Overwhelmed with thoughts of accidental deaths and a crippling fear of crowds, McKenzi Murdock, a 31-year-old biology major at OSU, found herself debilitated by her anxiety and unable to leave the …
Overwhelmed with thoughts of accidental deaths and a crippling fear of crowds, McKenzi Murdock, a 31-year-old biology major at OSU, found herself debilitated by her anxiety and unable to leave the house.
Murdock felt worn down, unmotivated and struggled to manage school and her life. In an effort to combat her fears and desperately searching for relief, Murdock took the advice of a family member and started using the herbal drug kratom three years ago.
“It changed my whole outlook on life,” Murdock said. “It put me at ease, and for someone with anxiety that’s a really big deal.”
Murdock is just one of the many people turning to the herbal drug for help. Kratom is being used as a remedy for pain reduction, anxiety and — more commonly — for opioid withdrawal symptoms. It’s unregulated and legal to buy, sell and use in the state of Oregon and several other states in the U.S. It is sold in most smoke shops, some dispensaries and, even, gas stations.
Kratom is a plant in the coffee family that is largely grown in Southeast Asia. The leaves can be ground down and extracted as an herbal supplement that has psychoactive and stimulant effects. It is sold in leaf, powder, extract and capsule forms.
Despite being incredibly accessible and popular, questions concerning public health, regulation and potential benefits of kratom remain unanswered.
The regulation discussion
In early March, an amendment to Senate Bill 1005, which ultimately added two members to the Task Force on School Safety, was introduced to Oregon lawmakers with the hope to change how the booming kratom industry operated. The amendment required all kratom products to be sold by registered processors, and tested and labeled by the Oregon Department of Agriculture.
The lack of regulation has led to competitive processors adulterating, or cutting the herb with dangerous and harmful synthetic opioids, and selling it mislabeled as kratom. The adulterating of kratom creates a product that is either a completely different product or one that is unsafe for consumption, said American Kratom Association lobbyist Sam Chapman during a Senate Judiciary Committee hearing.
For the majority of Oregon lawmakers, it was the first time they heard about kratom, Chapman said. Despite what lobbyists called common sense legislation to ensure consumer safety, the kratom regulation amendment was removed because there was much to learn about the herbal drug.
So while the amendment was what Chapman called “basic and fundamental for the industry,” it will take more time to lay the ground work for legislators to be receptive to a bill regulating the herbal drug.
“This is a product processed largely in Southeast Asia and sent to the U.S.,” Chapman said. “We really don’t have a full understanding of the chain of custody.”
Chapman believes kratom is an essential tool in fighting the opioid crisis. He and fellow supporters are hoping to have a new regulation bill ready for the next legislative session that would allow lawmakers to put in place policies that protect consumers.
Legislation requiring kratom to be sold by licensed producers, as well as product testing, packaging and labeling oversight could return to Oregon lawmakers at the beginning of the short session in February 2020.
“The kratom industry has been largely unregulated, for better or worse, up to this point,” Chapman said. “We’re ready for the state to join us and ready for them to put forth regulations that ensure consumers are aware of what is in their product.”
Health officials weigh in
The overall lack of regulation is what has health officials concerned. Adam Blumenburg, a OHSU Oregon Poison Center medical toxicologist, said the long-term effects of kratom use are unclear.
“There’s a lot more we have to learn about it,” Blumenburg said. “It does not seem to be as dangerous as other substances but it’s not completely safe either.”
The Oregon Poison Center received 54 kratom-related calls in 2018, he said. The herb is linked to seizures and to cholestasis, the stopping or reduction of bile flow from the liver, Blumenburg said.
The national Centers for Disease Control and Prevention recently reported overdose deaths where kratom showed up in postmortem toxicology testing. According to the report, kratom was involved in the overdose deaths of 91 people.
Blumenburg emphasized that people must understand the distinction between “kratom associated” and “kratom caused.”
“Deaths associated does not mean deaths caused,” Blumenburg said. “It’s unclear if (the deaths) are a direct effect of kratom because most reports showed additional substances that are known to be lethal.”
Nationally, the opinion on kratom also is up for debate. According to the American Kratom Association, six states — Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin, as well as Washington, D.C. — have banned kratom. Some of those states cited FDA and CDC reports, and then scheduled it as a controlled substance.
