From Leaf to Life: The Conversation We Should Be Having Around Kratom 🌱

Kratom gets a bad wrap. Some of it is warranted, but one thing we can't stand to see is unjustified fearmongering towards useful plants.

Sep 08, 2023

Both the DEA and FDA have been on a vendetta against kratom and other herbal medicines for decades.

The first attempt was in 2012 after the FDA listed kratom as an unapproved drug.
Two years later, it issued a second import alert, enabling the FDA to request the US Marshall’s Office seize multiple shipments containing kratom.
In 2016, the DEA attempted to add kratom to the Schedule I status (the highest tier of illicit substances) but was forced to withdraw due to overwhelming public backlash.
Later, in 2020, the FDA appealed to the World Health Organization (WHO) to have kratom added to its banned substances list — it failed — citing a lack of evidence to suggest the risks of kratom outweigh its benefits to society. You can read the WHO's full kratom review here.

Had the WHO decided to ban kratom, it would have provided all the ammunition organizations like the FDA and DEA needed to place a complete ban across the entirety of the United States and in other parts of the world, too.

The best the DEA could manage for the moment is to list kratom as a "drug of concern."

But here's the paradox.

Regulators want to ban kratom because it acts like an opiate — suggesting it’s as deadly as heroin, fentanyl, or other options, right?

Well, not exactly.

Kratom is actually an invaluable tool for harm reduction, providing an alternative source of relief to prescription painkillers — which are considerably more addictive and dangerous.

Kratom also has other, completely unrelated benefits — it's a stimulant, immunomodulator, and a useful sedative.

It also has a long history of traditional use for conditions ranging from diarrhea and infection to anxiety and fatigue.

Kratom As An Important Tool For Harm Reduction

Drug overdose is one of the leading causes of accidental deaths in the United States. The vast majority of these deaths are attributed to synthetic opiates.

Kratom — a stout tropical tree closely related to the coffee plant — offers people a viable alternative.

The reason kratom is such a good alternative to opiates is because it acts like one, too — in many of the same “good” and “bad” ways. Kratom has intoxicating effects in high doses and can lead to dependency over time.

The major difference between kratom and concentrated, synthetic opiates is that kratom contains dozens, if not hundreds, of separate active ingredients. Some of these ingredients hit the opiate receptors, but they perform a myriad of different effects, too.

Opiates, on the other hand, have one focus — they target the opiate receptors to a profound degree. This allows tolerance and dependence to form very quickly and enables users to achieve toxic levels with relatively small doses.

Kratom also lacks an important side effect inherent to conventional opiate drugs — that is, it triggers significantly less recruitment of beta-arrestins.

These proteins are responsible for the inhibition of autonomic breath control (the main cause of death from opiate overdose) as well as the desensitization of the receptor (a key factor in tolerance to opiate drugs).

Despite these important figures, the vendetta against kratom rages on.

Did 91 People Really Die From Kratom in 2019?

In 2019, the CDC released a report that claimed kratom "killed 91 people in 2019." This statistic has been seeded all over the internet at this point and is used as a major part of the argument that kratom is a danger to society.

Even the New York Times reported on this. The authors noted that "these numbers pale compared to the death toll from opioids: almost 48,000 in 2017," the same year as the data for this report.

Even more important is the fact that this report has some pretty ridiculous details if you look more closely…

Within their report, the researchers of the notice state just seven decedents (people who are now deceased) had kratom alone in their system — all had other drugs or alcohol in their system.

However, a drug doesn't have to be the reason for the event to have involvement with it. Kratom may have increased the effects of these other drugs, ultimately still playing a role in the death.

Within the kratom-involved deaths in the CDC study, several had other drugs listed as the actual cause (many likely listed multiple):

56% listed fentanyl or similar analogs
32.9% stated it was heroin
22.4% were the result of benzodiazepines
19.7% involved prescription opioids
18.4% listed cocaine as the cause of death

As for the other 7, they state, "the presence of additional substances cannot be ruled out" before pointing to another study from Colorado on kratom deaths.

In the Colorado study, researchers examined the three available blood samples of decedents for whom kratom was the only drug detected and found them to contain:

Benzodiazepines, anticonvulsant medications, stimulants, and "multiple medications affecting the central nervous system."
Selegiline (a mood stabilizer), geranium extract (a stimulant), and the antidepressant medication tianeptine.
Recent use of inhalant drugs (e.g., paint, glue, etc.) and a synthetic alkaloid acting as an analog of mescaline, a potent psychedelic with some amphetamine-like qualities.

