Kratom powder and capsules

The Department of Health and Human Services (HHS) has recommended kratom be classified as a schedule I drug, according to documents obtained by STAT News. If the Drug Enforcement Agency (DEA) accepts its recommendation, kratom, a substance people use for chronic pain, would become illegal.

Under the Controlled Substances Act, Schedule I drugs are substances the DEA claims have no “accepted medical use and a high potential for abuse.” Drugs on this list include ecstasy, LSD, heroin and methamphetamines. Marijuana is also in this schedule, though the DEA has reclassified a drug containing CBD, a compound found in cannabis, as Schedule V, meaning the substance has a low potential for abuse and has medical benefits.

Kratom is currently sold as a supplement. Unlike prescription and over-the-counter drugs, the Food and Drug Administration (FDA) does not control supplements. Kratom is a tropical tree in the coffee family from Southeast Asia and has been used for centuries. Traditionally, farm laborers in Asian countries would chew on the leaves or put it in tea as a stimulant to combat fatigue and increase work productivity. They’d also use it to relieve pain from working long hours, Oliver Grundmann, clinical associate professor at the College of Pharmacy at the University of Florida, told The Mighty.

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Kratom is unique because in low doses, it acts as a stimulant and in higher doses, a depressant on the central nervous system. Although it is not an opioid, it binds to some of the same receptors in the brain as opioids. Because of this, people have started to use kratom as a way to combat opioid withdrawal symptoms and decrease chronic pain without using opioids.

Kratom was already on the DEA’s radar before HHS issued its recommendation. The FDA released warnings against the use of kratom and began investigating the substance at the request of the DEA. It cited 36 deaths tied to the herbal supplement as well as an increase in calls to poison control from 2010 to 2015. Due to the FDA’s concern, the federal agency issued import alerts to impede the supplement from entering the U.S.

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Of the kratom-related deaths he’s aware of, Grundmann said most are due to mixing drugs. One of those dangerous combinations is krypton, which is a mix of tramadol and kratom.

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It’s unclear if and when the DEA would schedule kratom, STAT reported. Members of the public would be able to appeal the decision or comment on the issue before a final decision is made. Public opinion has changed the DEA’s decision before. In 2016, the DEA announced it would temporarily list the main active ingredients in kratom as a Schedule I drug. The decision to ban the ingredients was quickly reversed after outcry from kratom proponents.

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