The birth, life, and death of kratom: a little-known drug
By Catherine Sinow
Although marijuana is slowly becoming legal nationwide, the Drug Enforcement Administration (DEA) has plans to make a different herbal supplement Schedule I, alongside heroin and LSD.
The supplement is called kratom. It’s related to coffee, and it grows on a tree in Southeast Asia. Known for its smooth properties that both elevate and sedate, people use it for everything from chronic pain to insomnia to recreation. It’s been trusted for millennia by traditional medicine practitioners and peasants who spend long workdays under the blistering sun, but it only came to America around 2005.
Kratom comes in pills, powder or shot bottles channeling the likeness of 5-Hour Energy. Vein color and country of origin distinguish the strains, with names such as “Green Malay,” “White Thai,” and “Red Borneo.” Maeng da, which translates to “horseshoe crab” and “pimp” in Thai, supposedly indicates a finer, more potent strain. Anyone with pocket money can buy kratom at head shops, gas stations, sex stores and hundreds of online retailers.
Kratom costs a little under a dollar a cap, coming in packs ranging from 15 to 50 capsules.
“Any more than a dollar a capsule and you’re getting ripped off,” a friend and kratom user named Ryan (1) told me. At the time of our interview, he had recently switched to powder, paying only twenty-five cents for the equivalent of a capsule. Another friend I interviewed had used powder, too, and she brewed it into a tea. This was a steal compared to her first kratom extract capsule, which she purchased at her smoke shop for $10.
Ryan first tried kratom after losing his marijuana connections. He didn’t have access to anything illegal to self-medicate his depression and anxiety, but kratom was there at his local smoke shop.
“It seemed more like an anxiety medication than a recreational drug,” he told me. “It didn’t make me feel fucked up at all, just relaxed and somewhat sedated.”
Kratom contains opioids, but the media have compared it to bath salts, heroin and cocaine. One Florida teen, Ian Mautner, committed suicide with kratom in his system. Although he was being treated for depression, his mom blames kratom, and she lobbied extensively to illegalize the drug in Florida.
“Strong opiates have a reputation for making users immobilized and unproductive, sometimes to the point of doing nothing but dosing and laying around all day,” Ryan told me. “But the number one benefit I get from kratom is probably the energy and motivation that it gives me to get my tasks done. In larger doses, it can be sedating but in a much milder, more manageable way. It would take insane amounts to approach a heroin-like state of being ‘on the nod,’ and users would most likely throw up long before they could reach that threshold.”
When he discovered kratom, Ryan was taking Paxil, an antidepressant that made him fatigued 100 percent of the time. He couldn’t get ahold of his psychiatrist, so he decided to quit the drug on his own. The withdrawal symptoms were awful: more fatigue, paralyzing anxiety, and about half the sleep he needed. “I would always be stuck in this half-awake place,” he said. Ryan had kratom, however, and it made his Paxil withdrawal turn from nightmarish to merely irritating. His psychiatrist finally returned his call—after about three months. But Ryan had developed a habit.
“My life was just so much worse without it that I didn’t know how else to get through the day.” By this time, he was taking several doses of four capsules daily.
“Kratom has been involved in 15 deaths in the past few years. By comparison, about 18,000 Americans per year die from prescription opioid overdoses.”
My pen-pal from Seattle, Cass, first found kratom in a local smoke shop while buying cigarettes. She told me her story in a lengthy email:
“I remember reading a bit about it online, and knowing that it contained opioids, I was immediately interested in buying some. Although kratom is pretty weak in comparison to prescription opioids, I would say that the effects I was experiencing were equivalent to about 25mg of hydrocodone. (2) Granted, I was taking extract, which can be extremely potent.” Soon enough, kratom shipments were arriving at Cass’s apartment every other week.
Cass, Ryan and myself all pronounce “kratom” differently.
