In the midst of lawsuits and policy debates around the safety of kratom, one stream of information has seemingly dried up in the past three years: Formal studies into efficacy compared to health risks.
That has left local governments, consumers and even federal legislators stuck seeking more information into how kratom can potentially fit into a modern medical approach to treating pain and mental health ailments. Congress has called for further research, and a few attempts have been made at early clinical trials, but as the opioid crisis continues, the larger scientific community is still waiting for government agencies to take a closer look at the substance.
Until then, customers and lawmakers alike will continue juggling the kratom question without a full set of medical facts.
The debate has been fueled in recent months by potential legal actions in both legislative chambers and in court. Some have taken more moderate approaches, similar to those taken by Colorado lawmakers, and those proposed by their peers in Michigan. Earlier this year, Colorado enacted a law to regulate the production, distribution and sale of kratom in an attempt to regulate the market for the herbal supplement. In September, a bipartisan effort in Michigan introduced similar legislation in an attempt to create a structure of licensing and regulation around the substance.
On the more extreme end of reactions has been efforts by some lawmakers to ban kratom outright. Currently, kratom is illegal in six states, and after a bill died in the Mississippi legislature last year, the same state representative has vowed to make another run at making kratom illegal for sale in the state.
Kratom was also at the heart of a lawsuit filed in May 2022, and expanded last month, that blames kratom for the death of a 23-year-old Georgia man. The parents of Ethan Pope filed a wrongful death lawsuit that named 12 defendants, after an autopsy by the Georgia Bureau of Investigation found that Pope died from mitragynine intoxication and “had no alcohol or illegal drugs in his system.”
The available information in the lawsuit does not specify which substances were found in Pope’s system.
While lawmakers and advocates understand there are risks associated with any treatment option, available medical research and data points to kratom as a substance that many in the medical community believe can help alleviate the opioid epidemic, rather than add to it. That includes a group of medical researchers, in both the public and private sectors, who authored a paper on how healthcare providers can better understand kratom’s uses.
“More recently, as kratom has gained popularity in the West, United States federal agencies have raised concerns over its safety leading to criminalization in some states and cities,” read the paper’s abstract. “Some of these safety concerns have echoed across media and broad-based health websites and, in the absence of clinical trials to test kratom’s efficacy and safety, considerable confusion has arisen among healthcare providers.”
Yet even in that “absence” of clinical trials, the paper establishes how current research suggests that “there is no clear mechanism by which kratom alone and taken even at high doses would directly cause death.” The paper establishes the different ways in which kratom affects the body’s receptors, and directly states that perceived “poisonings” from kratom “a highly questionable cause of death.”
On top of the scientific reasoning, the paper also points out how there are “no reports of deaths due to kratom use in SE Asia for over a century.” The peer-reviewed publication specifically states how “sensationalized” media reports can arise from case studies or, like in the lawsuit, toxicology reports, which the paper says “at best, provide low levels of evidence.”
“Despite insufficient evidence for kratom’s role in harm, media headlines misleadingly insinuate that kratom has been established as a cause of death (e.g., “kratom deaths” and “kratom overdose deaths”).”
In applying the factors in the paper to current conversations, it is easier to see the influence these forces have on media reporting. In the Associated Press’ reporting on both the Mississippi legislative attempts and the death of Ethan Pope, the same fact appears as evidence against kratom.
“U.S. health officials said in a report released in 2019 that kratom was a cause in 91 overdose deaths in 27 states. While most of those who died had also taken heroin, fentanyl or other drugs, kratom was the only substance detected in seven of the deaths.”
By contrast, the National Institute on Drug Abuse reported that 14,139 people died by overdose from prescription opioids in 2019. In the case of the death lawsuit, the autopsy report stated there was no “alcohol or illegal drugs” present. That sort of ambiguity is what is referenced by the academic report as “sensational and biased information and the pursuit of legislative approaches that are disproportionate to apparent public health risks.”
Because of that, said the paper, some patients may be afraid to discuss potential kratom use with healthcare providers. Furthermore, the authors suggest that the answer is a regulated, controlled market for kratom, which can help destigmatize the substance and keep tainted products from making its way to unaware customers.
“Banning or criminalizing kratom, as six United States have done at the time of this writing, has the potential to create a new illicit market for kratom products, increasing the likelihood of adulteration and the use of dangerous substances as kratom substitutes.”
“A balanced examination of what can be drawn from the existing literature directed to healthcare providers and clinicians is warranted. This is particularly true given that the study of kratom is in its infancy: there is only one published clinical trial of kratom’s effects in humans.”
Academic paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8924421/