, one he helped form. Dr. Kirsten Smith from John’s Hopkins university focused on the behavioral studies she has conducted and the patterns of use in the population. Mac Haddow from the American Kratom Association spoke about the impact that the Kratom Consumer Protection Act has on the users and distributors of the drug. Dr. Jack Henningfield from John’s Hopkins university brought everything together by giving the senators down to earth information about the drug. The presentations worked very well, even though some did feel long.
The presentation I had originally written covered the pharmacology and pharmacokinetics of the drugs in question, as well as the impact prohibition has on the safety of using the drugs. Luckily, I did not have to go into too much detail about these topics because credentialed scientists had already covered that for me. When it was finally my turn to speak, roughly 3.5 hours after I showed up at the building, I could just address some of the arguments made from both sides. I had never done anything like this before, so I was very nervous and didn’t cover everything I wanted to. However, I covered some of the more important aspects of the hearing.
I started by explaining that one of the staples of the department of health’s argument was misleading. They repeatedly claimed that there is very little clinical literature about kratom. That is simply not true. According to ChatGPT, since 2022 there have been over 450 peer reviewed, pharmacological, toxicological, and clinical studies published about kratom. Thousands of studies have been published in the past 20 years, from all over the world. Ranging from behavioral studies to lethal dosage studies. That is not ‘very little clinical data.’ Kratom is one of the most well studies plant drugs in the world. Of course, plant drugs like the opium poppy, the coffee plant, tobacco, and cannabis have been studied more rigorously. However, it is not as if we are talking about an obscure plant drug like salvinorin-A or bufotenine. I found it very annoying that the Department of Health spent so much time harping on this non-issue. If they looked into the literature of the more obscure plant drugs, they would quickly understand that the clinical data on kratom is robust.
Secondly, I moved onto a point one of the anti-kratom senators continued to bring up. Multiple times throughout the hearing he was asking for death statistics or referencing death likelihood in some way. I wish I would’ve articulated this a little better, but again I was very nervous. I can not, for the life of me, understand why death rates are even in the discussion when it comes to drug policy. It has never been the standard in the US that something must be perfectly safe for adults to partake. It is not perfectly safe to ride motorcycles, people die every year even though it isn’t a necessary part of life. People die snowboarding, sky diving, smoking tobacco, drinking alcohol, scuba diving, etc. No one in our government is seriously advocating to prohibit these dangerous activities. Instead, they pass laws and regulations to make these activities as safe as possible. One must pass a series of tests to be able to legally ride a motorcycle, there are speed limits, some states require helmets. To drink alcohol or smoke tobacco you must be over the age of 21, you can not drink and drive legally. Regardless, even if there was solid evidence for kratom use being as dangerous as alcohol or tobacco (there isn’t) that shouldn’t change anything. Safety ultimately doesn’t matter, being a free population is allowing adults to do potentially dangerous things. The Kratom Consumer Protection Act is an act that employs these safety regulations previously mentioned on the kratom market. We are not advocating that everyone and their mother take kratom. We are simply advocating for safety regulations to be put in place.
We live in a free country, the original document that led to the founding of our country promised us that the pursuit of happiness was an inalienable right. Even if we pursue happiness in ways that may pose a risk to ourselves. That same senator, I’d imagine, would not be campaigning to ban alcohol, which kills 140,000 people a year. Nor would he be advocating for prohibiting tobacco, which kills 480,000 people per year. This is a blatant display of likely unconscious hypocrisy. I raised this issue to the audience. Albeit, not as effectively as I would have wished.
I then made a brief mention of why kratom kills so few people, just to ease his mind. Kratom has had less than 20 deaths attributed to it by the NIDA.(3) The reason for that is simple. Its pharmacological mechanisms do not cause lethal overdoses.(4) They cause extremely uncomfortable overdoses, but they are rarely, if ever, lethal. I mentioned that most of the deaths attributed to kratom should be attributed to poor quality kratom. Phenethylamine contamination in kratom products has killed people due to brain bleeding,(5) heavy metal contamination has caused hospitalizations,(6) salmonella outbreaks have done the same.(7) These issues are preventable, if there is some form of regulatory oversight. That regulatory oversight lies within the KCPA. That is a point every single scientist, and myself, made sure to mention.