“Kratom made me feel exactly how I wanted to,” she said. “In some regards, it even helped me to be a better person. I was working a bike delivery job at the time, which is inevitably pretty hard on the body—I’m talking 150-200 miles of biking a week. Once I started taking kratom though, I felt a lot less pain, which meant I had more endurance; this allowed me to bike faster, take more deliveries, and subsequently, make more tips. Kratom was literally helping me to make more money. I could feel a habit forming, but I thought to myself: if this habit is paying for itself and more, is there really anything wrong with it?”
The DEA announced their nationwide ban on Aug. 30, 2016, calling kratom an “imminent hazard to public safety.” They plan to make it Schedule I, denoting high potential for abuse and no medical use. The ban was supposed to go into effect on Sept. 30, but on the 29, they decided to delay the scheduling until further notice.
The date’s push-back was probably caused by the immense backlash that came after the announcement. This outcry included coverage from major news outlets like The Guardian and NPR, a petition on the White House’s “We The People” website that gathered over 130,000 signatures and a march on the White House where about 300 people yelled “I am kratom. Kratom saves lives,” and drank kratom. However, the deciding factor was most likely the 51 Congresspeople who asked the DEA to delay the ban.
“[The ban] could be this week, it could be in the future, I just don’t know,” said DEA spokesman Rusty Payne.
In their the original announcement, the DEA did not ask for comment from experts or the general public, which is unusual. However, the agency did suggest they may move kratom to a lower level of prohibition after the initial Schedule I. Their statement mentioned that kratom causes “hepatotoxicity, psychosis, seizure, weight loss, insomnia, tachycardia, vomiting, poor concentration, hallucinations, and death,” but without incidence numbers. Meanwhile, users report that the worst it can do is nausea and vomiting.
This isn’t the first time something like this has happened. Thailand banned kratom in 1943 to encourage demand for opium, which was taxed and very, very profitable. This ban wasn’t really a success, however, since the tree is indigenous to the area. Along the way, kratom also became illegal in Australia, Malaysia, Myanmar, Romania and a handful of U.S. states and counties.
The DEA statement also mentioned kratom’s use as a step-down from severe opioid addiction, which they consider a “misuse” of the substance. This isn’t completely untrue; one New York Times article interviewed Dariya Pankova, a woman who spent $60 or more at kratom bars per day and said her friends did the same. (3) This adds up to almost $22,000 a year spent on kratom. These people stopped when they remembered that heroin is cheaper. On the other hand, some have used kratom as a step-down to great, even life-saving, success.
The DEA reported 15 kratom-related deaths from 2014 to 2016. However, none of these deaths can be attributed to kratom alone. In fatal cases, kratom was taken in addition to benzodiazepines, research chemicals and more powerful opioids. It’s unknown how these drug combinations caused death, but kratom doesn’t cause lung depression. So as far as anyone knows, it’s not possible to die from an overdose. And although there is a propensity for people to develop a slight tolerance to kratom, a study from the Universiti Putra Malaysia showed that morphine creates much less tolerance when mixed with kratom. For these reasons, scientists have hailed kratom as a breakthrough in painkiller research. But when it becomes Schedule I, researchers will have a much harder time obtaining a study license.
Kratom has been involved in 15 deaths in the past few years. By comparison, about 18,000 Americans per year die from prescription opioid overdoses, 10,000 from heroin and 88,000 from alcohol-related incidents.
For more scientific details, I spoke with CC chemistry major, Marco, who also has his own unique way of pronouncing kratom. Marco uses lots of drugs, including a host of research chemicals that I can’t be bothered to remember the names of. But he only uses them irregularly. This includes kratom, which he’s dosed in high amounts at distant intervals.
“Using kratom daily is a very bad idea. It’s playing with fire. There’s no precedent for using opioids to treat anxiety,” he told me.
“Why is it dangerous to habituate to an opioid, even a mild one?” I asked.
“Because it is such a difficult addiction to beat.”
“So why not just stay on it forever?” I asked.
“What if they ban it? Or you run out? Or the mailmen strike? Plus you will begin to prioritize this substance over the other important parts of life. Basically, habituating anything is dangerous.”