The majority of the CDC-documented deaths included fentanyl, heroin and other drugs as partner substances in toxicology reports. Kratom, however, was the only substance found in seven of the deaths. However, the CDC’s methods in determining kratom was the official cause have been called into question because many deaths involved partner substances and or preexisting conditions.
The DEA lists kratom as a drug of concern due to the potential of dependency.
In recent years, the FDA also issued warnings about unregulated kratom and high levels of metals found in kratom products. The most recent warning came in June, when the FDA issued warnings for two U.S. companies that were allegedly selling mis-branded and illegal kratom products.
“Despite our warnings, companies continue to sell this dangerous product and make deceptive medical claims that are not backed by science or any reliable scientific evidence,” said acting FDA Commissioner Ned Sharpless in the news release.
The FDA reported that those companies sold and marketed kratom products as having the ability to treat or cure opioid addiction and withdrawal symptoms. Products also claimed to treat pain, mental health problems and cancer. None of the uses have been regulated, recommended or approved by the FDA.
“FDA is concerned that kratom, which affects the same opioid brain receptors as morphine, appears to have properties that expose users to the risks of addiction, abuse and dependence,” said the FDA in an April news release. “There are no FDA-approved uses for kratom, and the agency has received concerning reports about the safety of kratom.”
The science behind kratom
New collaborative research from the colleges of pharmacy at High Point (North Carolina) University, University of Florida and University of South Carolina, found that one of two main psychoactive compounds found in kratom, 7-hydroxymitragynine, has high abuse potential and may increase the intake of additional opioids. However, the report also states that the other main psychoactive compound, mitragynine, reduces morphine intake and doesn’t have abuse potential — characteristics desired for pharmaceutical therapies used to treat opiate addiction and withdrawal.
The connection between opioids and kratom often is noted as a cause for concern. While kratom attaches to the same brain receptors an opiate does, allowing it to create that same euphoric feeling, people are too quick to classify it as an opiate, said James Joseph, director and co-founder of Edelic Center for Ethnobotanical Services. The nonprofit Springfield organization focuses on ethnobotany, the relationship between human and plant species. Opiates are in the poppy plant family and kratom is in the coffee family, Joseph said. The kratom plant has very different effects on the body.
“The problem with the terminology of calling it an opioid, is that it doesn’t actually function like an opioid, except in a small area,” Joseph said.
The Edelic Center works with the research and science community and local practitioners to understand and study the safety of medicinal plants and protect people’s rights to access plants for health and as a form of alternative medicine. Joseph said that kratom does effect the same brain receptors as opioids, but that it impacts different systems in the body.
While opioids offer pain relief, they also cause nausea, drowsiness and respiratory depression, often times dangerously and potentially fatal slowing of breathing in users, he said. Kratom can provide pain relief, but because it’s a stimulant in the coffee family, Joseph said, it excites the nervous system and has no significant impact on the respiratory system. People have the right to know what’s in their product as well as the right to ask where it came from, which is why Joseph thinks product safety testing is key for kratom’s future.
However, Joseph said people educating themselves about kratom and understanding what it is, is just as important.
“The less information that individuals have when they first begin approaching a plant, the more likely there are to be divergent outcomes,” Joseph said. “Whereas when individuals have access to high-quality information or maybe even some guidance from the community or others that have worked with it, the outcomes tend to be more beneficial.”
Despite warnings, kratom user Murdock said the herb is a benefit to her life. She has experienced issues with addiction to kratom, she said, and she tells everyone who asks her about it that addiction is a possibility. Murdock said her withdrawal symptoms, such as irritability, rise in body temperature and muscle aches, are mild, but do happen when she stops using kratom after having used it for a prolonged period of time. However, she’s not worried about the addictive possibilities and doesn’t think kratom should be banned.
“People are addicted to cigarettes, people are addicted to alcohol and there are a lot of legal things people can be addicted to,” Murdock said. “It’s up to the consumer to choose what they want to put in their body.”
Murdock also takes prescription anxiety medication with the herb. She told her doctor when she started taking kratom, and she advises others asking for kratom advice to do the same, as well as educate themselves on the herb. The National Institute on Drug Abuse said talking to a doctor prior to mixing kratom with prescriptions is key, as the majority of deaths surrounding kratom involve other substances.