The only other person who supposedly died from kratom use alone didn't have any residual blood for them to study. This illustrates how poor our toxicology screening process can be, missing out on major drug interactions in the initial investigation.

In 2011, a similar report from the FDA reported on a number of "kratom-related deaths." This report was inflated, too, as most of the cases involved a cocktail of other drugs detected in the system or serious underlying medical disorders. It's very difficult to attribute these deaths to kratom alone.

Why Mixing Kratom is a Bad Idea

Kratom primarily interacts with opioid receptors, so the most dangerous interactions come from co-use with other opiates.

Whenever you have two drugs that cause the same effect, they're going to compound each other. What might be a safe dose on their own quickly extends into the toxic range.

Overdosing on opiates can cause respiratory and cardiac depression, and while kratom likely doesn't lead to this on its own, it can certainly potentiate other drugs capable of doing so.

Similar problems can arise from other sedatives, too, such as benzodiazepines, barbiturates, alcohol, xylazine, or Z-drugs.

Kratom's interaction with dopamine and serotonin receptors can also make it a dangerous choice to take, along with antidepressants, antipsychotics, and other substances that influence these neurotransmitters.

How Overdose Deaths Are Determined

Part of the problem for the FDA and CDC studies is in how overdose deaths are reported. All notable drugs are listed on these reports regardless of how deadly they may or may not be or in what quantities are discovered.

While 91 kratom-involved deaths sound scary, much of the darkness disappears when you note the more dangerous drug interactions involved in the vast majority of these cases.

Overdose death statistics are notoriously opaque and often shield much of what is happening to fuel the narrative of drug prohibition. For instance, coroners rarely consider or report on the potential for contamination of drug supply being the cause of overdose.

Instead of stating a person bought counterfeit pills laced with something else, it may list (for example) benzodiazepines and fentanyl co-use. In actuality, the person died because of the fentanyl contamination in their drug supply, not because they intentionally used two dangerous drugs together.

Take the 18.4% of kratom-involved deaths involving cocaine in 2017 as an example of this. According to the CDC, cocaine overdose deaths decreased for the first time in 2007 and stayed below peak levels until 2016 — around the time the report on kratom was looking at.

The "main driver" of this increase, according to the report, is using cocaine "in combination with synthetic opioids." If it weren't for the increase of fentanyl hitting the scene as a contaminant and/or cutting agent, there's no way to know if this number would have stayed the same or continued to move lower.

Of course, we can't ask the deceased about their intentions, so many consider it to be impossible to know for sure if this is the case. While this may be true, the default reading has become co-use instead of contamination, despite this largely not being the case.

Why Overstate the Harm of Kratom?

For the simple fact of influencing opioid receptors, kratom receives the same vitriol from the media as fentanyl and heroin. Leaving aside the number of overdoses, which are likely a direct result of prohibition and contamination, this does a drastic disservice to the plant.

As more people continue to die from overdoses, everyone wants to take a stance to make them appear tough on drugs. Even though prohibition has been an abject failure — there are more drugs on the street, and they're more harmful than ever — it's still the emotional response we typically reach for.

As the harm reduction magazine Filter reported, "nearly 30 US states have introduced or adopted kratom legislation."

This ranges from outright prohibiting the plant to enacting regulatory measures — sometimes, as was the case in West Virginia, regulatory measures effectively restrict profitability and make it hard to operate.

The media's misrepresentation of the report — and, to an extent, the CDC's as well — fuels the emotional response of their viewers and makes them seem tough on crime.

Actually, they're being tough on a plant.

The Implications of Suppressing Kratom

While everyone feels like they're helping by "keeping another opiate off the streets," removing kratom from the equation leaves only more dangerous options behind. For some who choose to seek out the less harmful plant in restrictive areas, even kratom may become more dangerous.

When regulations get too restrictive, more people begin operating outside of them. Don't mistake this as a call to remove regulations — the kratom industry desperately needs better control.

However, regulations often enact harsh fees and taxes along with the requirement to pursue expensive testing on products. Regardless of whether the government approves of kratom as a treatment for any of the conditions people use it for, they're still going to use it.

For some uses — like withdrawal symptoms or tapering off opiates — the removal of kratom from the equation can have devastating consequences. It was for this very reason the DEA failed to ban kratom when it tried to do so in 2016.

New rules proposed by the DEA have to go through a public comment period, and they're required to respond to those comments. In this case, they were overwhelmingly in opposition and left the DEA no choice but to withdraw the proposal.

This has since inspired two similar occasions — once when the DEA tried to ban five obscure psychedelic chemicals and again when they tried to restrict telemedicine.