Seeking actual medical opinions, I got on the phone with a cardiovascular surgeon I happen to know. I figured that he must have some knowledge on the subject, since he prescribes painkillers. He wished to remain anonymous.
“You’re a journalist. You might twist my words,” he said.
“You can think what you want to think,” I said.
“Well, alright. I’m generally not in favor of those sorts of herbal compounds, especially with something that can cause addiction and heavy withdrawals. Of course, you could argue coffee does the same thing. But I think that herbs being regulated leads to questions of purity, origin and whether or not they do what they say they’ll do. A bunch of drugstores including Target were selling vitamins that did not contain the vitamin they said it contained.”
While his stance seems pretty unambiguous, he also said: “I’m generally not in favor of making things illegal.”
“Their statement mentioned that kratom causes ‘hepatoxicity, psychosis, seizure, weight loss, insomnia, tachycardia, vomiting, poor concentration, hallucinations, and death,’ but without incidence numbers. Meanwhile users report that the worst it can do is nausea and vomiting”
Dr. Anonymous prescribes a lot of painkillers for surgery recovery, but he doesn’t recommend opioids as a first-line chronic pain treatment due to the risk of patients quickly building up tolerance. This statement seems to go against kratom, but after he cited the overdose epidemic and widespread painkiller theft, it almost seems like a case for it. Still, he’s even firmer on the anxiety stance than the chronic pain stance: “No medical professional will recommend opioids for treating anxiety,” he told me.
A study of Malaysians who regularly use kratom discovered that more than half had developed a severe dependence. In another study, 80 percent of people who tried to quit couldn’t quit. There are 1,364 people subscribed to a subreddit called /r/quittingkratom.
Cass no longer uses kratom. “Three months into my habit,” she said, “I remember being at home one night trying to focus on some schoolwork, and my entire body was aching. I had a pounding headache, and I was in an absolutely terrible mood. I thought that maybe I was getting sick, but then I started to put the pieces together. I realized that I hadn’t taken any kratom in two days, and I tried to think back to the last time that I had gone that long without it—I couldn’t. I started to realize that I might be withdrawing, so to test this theory, I took a small amount of kratom to see what its effects would be on me. I felt pretty stupid when 20 minutes after dosing, I felt completely normal again.”
After quitting, Cass took up a succession of new drugs, such as illegally-obtained Adderall. Currently, she’s taking a mail-order antidepressant called tianeptine that has reduced her drug usage all around.
“The worst part about kratom withdrawals isn’t the physical aspect, it’s the mental aspect,” she told me. “It’s trying to be the person that the drug made you into without actually using it.”
Ryan has been tapering since May. At first he was trying to save money, and now he doesn’t want to be dependent on a soon-to-be illegal drug. Reducing his use has left him tired, anxious and bored almost all the time. It also decreased his appetite (not good, as he is already severely underweight) and gave him restless leg syndrome… in his arms. But he remained adamant that kratom shouldn’t be banned.
“If people are addicted to it and supplies are cut off, they’ll experience withdrawals and look for something else to medicate with,” he said. “Since kratom has been legal this long, it will take awhile for an underground market to form, if at all. More dangerous drugs, like heroin, however, already have a well-established black market presence, and may be easier to obtain for the struggling addict in the throes of withdrawal.”
Marco is mostly disappointed because kratom was a good, cheap, legal high. He’s also disappointed because he supports the decriminalization of all drugs and reduction of painkiller scripts.
“The problem isn’t people abusing kratom,” he said. “The problem is the mass overprescription of painkillers.”
As of the day I’m writing this sentence, nobody knows what’s next for kratom. The DEA might schedule kratom at a lower level, back off completely or continue as planned along their ambiguous trajectory. Like many research chemicals, kratom might be limited-edition. “Kratom is just not good enough to be accessible post-ban,” said Marco. The passionate YouTube videos tell another story, though. Kratom: coming soon to a black market near you.
1. All names have been changed to protect anonymity.
2. If you didn’t already have opioid tolerance, this amount of hydrocodone would get you really high.
3. These bars definitely existed, but only in Florida. Really.