September 21, 2016

Not Everyone Wants to Ban Kratom: Here Are Some Issues to Consider

Not Everyone Wants to Ban Kratom: Here Are Some Issues to Consider

Never heard of kratom? The media has been so focused on the ongoing opioid epidemic that it’s easy to miss a less frequently used or abused substance, like kratom. But a movement to ban or restrict the sale of kratom in cafes, at head shops and on the internet is gaining momentum across the country and states are taking legal action to curtail the public’s use of this drug. So what exactly is kratom, and why are people divided about its use?

Common in the United States for almost ten years before catching the attention of the federal government, kratom is a plant grown in Southeast Asia and cultivated as a kind of organic medicine. Currently the drug is classified by the Food and Drug Administration (FDA) as an herbal supplement. Kratom is primarily used to treat and manage pain, but it can also produce a euphoric high similar to, but not as strong as, that created by opiates like heroin. Kratom is also unique in that it creates both stimulant and depressive physiological responses in the brain, a potentially harmful combination.

Proponents of the drug point to its long-term, widespread use without serious public health repercussions as proof that overall, people are using the drug responsibly. A press release recently issued by the American Kratom Association (AKA) and the Botanical Education Alliance (BEA) condemns the Drug Enforcement Agency’s emergency action to make kratom a Schedule 1 substance, the same classification used for heroin and ecstasy. Banning kratom is really about creating the appearance of making progress in the fight against prescription opioids, the press release suggests, and is not in the best interest of the public.

Despite the benefits outlined by the AKA, BEA and other supporters, several states have already moved to ban or restrict the sale and possession of kratom. Some regulations focus on a mandatory minimum age for purchase, as is common with alcohol and tobacco, while other legislation blocks the use of kratom in the state by identifying it as a synthetic drug with the possibility of abuse. Several of the states that have already banned kratom cited a potential for abuse and addiction as a significant reason for their bans.

Kratom advocates are also concerned that many people who use the drug as a “less dangerous” alternative to heroin or prescription opioid painkillers or as an ongoing recovery support mechanism, in place of drugs like methadone or Suboxone, will relapse as a result of the national crackdown. These relapses could have deadly outcomes.

Addiction treatment professionals see the possibility for harm and some overdoses, but point out that there are several medications available to help opioid addicts, substances that have been researched and are regulated. Instead of relying on a drug that can itself be abused and cultivate addiction, addiction treatment professionals recommend utilizing medicines that have a proven safe dosage and that are regulated so that the user knows exactly what s/he is getting. Instead of kratom, medications like Vivitrol should at least be considered as an option. Addiction treatment professionals and organizations are wary of kratom as both a substance with addictive potential and an unstable coping mechanism to support recovery.

What is unacceptable is an outright ban on kratom without allowing scientists to study it. The plant has been used for hundreds of years and has regularly been used to treat both pain and to wean individuals off of opioids. It seems prudent to allow researchers to study the plant to find out which chemicals inherent in the substance provide medicinal effects and in what doses. We also need to know what long-term side-effects, if any, kratom causes, so that we can compare it with other medications for safety and efficacy.

It is in the public health interest to ensure that all substances that we ingest – be they foods, medicines, or supplements – are safe. Consumers need to know what’s in the products they buy and the dosage that will give them the best effect. While proponents of kratom downplay its potential for abuse and highlight its use for many as a person with substance use disorderion recovery or pain management tool, enabling continued use of kratom by the general public largely without restrictions of any kind contributes to a culture of addiction and obscures the prerogative of states and the country to protect citizens from potentially unsafe products. This drug should not be sold without regard to age in supplement stores or head shops. It is not a product that should be haphazardly used by teens or young adults. However, it also should not out of hand be made a Schedule 1 substance and research prohibited. Kratom should be studied so that those adults who might want to use it for pain relief or to assist with addiction treatment have a choice, assuming that it is found to be as safe and useful as proponents claim.

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