Not knowing and not grasping a full understanding of kratom is what makes measuring kratom’s local impact on Lane County extremely difficult. There just isn’t enough information, research or quantifiable data available to track if kratom has a negative or positive impact. A big part of that is due to kratom being legal in Oregon and that means local law enforcement and health agencies are not required to collect data or track it.
Melinda McLaughlin, Eugene Police Department spokesperson, said the department isn’t tracking kratom, and that the agency’s Street Crimes Unit hasn’t seen it much in Eugene.
“We don’t track legal substances,” McLaughlin said. “It’s not something we’d get involved with from a law enforcement standpoint because it’s legal.”
The same goes for the Lane County Sheriff’s Office, according to spokesperson Carrie Carver. The agency received three calls involving kratom in the last three years, but those mentions are from information listed by callers as a possible substance and not because of kratom itself, nor were they life-threatening issues.
“As the sheriff’s office we’re aware that it’s out in the community,” Carver said “Any substances out there that might change people’s behavior would be a concern for the department. We just don’t know enough about it.”
At a county level, kratom is making officials nervous. Jason Davis, Lane County Health & Human Services spokesperson, said the agency can’t support people using kratom because the scientific community does not have good information on it.
“From our standpoint, kratom is an unsafe product,” Davis said. “Not because it doesn’t have any sort of medicinal use, but there’s just so much we don’t know about it.”
According to Davis, Health & Human Services has been vocal about making sure the community is aware of FDA warnings and local recalls. In March, Sunstone Organics, a local business out of Springfield, voluntarily recalled Kratom products for potential salmonella contamination. The products came from two separate lots that were sent to retail outlets in Washington, Oregon, California and Nebraska.
Oregon Health Authority tracks opioid data for the state but not kratom. OHA spokesperson Jonathan Modie said the agency initiated the investigation into the kratom product salmonella outbreak in March and issued public health warnings about kratom over the past few years.
“When it comes to reports of illness, we will let people know so they can protect their health,” Modie said.
Despite the herbal drug’s rise in popularity as well as concern, OHA doesn’t track negative incidents involving kratom, because it’s a non-scheduled substance.
Joe Schnabel, Oregon Board of Pharmacy executive director, said while the board is aware of kratom there isn’t enough information to do further research, “there’s still a lot of questions about the safety.”
Calls and emails to police and health departments in major cities including Boston, Seattle, New York and Boise, further confirmed the kratom situation is similar across the nation. Many were aware of kratom as a substance, but some had never heard of it. Even in places where it was banned, law enforcement wasn’t tracking it.
There are many people such as Murdock, who support the use of kratom and believe in the potential health benefits it possesses in its pure, unadulterated forms. Austin Berge, assistant manager of Midtown Direct in Eugene, said he’s used kratom before but doesn’t actively use it and believes the benefits are unmatched. Berge said different strains of the herb have different effects on people, but no matter how it’s used, Berge thinks it’s a healthier way to overcome addiction.
“Having longtime friends who are able to come out of their addictions and make complete turnarounds in their lives is incredible,” Berge said. “That’s the biggest blessing.”
Berge said some of the smoke shop’s customers come in looking for kratom to help with pain relief, health ailments and for curbing addiction.
“It’s a lot healthier than prescription drugs,” Berge said. “A lot of our customers used to take prescriptions and now they use kratom. It takes the urges away.”
Advertisements for kratom can be seen just about everywhere it’s sold, including shops near local elementary, middle and high schools, according to Prevention Lane Senior Community Health Analyst Elisabeth Maxwell. Maxwell said she wants parents to educate themselves on kratom and to talk about it with their children.
“The average adult may not have heard of or know what kratom is,” Maxwell said. “But there’s a good chance their kids and a lot of other young people have.”
There is no age limit on kratom, allowing many young people the ability to easily gain access to it. While not legally required to, many shops self-impose an age requirement on who can buy kratom — often the age of 18. Maxwell noted that she and Prevention Lane don’t know enough to say kratom is a danger but emphasized the real risk is ultimately exposing youth to an untested and unregulated product.
“We have no way of knowing what’s actually in it,” Maxwell said.
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