You can find it at health food stores, gas stations and smoke shops. It is considered an opioid-like substance and binds to one of three types of opioid receptors in the brain. In most states it is completely unregulated.
That’s because kratom, a product typically purchased as a green powder or in capsules, is sold as an herbal supplement.
Its popularity has increased over the years, with purported benefits including mood enhancement, energy boost at low doses, and aiding with opioid withdrawal, pain, or sleep.
August Frank
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The Lewiston Stand
Kratom powder is pictured Friday in Lewiston.
Kratom comes from a plant from Southeast Asia that is botanically related to coffee. Kratom vendors offer several varieties known as red, white, and green kratom, which offer slightly different levels of alkaloids that influence its psychoactive properties.
Dr. Scott Phillips, the medical director of the Washington Poison Center, said that even though kratom is natural in origin, it can still have serious consequences.
“Your brain’s receptors don’t know whether it’s man-made or nature-made,” he said. “It just responds to that chemical structure.”
Kratom contains two active chemical compounds, mitragynine and 7-hydroxymitragynine, which bind to opioid receptors in the brain called mu-opioid receptors.
Kratom is considered a partial opioid agonist, meaning it activates opioid receptors, but to a much smaller extent than a full agonist. Buprenorphine is another example of a partial opioid agonist. It is a medication used to treat opioid use disorder.
Since 2015, the Washington Poison Center has had 480 calls related to kratom, including about 39 in Spokane County, 15 in Benton County, 14 in Walla Walla County and five in Whitman County, Phillips said. The list is not complete, because the center only records for which they receive calls.
A Study from 2019 published in the Journal of Preventive Medicine showed that other morphine-like opioids carried an overdose risk a thousand or more times greater than kratom.
However, some people who use kratom are more likely to use other drugs or alcohol, which increases the risk of overdose and death.
Kratom deaths due to overdose are relatively rare, according to data from the Centers for Disease Control and Prevention, with most overdose deaths involving kratom detected including the use of other substances. About 80% of those who died from a kratom-related overdose also had a history of substance abuse.
Although deaths from kratom are rare, there can still be significant risks associated with its use, according to Phillips.
One is that while kratom is less addictive than opioids such as morphine, heroin, fentanyl and oxycodone, it can still cause physical and psychological dependence. According to a study that surveyed nearly 3,000 respondents, or 12.3% of kratom users qualified as misuse of the substance.
Kratom also has the potential to do that interaction with other medicationsincluding benzodiazepines, barbiturates, alcohol, opioids, antidepressants and anti-anxiety medications. Chronic use can also come with risks, including: liver toxicityas well as seizures – especially in people with epilepsy.
In addition, because kratom is unregulated, it can be difficult to determine whether something is what it is marketed for, Phillips said.
“One of the issues that has arisen is that it is not always pure kratom,” he said. “If it is categorized as an herbal, non-regulated substance, it doesn’t actually have to go through a formal (Food and Drug Administration) approval process.”
Guillermo Rojo Martinez is co-owner of Kratom Kings in Moscow, Idaho, with his business partner Ty Pierce. The company sells kratom powder and capsules, in addition to cannabidiol or CBD products. They also sell kava, a supplement with depressant effects used to treat problems such as anxiety and insomnia.
Kratom Kings independently sends its product for testing to Wonderland Labs in California to test for contaminants, including heavy metals, E.coli and salmonella, as well as the strength of the product, Rojo Martinez said. But that testing is not necessary.
“It basically means building trust with every customer,” he said.
Rojo Martinez said he and Pierce first started their business in 2018, which is when kratom first started gaining popularity. At the time, he said, there weren’t many reputable options to purchase kratom.
“A lot of people started using kratom because it wasn’t regulated,” he said. “You could sell a very low quality product and it would still sell because it was such a niche product.”
Rojo Martinez said he is in favor of regulation and standardized testing.
“What I’m more concerned about is people being sold ‘kratom,’ which is nothing,” he said. “They just got ripped off.”
His company offers several types of kratom in capsules and powders, which Rojo Martinez says his customers use most often for its calming and sleep-enhancing properties. If not, he says, the second most common reason customers use it is the low dose for energy.
“A lot of people report that you just have more focus,” he said. “Boring, monotony, that doesn’t bother you that much.”
The FDA does not recognize kratom as a drug to treat medical conditions nor does it consider it a safe supplement. Doctors are often wary of kratom due to its potential risks and lack of research or regulation.
Despite this, kratom has become increasingly popular to treat a litany of problems online forums dedicated to kratom and the many ways its users say they benefit from it.
Many users are passionate about kratom and the benefits they see from it, Rojo Martinez said.
In 2016, the Drug Enforcement Agency announced it would temporarily reclassify kratom as a Schedule I drug. But the DEA later reversed that decision after widespread public outcry, including people who said they were using it supplement for the treatment of chronic painand scientists worried about the impact of a ban on their research.
“The thing is, kratom has some of the basics,” Rojo Martinez said. “I’ve noticed that a lot of people will talk about it quite passionately when they realize that someone else may have the same problems as them and that they could potentially be solved by kratom.”
While kratom has the potential for abuse, Rojo Martinez says, it’s not something he thinks most people would enjoy as a recreational drug. The doses needed to get high, he says, generally make people feel heavy and sluggish.
Liesbeth Machten
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Moscow-Pullman daily news
Capsules filled with kratom fall from a machine that closed the capsules on Friday at Kratom Kings in Moscow.
“I think a very, very small portion of users use it that way just because there are easier options to get high,” he said.
Kratom Kings does offer some guidelines for use, Rojo Martinez said. They do not sell to people under 18 and do not recommend taking more than 10 grams per day. They also do not recommend mixing kratom with other substances such as alcohol.
“The most common way we get, let’s say, complaints that we think are misplaced is because they’re taking alcohol or kratom, (and) they say it makes them feel weird or bad or something like that,” he said. “There’s a pretty clear interaction there.”
Rojo Martinez said he also doesn’t recommend kratom to pregnant people because little is known about how it can affect pregnancy.
In some rare cases it can Kratom has been linked to neonatal abstinence syndromeor NAS, a condition in which babies exposed to a drug in the womb, often opioids, experience withdrawal symptoms.
NAS is characterized by symptoms such as poor feeding and lower birth weight, agitation, irritability, jerky movements and sweating. It is sometimes treated with morphine, methadone or buprenorphine.
Dr. Robin Sautter is a family medicine physician at Gritman Medical Center with a focus on women’s health, as well as prenatal and newborn care.
Sautter has not personally worked with cases of NAS caused by kratom, she said, although it can happen.
In general, people should be careful not to make assumptions about the safety of herbal supplements, she said.
“None of them are FDA approved, which means they haven’t gone through the vetting process to make sure they’re really pure, like we know exactly all the ingredients,” she said.
In her practice, Sautter said, she will go through an extensive medical history, including medications and supplements a person takes if they come in with a positive pregnancy test. Not all supplements, including kratom, are considered safe to use during pregnancy.
“We really want to identify and see if there is anything that could be harmful. An example could be an iodine-containing supplement, which is labeled as healthy for your thyroid. That can affect a baby’s thyroid development,” she said.
It can be difficult to know how much something will affect a fetus, Sautter said.
If a pregnant woman is using kratom for pain management or opioid withdrawal, it is safer to talk to the doctor about finding a pregnancy-safe alternative.
“There are medications that can be safely used for opioid withdrawal during pregnancy,” she said. “We want to make sure that the mother’s health is addressed first and foremost, so that the baby also does well.”