Lastly, I had to take aim at some of the rhetoric being shared by scientists who supported passing the KCPA. There was a consistent negative overtone regarding kratom extracts. I had to make clear that this is nonsensical. The reason for my disliking of their attitude towards extracts is twofold. Number one; If we are going to legalize kratom, I should be able to ingest it however I see fit. Number two; mitragynine and 7-HO-mitragynine are opioids. They are partial agonists of mu-opioid receptors, among many other things.(8) Regardless of how these receptors are activated, mild to moderate constipation is a side effect.(9) That problem is compounded with kratom because there is so much insoluble fiber in the plant. This adds bulk to bowel movements and removes water from the bowels to help the stools pass more effectively. Extracts take the insoluble fiber out of the equation, as does lyophilized kratom tea, which is also a form of extraction.
Overall, the experience was encouraging. I was very happy to see so many people coming to Arkansas to help us change these laws. A victim of kratom prohibition also spoke before the hearing was adjourned. Her Father, Marshall Price, was arrested for kratom possession and was sentenced to ten years in prison. Less than two weeks later he died in prison. Just like the contamination issue is preventable, so are stories like these. I hope the senators of Arkansas were pushed towards legalization and that our message came across loud and clear. Kratom is a drug with enjoyable and potentially medically beneficial effects. It poses no significant health risks to the users, even if they are dependent on the drug and use it multiple times a day.(10) It was a great day, great hearing, and lots of great information was distributed to anyone listening. Hopefully the senators were the ones listening the closest.
Sources:
(1): Palamar, J. J. (2021, August). Past-year kratom use in the U.S.: Estimates from a nationally representative sample. American journal of preventive medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC8319032/
(2): Henningfield, J. E., Chawarski, M. C., Garcia-Romeu, A., Grundmann, O., Harun, N., Hassan, Z., McCurdy, C. R., McMahon, L. R., Sharma, A., Shoaib, M., Singh, D., Smith, K. E., Swogger, M. T., Vicknasingam, B., Walsh, Z., Wang, D. W., & Huestis, M. A. (2023, March 15). Kratom withdrawal: Discussions and conclusions of a scientific expert forum. Drug and alcohol dependence reports. https://pmc.ncbi.nlm.nih.gov/articles/PMC10311168/
(3): Blum, D. (2023, July 26). What you should know about the potential risks of Kratom. The New York Times. https://www.nytimes.com/2023/07/26/well/mind/kratom-health-risks.html
(4): Hill, R., Kruegel, A. C., Javitch, J. A., Lane, J. R., & Canals, M. (2022, July). The respiratory depressant effects of mitragynine are limited by its conversion to 7-oh mitragynine. British journal of pharmacology. https://pmc.ncbi.nlm.nih.gov/articles/PMC9314834/#:~:text=The%20limiting%20rate%20of%20conversion%20of%20mitragynine%20into,safety%20profile%20of%20mitragynine%20as%20an%20opioid%20analgesic.
(5): Nacca N;Schult RF;Li L;Spink DC;Ginsberg G;Navarette K;Marraffa J; (n.d.). Kratom adulterated with phenylethylamine and associated intracerebral hemorrhage: Linking Toxicologists and Public Health Officials to identify dangerous adulterants. Journal of medical toxicology : official journal of the American College of Medical Toxicology. https://pubmed.ncbi.nlm.nih.gov/31713176/
(6): Mammoser, G. (2019, April 12). What to know about heavy metals in kratom products. Healthline. https://www.healthline.com/health-news/what-to-know-about-heavy-metals-in-kratom
(7): Program, H. F. (n.d.). Outbreak of salmonella infections linked to products contain kratom. U.S. Food and Drug Administration. https://www.fda.gov/food/cfsan-constituent-updates/fda-investigates-multistate-outbreak-salmonella-infections-linked-products-reported-contain-kratom
(8): Karunakaran, T., Ngew, K. Z., Zailan, A. A. D., Mian Jong, V. Y., & Abu Bakar, M. H. (2022, February 24). The chemical and pharmacological properties of mitragynine and its diastereomers: An insight review. Frontiers in pharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8907881/
(9): Mori T;Shibasaki Y;Matsumoto K;Shibasaki M;Hasegawa M;Wang E;Masukawa D;Yoshizawa K;Horie S;Suzuki T; (n.d.). Mechanisms that underlie μ-opioid receptor agonist-induced constipation: Differential involvement of μ-opioid receptor sites and responsible regions. The Journal of pharmacology and experimental therapeutics.
Mason Sanders is a science writer that focuses on drug science and policy, as well as geoscience.
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