The DEA had previously tried to ban it. Now the FDA is leading the charge.
More than a year after backtracking on plans to ram through a ban on the herbal supplement kratom, federal authorities once again appear to be getting ready to crack down on the botanical drug used by many Americans.
On Tuesday, Scott Gottlieb, commissioner of the Food and Drug Administration, issued a public health advisory on kratom, outlining concerns about its “deadly risks.”
Kratom, which is derived from the leaves of a Southeast Asian tree related to coffee, has been consumed for millennia, usually as a tea or powder. The product sold in the U.S. today ranges from bags of raw kratom powder, marketed as an herbal supplement, to consumables in brightly colored packaging, found at gas stations and pushed as a cheap high, with minimal information about what might be mixed in with the kratom.
Gottlieb’s statement outlined concerns about the herb’s potential for abuse and addiction. He claimed there was “clear data” on these harms, pointing to reports of 36 deaths associated with kratom-containing products and a tenfold increase in calls involving kratom to U.S. poison control centers from 2010 to 2015.
Although kratom users have touted the herb as a safe and effective treatment for conditions like chronic pain, anxiety and depression, as well as a replacement drug for opioid addiction, Gottlieb said there is “no reliable evidence to support” those applications. In particular, he called the use of kratom as an opioid substitute “extremely concerning” and suggested that it could actually “expand the opioid epidemic.”
While kratom is not an opioid, its active ingredients mimic some opioid effects, including euphoria.
“We’ve learned a tragic lesson from the opioid crisis: that we must pay early attention to the potential for new products to cause addiction and we must take strong, decisive measures to intervene,” said Gottlieb. “From the outset, the FDA must use its authority to protect the public from addictive substances like kratom, both as part of our commitment to stemming the opioid epidemic and preventing another from taking hold.”
In a speech later on Tuesday, Gottlieb said the FDA would use “import alerts and other authorities” to increase seizures of kratom coming into the U.S. He also appeared to lump kratom in with a broader category of “illegal opioids,” of which he said 340 million packages enter the U.S. each year.
The FDA previously issued import alerts in 2012 and 2014, reportedly leading to the confiscation of thousands of pounds of kratom products.
Gottlieb’s characterization of kratom stands in stark contrast to the one coming from its advocates, who last year fended off a Drug Enforcement Administration push to place kratom’s active ingredients on the list of Schedule I drugs. (Schedule I, which includes heroin and LSD, is supposed to identify the most dangerous substances, with a high potential for abuse and no known medical benefit.) Many kratom users claim it’s nothing short of a miracle drug, which has allowed some people to manage chronic pain and even mental health problems without the use of more powerful pharmaceuticals.
Apart from these glowing anecdotes, there’s also a growing body of scientific evidence supporting kratom’s therapeutic value ― or at the very least, suggesting it is low risk with minimal potential for recreational abuse. Kratom contains an alkaloid called mitragynine, which appears to activate opioid receptors in the brain and reduce pain. Although most opioids have sedative qualities, low to moderate doses of kratom serve as a mild stimulant.
Last year, researchers at Columbia University published a study on mitragynine finding that it activates opioid receptors without triggering respiratory depression, the side effect of narcotic painkillers that is typically responsible for fatal overdoses. The scientists concluded that drugmakers could look to kratom to develop safer pain medications. At least one pharmaceutical company is currently working to develop a medication that targets pain with a semi-synthetic compound derived from kratom.
Despite those promising developments, the FDA has not yet approved kratom itself for any medical purpose. Gottlieb noted that fact in his statement, saying that kratom vendors had not gone through the FDA process for evaluating botanical drug products. He encouraged researchers to continue conducting “research that will help us better understand kratom’s risk and benefit profile.”
Gottlieb’s statement underscores the tricky regulatory challenge that kratom faces. Developing a drug that will win FDA approval can cost more than $2 billion. Since the product in this case is a leaf that’s been around for thousands of years and cannot be patented on its own, Big Pharma has little financial incentive to go down that road.
Previously on Kratom: Read More