Kratom: Natural pain relief or ‘gas station heroin’?

People in Southeast Asia have brewed tea with leaves from the kratom tree for centuries. It’s a long-trusted home remedy known to relieve minor aches and pains and put a spring in users’ steps.

Many experts characterize the tradition as relatively benign. But today, thanks to a distinctly American brew of modern science and entrepreneurial enthusiasm, that once-mild Asian analgesic is fast becoming the latest flashpoint in the U.S. war on drugs.

The problem? Americans aren’t brewing weak tea from fresh-picked leaves. Instead, they’re spending about $1.5 billion a year on highly-concentrated kratom-infused products like energy drinks and gummies at vape shops and in convenience stores all across South Carolina and the nation — products that a growing number of industry critics are calling “gas station heroin.”

And public health officials are starting to sound the alarm — particularly with regard to products containing 7-OH, a powerful opioid compound that can be synthesized or concentrated from the plant.

“7-OH is an opioid that can be more potent than morphine,” U.S. Food and Drug Administration (FDA) Commissioner Marty Makary said in a July 29 release. “We need regulation and public education to prevent another wave of the opioid epidemic.”

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Currently, kratom and its derivatives are lightly regulated under a patchwork of state laws. Here in S.C., for instance, kratom sales were restricted to adults 21 and older under a law that went into effect on July 11 of this year.

Meanwhile in response to a July FDA request, the U.S. Drug Enforcement Administration is studying whether to classify 7-OH — or 7-hydroxymitragynine as it’s formally known — as a Schedule I drug like LSD or heroin, which would essentially make products containing the compound illegal under federal law.

In a Sept. 4 interview, Mac Haddow of the American Kratom Association said his group backs the FDA’s request.

“We fully support those efforts,” he said. “This is a chemically manipulated product that poses an imminent threat to consumers and shouldn’t be on the market.”

What the science says

According to 7-OH marketers, who claim that millions find pain relief with responsible use of their products, the FDA isn’t following the science.

“If 7-OH were truly the threat being claimed, the data would show it,” said Jeff Smith of the Holistic Alternative Recovery Trust, an industry trade group. “It doesn’t.”

But University of Florida researcher Christopher McCurdy, who’s studied kratom for more than 20 years, told Statehouse Report that highly concentrated 7-OH-infused products amount to unregulated opioids.

“It’s essentially legal morphine,” he said.

To understand why, he said it helps to know a little more about kratom and its primary active agent, mitragynine.

Mitragynine is what chemists call an alkaloid, meaning that it’s an organic compound that has pronounced effects on the human body. At low doses, it acts as a mild stimulant. At higher doses, it becomes a sedative with pain-relieving qualities.

It achieves those effects by binding lightly with opioid and serotonin receptors in the brain.

By contrast, 7-OH, an alkaloid that’s only found in trace amounts in dried kratom, binds tightly with opioid receptors, making it 10 to 20 times more potent than morphine, according to some animal studies.

“That molecule is one we’ve been very concerned about for many years now,” McCurdy said. “It’s very different from the whole leaf kratom.”

That’s not to say that the kind of highly concentrated kratom products now on shelves aren’t also a matter of concern, he noted.

“I don’t really see that there’s too much problem with the leaf material as it exists in nature,” he said. “But as with anything, when you look at increasing exposure to a substance, you increase the effects and you increase the risk of harm.”

Meanwhile in South Carolina

S.C. Sen. Russell Ott, D-Calhoun, said he wasn’t familiar with kratom before receiving a call from a constituent a few years ago. But what he heard from that concerned family member kicked off a research project that eventually led him to introduce a bill to ban kratom products from S.C. store shelves.

“That didn’t go anywhere,” he told Statehouse Report Sept. 3. “It just wasn’t on anyone’s radar.”

So this year, he said, he came back with a narrower bill that took aim at what he saw as the industry’s worst practices — unrestricted sales to minors, poor labeling regarding ingredients and potency, and synthesized products like 7-OH.

Ott’s legislation passed in May — after a furious lobbying effort by the 7-OH industry that got the provision banning products removed.

“It was still a heavy lift,” he said. “But I put as many guardrails around it as I possibly could.”

Beyond that, he said he’s pleased that the federal government is considering tougher action, because “for me, it’s not over.”

“I’ve made it clear to everybody that if I get an opportunity to vote on a bill to ban kratom, I probably will,” he said.

That day can’t come fast enough for one Lowcountry professional who spoke to Statehouse Report anonymously to protect his family’s privacy.

He said he first learned of kratom from his adult children, who said it helped them emotionally.

After trying kratom, he said he got pain relief similar to what he’s experienced in the past from prescription opioids. And, he added, “it feels pretty damn good.”

But after looking into kratom carefully and later experiencing some after-effects, he said he decided to set it aside before addiction could become a problem — an issue he believes is affecting his children, who spend hundreds of dollars monthly on kratom-infused drinks.

“I know it won’t be easy, but I wish they’d get off it,” he said. “Eventually, they’re going to have to go through the withdrawal and just do it.”

The DEA has not announced a timeline for the 7-OH scheduling process. In the meantime, several states, including Ohio and Utah, are currently considering bans.