What's the Deal With Kratom?

To its proponents, the herbal medicine kratom represents a safe and natural plant-based supplement that enhances mood and offers mild pain relief. Government agencies warn that the botanical substance, used for several centuries in Southeast Asia, can be harmful and possibly addictive. However, some U.S. scientists and doctors aren't so sure.

The X-factor is whether kratom might have a role to play in treating opioid addiction or withdrawal or serve as a safer alternative to drugs such as heroin, fentanyl, and oxycodone now fueling the opioid epidemic. But for now, kratom is unregulated, under-researched and unproven.

Salmonella contamination is another concern. On April 3, the Food and Drug Administration issued a mandatory recall of kratom products from a Las Vegas-based company because they were tainted with the bacteria. Previously, other brands of kratom supplements have been tied to salmonella cases.

Kratom is native to Thailand, Indonesia, Malaysia, Myanmar, the Philippines and New Guinea. It's pronounced several ways (KRAY-tum, crate-UHM or KRAY-tom). Traditionally, kratom's fresh or dried leaves have been chopped and either chewed or made into tea as a workday pick-me-up for manual laborers, according to a historical summary in BioMed Research International. It's also been used as a folk remedy to relieve pain, ease withdrawal from morphine or opium and sometimes act as a replacement for the drugs.

Today, people can find kratom in many tobacco or vape shops, gas station convenience stores or simply by going online. It comes in a variety of forms including crushed leaves, capsules, tablets, powers and even gum. Users describe it as having a bitter taste.

Price ranges for kratom appear similar to other supplements. On one online site, a bottle of 50 capsules costs about $25. Consumers are on their own when choosing a dose for the desired effect.

Based on various surveys, an estimated 3 to 5 million people use kratom throughout the U.S., says Dave Herman, chairman of the American Kratom Association. As head of the advocacy group, Herman is determined to maintain public access to kratom. "You've got a grassroots feeling from consumers that they should have the right to make their choices for their health and well-being, as long as it doesn't harm them," Herman says. "They want access. Why shouldn't they?"

Dr. Alicia Lydecker, a medical toxicologist and emergency physician at Albany Medical Center, sees kratom from her dual professional perspectives. "At low doses, kratom acts like a stimulant – like coffee – but at high doses, it has opioid-like effects," she says. "This explains why the same drug historically has been used for things like work productivity, but on the other hand is also used to self-medicate anxiety, opioid addiction, and restlessness."

Nausea, itching, sweating and dry mouth are some side effects of kratom. Users may also have symptoms such as anxiety, irritability, dry mouth, increased urination, constipation and loss of appetite. Several cases of seizure associated with kratom have been reported, along with at least one case report of liver injury.

By Lisa Esposito, Staff Writer  |April 6, 2018, at 11:23 a.m

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