A bag of kratom collected by officials from the Grand County Coroner's Office in late 2018 at the scene of a death where the substance is considered to be a contributing factor.

Courtesy Photo

WHAT IS KRATOM? You could easily be forgiven for never having heard of kratom. With Colorado’s still relatively recent legalization of recreational marijuana and the state’s ongoing struggles with heroin and meth, kratom rarely makes headlines. But over the past several years concern has grown amongst public health officials, federal regulators and the standard chorus of individuals and groups who oppose the use of mind-altering substances. Kratom is a substance derived from Mitragnya speciosa, a tropical evergreen tree that is native to Southeast Asia. Much of the kratom sold in the US is grown and harvested from Thailand, Malaysia and Indonesia, where the narcotic has been used in traditional medicine for centuries. Kratom can be consumed in pure leaf form but it is most often sold in the United States as a greenish colored powder, made of ground up leaf material. It is typically purchased either as a bulk powder, which can be mixed with liquids and drank, or as a capsule containing powdered kratom. The substance is often marketed as a dietary supplement without any directions or claims. The effects of kratom vary depending upon the strength of the kratom being consumed and amount being consumed. Consumed at low doses, kratom acts more as a stimulant. At higher doses kratom becomes a sedative with effects that are analogous to opioids, resulting in pain-relief, sedation and feelings of euphoria. According to the National Institute on Drug Abuse, the FDA has identified over three dozen death cases in which kratom was related. In Colorado a mid-November report from Denver’s 9News revealed a series of 17 coroner’s reports from across the state, from 2016 through 2018, that identified kratom as a contributing substance in overdose deaths. In six of those cases, kratom was the only drug listed as contributing to the person’s death. Neither the FDA nor the U.S. Drug Enforcement Administration currently regulates kratom. Both agencies have taken steps to ban the substance but backed down in the face of protest from proponents of kratom. Kratom is currently legal in Colorado but has been banned in six other states in the United States.

From the explosion of morphine addiction in the post-Civil War era, through Prohibition and into the modern War on Drugs, American citizens have seen the impacts of addiction and the unintended consequences of efforts to eradicate it. Over the past several decades, the substances that have produced these problems have become familiar to most people.

Words like meth, crack and oxy, all forms of slang, typically need no explanation.

But in recent years, a relatively unfamiliar substance, called kratom, has begun making inroads into the United States.

Kratom is a substance derived from Mitragnya speciosa, a tropical evergreen tree that is native to Southeast Asia. Much of the kratom sold in the United States is grown and harvested from Thailand, Malaysia and Indonesia, where the substance has been used in traditional medicine for centuries.

While it may initially appear innocuous, like any other natural supplement, many public health officials, including the U.S. Food and Drug Administration, are beginning to sound the alarm on the still unregulated substance.

Advocates, however, claim the picture is more complicated than government officials acknowledge and that a ban on kratom could make addiction issues worse, not better.

LOCAL PREVALENCE

Kratom has been linked to two specific deaths in Grand County in the last four months alone, according to the county coroner.

Grand County Coroner Brenda Bock said kratom was found at the scene of two local deaths, one occurring in late October 2018 and another in early November 2018. Bock indicated kratom was found in the systems of both deceased individuals, both of whom were young adult males who had histories of opioid use.

In one of the cases Bock said two substances were found in the system of the deceased man, inhalants and kratom, and that both substances were found at levels that would be fatally toxic. In the other death, multiple drugs were found in the person’s system and, while the kratom levels were not considered to be toxic, its presence was considered to be a contributing factor to death.

“In both cases the caretakers for these people truly believed it was an herbal supplement and they were using it to kick their opioid habit,” Bock told Sky-Hi News. “In both cases they had gotten it over the internet and it was delivered to their homes.”

Bock emphasized her concern that local teenagers and youths could legally purchase and ship kratom to their homes and that parents might not be aware of the potential seriousness of the substance.

Kratom packaging typically offers little in terms of clarity regarding what the substance is and does. Bock said she and members of her office were initially made aware of the substance in October 2018 during a state coroner’s conference.

LOCAL SALES

Kratom consumed in the United States is typically sold either via internet and delivered directly to homes or purchased from smokes shops, head shops and other retailers that often sell glass paraphernalia. It also is sometimes sold at convenience stores.

Grand County’s only smoke shop, K&J Smoke Shop with locations in Granby and Winter Park, confirmed they do not sell kratom. A check with convenience stores across the county, and Sunshine Herb Corner in Fraser, found the same — none of them sell the substance.

Ken Fife, owner of K&J, said he chooses not to sell kratom for multiple reasons, including promises he made to both Granby and Winter Park that his stores would not sell such substances. K&J Smoke Shop receives calls daily asking whether or not kratom is sold at the store, according to Fife.

“We will not carry something that is not directly related to our business,” Fife said. “We barely carry incense. I quit selling cigarettes, so I’m not going to start selling kratom.”

A FURIOUS DEBATE

Much of the ongoing debate about the regulation or banning of kratom revolves around the drug’s unique properties and the way in which it mimics the effects of opioids.

Not only does the substance produce opioid-like effects, its active compounds interact with the brain’s opioid receptors.

Last September, FDA Commissioner Scott Gottlieb went so far as to say, “there is evidence that certain substances found in kratom are opioids.”

Proponents of kratom claim regulators and health officials are scaremongering and that the substance is beneficial for opioid addicts, either as a way of fighting opioid cravings or as a way of mitigating the symptoms of withdrawal.

Proponents also claim the drug is a viable pain-relief substitute rather than prescription pills, which are typically forms of synthetic opioids. Unfortunately, there has been little in terms of formal research into kratom to help the public and public officials determine how best to address the substance.

A USER’S FIRST-HAND ACCOUNT

In absence of formal studies, what evidence exists pertaining to kratom is anecdotal. But those accounts can be quite powerful.

Former Grand County resident Hank — who asked Sky-Hi News that his last name not be printed — first used kratom in 2015. At the time, the young adult man was struggling with a heroin addiction and found relief in kratom.

Hank broke his use of kratom down into therapeutic uses, controlling opioid cravings and withdrawal symptoms, and recreational use, when he took kratom just for “fun.”

The substance’s effects vary depending upon its strength and amount consumed. Consumed at low doses, kratom acts more as a stimulant. At higher doses, however, kratom becomes a sedative with effects that are analogous to opioids, resulting in pain-relief, sedation and psychoactive effects such as feelings of euphoria.

Hank, who said he has been clean from opioids for roughly two years now, said he has not used kratom in several months and that his use over the past two years has been sporadic. Hank attributed his cessation of kratom use to several factors, including the difficulty of acquiring the substance.

“For the last couple of years, I just haven’t really needed it on the therapeutic side,” he said. “On the recreational side, it’s not super convenient. I have to order it online. It is not something I get around to. It’s not like dropping by to get a six-pack.”

Hank said he believes kratom can and does have real benefits, however, for people struggling with opioid addictions.

“It helped me kick the most self destructive habit I have ever had and I don’t think I could have done that had it not been legal,” Hank said. “But at the same time it is a really strong substance and a lot of people are making enhanced versions of kratom.

“I feel like some forms of it should be legal, but I do think there should be some regulation. I think it is something we need to grapple with as a society and figure out where that cutoff is.”