Both successes are temporary but illustrate the power people have over their substances of choice. Those of us who have experience and understanding of these drugs should be in charge of the legislation, not some agency trying to appear "tough on crime."

The Truth About Kratom & It's Risk

Any plant with powerful pharmacological effects also carries a heightened risk of side effects.

You can't really have one without the other. Pretty much all of the best herbal medicines we have are also toxic if used incorrectly.

It was Paracelsus who said:

"The difference between medicine and poison is the dose."

Well, kratom is a perfect example of this.

Is Kratom Useful? — Yes, Undeniably

I challenge anybody to find a better natural, all-purpose painkiller. But it does much more than that, too. Kratom contains 16 major alkaloids, each one with a different group of target receptors.

Kratom is a reliable nootropic, muscle-relaxant, and immunomodulator. Its opiate-binding effects also provide similar euphoric effects found in painkillers. This, of course, is one of the main reasons people use this plant recreationally.

One of the more interesting features of kratom is that its effect profile can be both stimulating like coffee or coca — but also sedating like valerian or chamomile.

Is Kratom Dangerous? — Also Yes

Our body feels pain for a reason; blocking it too often or for the wrong reasons is going to result in problems surrounding tolerance and abuse.

Anything with as strong an impact on the central nervous system — particularly the opiate system — as kratom is going to carry the risk of dependency over time.

Mixing kratom with other substances, especially painkillers, benzodiazepines, alcohol, or GHB, is going to increase risk significantly.

While it's true that kratom is unlikely to lead to death, that doesn't mean it can't cause some very unpleasant side effects.

In fact, this is one of the factors that prevent people from ever consuming anywhere near enough kratom to actually die from it.

This is because the most common side effect of kratom is nausea. Novice users may experience nausea starting as low as 4 grams — but most users don't start to feel this way until closer to the 8-gram mark.

By the 10-gram mark, most people experience severe nausea, dizziness, and blurry vision — a condition commonly referred to as the "kratom wobbles."

These effects wear off after a few hours (at the same time, the other effects of kratom wear off).

Regardless, this experience is uncomfortable and well worth trying to avoid.

This protects people from overdoses because it stops people from ever taking enough to reach fatal doses.

Nobody who is actively experiencing uncomfortable nausea and dizziness from kratom goes back for another dose. People who take kratom learn where their limits are and stick within the lines.

A 10-gram dose is very high for novice users, but it's still a far cry from what the evidence suggests to be a lethal dose.

For example, animal studies have found the LD50 of pure mitragynine is around 547 mg/kg.

For a 150-pound person, that works out to an equivalent of around 1.5 kilograms (1500 grams) of kratom leaf.

Nobody could ever reasonably take that much kratom.

For reference, the standard dose range for an intolerant kratom user is between 2 and 8 grams of dried leaf powder. Lower doses are used as a stimulant, similar to coffee; higher doses are more euphoric and analgesic. Very high doses are sedative.

Tolerance does develop to this plant after a few weeks — so frequent users will often take upwards of 10 grams for a similar effect. Even among the heaviest kratom users, exceeding the 20-gram range is rare.

Tolerance is the other main risk factor for this plant. It means that kratom can form physical dependence over time, which is why it's important to use this plant only when needed, take tolerance breaks often, and avoid relying on it as a long-term crutch whenever possible.

Where Do We Go From Here?

Placing stigma on a tool people use to reduce harm is not an effective way to help with the crisis of overdose deaths we're experiencing. The DEA likely thought they'd slip scheduling kratom through like they normally would for any other drug, but instead, they pushed people too far.

As an unregulated product, kratom has plenty of concerns for the DEA and FDA. Currently, the onus of finding a reputable kratom product is on the user, and there are plenty of bad options out there.

This is not the same for alcohol, tobacco, or caffeine, which follow strict regulatory measures to ensure they don't misrepresent the contents of the package.

Kratom is in dire need of similar regulation to cut out bad players in the market — but banning it isn't the solution. Movements like the American Kratom Association (AKA) are making strides in this direction with their approved vendor program — but it still has a long way to go.

Our advice for buying kratom — opt for the dried, powdered leaf only, order from reputable brands, avoid companies that overpromise or use concentrated mitragynine or 7-hydroxy-mitragynine products, and seek out brands with the AKA stamp of approval.

This is an important plant medicine and should remain available as such.

Give this post a like if you want to see more posts on kratom and other stigmatized plant medicines in the future ♥️

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This post was co-written by

Justin Cooke 🍄

J Gordon Curtis