The state of Kratom

iStock_000010324123_ExtraSmall-206x300On August 25th, 2016, the DEA administer, Chuck Rosenberg, released a document announcing the agency would temporarily be placing Mitragyna speciose, commonly called Kratom, and its two primary chemicals, mitragynine and 7-hydroxymitragynine, on the Schedule I list of the 1970 Controlled Substance Act as of September 30th, 2016.[1] The DEA announced its decision after citing health and safety concerns relating to the opioid-like drug. The decision of the DEA comes two months after a report was released by the CDC citing an upswing in poison control calls with 660 reports relating to the plant between 2010 and 2015.
What is Kratom?
Mitragyna speciose otherwise known as Kratom is a deciduous and evergreen tree in the coffee family native to southeast Asia, Thailand, and Malaysia[2]. Kratom contains opioid like compounds mitragynine and 7-hydroxymitragynine which act upon opioid receptors much like morphine.

Traditionally Kratom has been used for centuries in Southeast Asian and Thai medicine as a painkiller, much like aspirin and as an Antidiarrhoeal remedy. In the United States, and much of western Europe, Kratom is used both as a recreational drug and as a means of coping with opioid withdrawal. Kratom has proven popular as a recreational drug because of its prior legal status, and because the drug is undetectable in normal drug testing[3].

Kratom has also found popular use by those who are currently addicted to opioids as a way of weaning off of harder opiates. Due to Kratom’s active chemicals binding to the same opioid receptors that opiates such as hydrocodone, heroin, and fentanyl, Kratom satiates the craving for the drug without giving the high, much like methadone. Also a result of Kratom’s primary side effect; nausea, it is very difficult to overdose on the drug. Further, since Kratom only works when eaten, it avoids intravenous abuse.

Outcry
In response to the announcement, thousands contacted their representatives demanding a halt to the DEA’s action.[4] For many, Kratom is seen as a possible way out of opioid addiction as the plant’s opioid-like properties are known to halt withdrawal symptoms without creating the high associated with other opioid replacement drugs such as methadone[5].

Responding to public pressure, Senators Orrin Hatch (R-Utah), Cory Booker (D-N.J.), Kirsten Gillibrand (D-N.Y.) and Ron Wyden (D-Ore.) all sent letters to the DEA acting administrator demanding a delay of the ban to give time for public comment and to encourage health and scientific review[6].  An additional forty-five congressmen and women joined the senators’ call for reprieve.[7] The senators also raised concerns of the unintended consequences of scheduling Kratom citing the explosion in the prison population caused by the scheduling of marijuana as a Schedule I drug.

Further, Columbia University research scientist Andrew Kruegel and eleven other scientist and doctors who have conducted medical and scientific research on Kratom joined the senators call for a reprieve[8].

Result
Following the public outcry, on September 30th, 2016, the DEA announced a brief reprieve stating that the emergency ban would be delayed “a few days, perhaps more” to allow for public comment and medical review.

As of today Kratom remains federally legal, however, Kratom is banned under state law in Alabama, Arkansas, Indiana, Tennessee, Vermont, and Wisconsin.[9] In addition to state bans, as of January 1st, 2016, the United States army enforced a ban on soldiers using Kratom.[10]

The Future
Kratom’s scheduling comes at an interesting time. The DEA sees the drug as yet another front in epidemic of opioid abuse that is sweeping this country[11]. Users of the drug, however, see it as a safe alternative to prescription opioids and a gateway out of opioid abuse. The DEA will make its final decision regarding the scheduling of the drug in the coming months.

Written By Hunter J White

[1] https://www.dea.gov/divisions/hq/2016/hq083016.shtml

[2] Rech, MA; Donahey, E; Cappiello Dziedzic, JM; Oh, L; Greenhalgh, E (February 2015). “New drugs of abuse.”. Pharmacotherapy. 35 (2): 189–97. doi:10.1002/phar.1522. PMID 25471045.

[3] Rosenbaum CD, Carreiro SP, Babu KM; Carreiro; Babu (2012). “Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines”. Journal of Medical Toxicology. 8 (1): 15–32. doi:10.1007/s13181-011-0202-2. PMC 3550220 . PMID 22271566.

[4] http://thefreethoughtproject.com/kratom-ban-suspended-backlash/

[5] http://opiateaddictionsupport.com/how-to-use-kratom-for-opiate-withdrawal/

[6] http://www.forbes.com/sites/davidkroll/2016/09/30/dea-delays-kratom-ban-more-senators-object-to-process-and-unintended-consequences/#21fa15374f71

[7] http://www.salon.com/2016/10/02/is-the-dea-high-the-agencys-emergency-ban-on-kratom-has-to-make-you-wonder-what-theyre-smoking/

[8] http://www.scientificamerican.com/article/kratom-drug-ban-may-cripple-promising-painkiller-research/

[9] http://www.usnews.com/news/us/articles/2016-05-20/states-ban-kratom-supplement-over-abuse-worries

[10] http://www.nytimes.com/2016/01/03/us/kratom-an-addicts-alternative-is-found-to-be-addictive-itself.html?_r=0

[11] https://www.rt.com/usa/359123-opioid-addiction-healthcare-cost/

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