It's banned in six states and three American cities but still legal — for now — as far as the feds are concerned.
Kratom is the controversial herbal supplement you might not know about.
Fans who take kratom in capsule form or drink it in tea say it can can alleviate a host of ills. Some say it is a natural cure for opioid withdrawal symptoms; federal health officials say that is not true.
Federal authorities cracked down this week on kratom sellers as talk arose again of making it illegal at the federal level.
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The drug agency is "still waiting for analysis" before taking that step, special agent Melvin Patterson of the Drug Enforcement Administration told KIRO in Seattle this week.
The DEA has already considered designating kratom a Schedule 1 drug, which would effectively ban it.
Federal concerns about health risks and potential abuse of the supplement manifested in a public health advisory from the Food and Drug Administration last year that said the FDA was aware of reports of 36 deaths associated with the use of products containing kratom.
"There’s clear data on the increasing harms associated with kratom," the advisory said. "Calls to U.S. poison control centers regarding kratom have increased 10-fold from 2010 to 2015, with hundreds of calls made each year."
This week, the U.S. Food and Drug Administration sent letters to three kratom sellers, including one in Kansas City, warning about marketing "kratom products for, among other things, the treatment or cure of opioid addiction and withdrawal symptoms."
Here are eight things to know about kratom:
1. What is it? Kratom comes from the leaves of a tropical evergreen plant in the coffee family that, according to the FDA, grows naturally in Thailand, Malaysia, Indonesia and Papua New Guinea.
American fans grow their own plants from seeds, which can be purchased along with the actual plant and extracts online or in head shops, according to the men's publication MEL magazine.
2. How is it used? According to MEL, kratom is usually brewed like a tea or crushed into a powder and mixed with water, and is usually taken in capsule form or in tea.
3. The industry has grown like a weed. The American Kratom Association, a grassroots organization working to keep kratom use legal in the United States, estimates that between 3 million and 5 million people use it regularly.
Just a few years ago kratom was mostly found at head shops and gas stations across the country, according to Mother Jones, sold as "feel good relief" or in packets labeled "Kapow! Kratom.”
In recent years the industry has exploded in the United States, Mother Jones reports. Based on 2016 numbers from kratom purveyors, the Botanical Education Alliance estimates that the industry is worth at least $1.13 billion.
4. Why fans like it. Kratom users say it quells pain, reduces anxiety, boosts mood and increases energy. Stories from users on the American Kratom Association website include testimonials from people with fibromyalgia, back pain, PTSD, arthritis, carpal tunnel syndrome, debilitating headaches and depression who have used it instead of prescription drugs.
Susan Ash, the woman who founded the Colorado-based association, told Mother Jones how she became addicted to painkillers and a powerful opioid called Opana ER to deal with pain from Lyme disease eight years ago. In 2014 when she was trying to kick the opioid addiction, a woman in an online Lyme disease support group told her about kratom. She began taking it every day.
In “literally two weeks, I became a productive member of society," she told Mother Jones.
5. Why the feds don't like it. The FDA has repeatedly warned that kratom offers no medical benefits but has the potential to become addictive and could even cause death.
"The FDA knows people are using kratom to treat conditions like pain, anxiety and depression, which are serious medical conditions that require proper diagnosis and oversight from a licensed health care provider," the agency wrote in its health advisory last year.
"We also know that this substance is being actively marketed and distributed for these purposes. Importantly, evidence shows that kratom has similar effects to narcotics like opioids, and carries similar risks of abuse, addiction and in some cases, death.
"Thus, it’s not surprising that often kratom is taken recreationally by users for its euphoric effects. At a time when we have hit a critical point in the opioid epidemic, the increasing use of kratom as an alternative or adjunct to opioid use is extremely concerning."
The FDA has also warned against people using kratom to treat opioid withdrawal symptoms.
"There is no reliable evidence to support the use of kratom as a treatment for opioid use disorder. Patients addicted to opioids are using kratom without dependable instructions for use and more importantly, without consultation with a licensed health care provider about the product’s dangers, potential side effects or interactions with other drugs," it wrote.
6. It's already illegal in some places. A few states and cities have banned kratom. According to the Pew Research Center, kratom is illegal in Alabama, Arkansas, Indiana, Tennessee, Vermont, Wisconsin and the District of Columbia. Denver, San Diego and Sarasota, Fla., have banned it, too.
Six other states last year — Florida, Kentucky, New Hampshire, New Jersey, New York and North Carolina — considered kratom legislation last year, Pew reported.
7. The feds are cracking down. This week the FDA sent warning letters to three companies for marketing and distributing kratom as a treatment for opioid addiction, pain treatment and other symptoms, Marketwatch reported.
“Despite our warnings that no kratom product is safe, we continue to find companies selling kratom and doing so with deceptive medical claims for which there’s no reliable scientific proof to support their use," FDA Commissioner Scott Gottlieb said in a statement.
The Kansas City Star has reached out to Revibe for comment.
The letters referenced more than 65 kratom products, including Red Thai Kratom Powder, 50X Black Diamond Extract, Super Elephant and White Sumatra.
8. The first attempt to make it illegal met with a backlash. In August 2016, the DEA announced plans to use its emergency authority to add kratom to its Schedule I list. The DEA's announcement called it an "imminent hazard to public safety."
When the move became public, Ash and the AKA mobilized its then-8,000 members, according to Mother Jones. Protests were organized. The group collected more than 142,000 signatures on a petition, lobbied Congress and enticed thousands of people to flood the DEA's website with their opposition.
The DEA withdrew its plan and ordered the FDA to spend more time doing kratom research. “I was in complete and total shock,” Ash told Mother Jones.