DOVER – Members of the medical community have concerns about an unregulated drug that can be bought at a convenience store, or even a gas station.

Kratom leaf comes in many forms and proponents of the drug make a lot of claims about its benefits. However, the Drug Enforcement Administration and the Centers for Disease Control have both raised concerns. In fact, the DEA tried to have kratom listed as a Schedule 1 drug last year, meaning it felt kratom has no approved medical use and the potential for abuse. The agency withdrew that request after some opponents asked for a public comment period, which is pending.

On Nov. 14, 2017, the DEA issued a public warning about Kratom, citing 36 deaths.

Kratom is considered a “naturally occurring opioid” with two main chemical ingredients. Mitragynine is considered to have a mild opioid effect, but Kratom's other ingredient - 7-hydroxymitragynine - is considered to be 13 times more potent than morphine.

While kratom can be addictive, it has been used in Asia for years for fatigue, pain and anxiety. Proponents say it is even considered useful in helping people with opioid withdrawal symptoms. It is reversible with Narcan.

“You can buy this in every gas station in Dover,” said Justin Looser, director of behavioral health at Portsmouth Regional Hospital. “Advocates say it is a drug that works for withdrawal symptoms. I think if it worked so well, big pharma would be all over this, taking control.”

Dr. Lukas Kolm, an emergency room doctor at Wentworth-Douglass Hospital, said kratom leaf is just the latest of many such products. He said it has risks and people using it are doing so blindly, with no clear idea of how it is going to affect them.

“What I want to say is that this being sold everywhere, just like bath salts were, begs the question of why people want to sell this in their stores,” said Kolm. “Why are shop owners capitalizing on stuff that can potentially injure other people. In the stores, it is marketed as anything other than what it is used for, but they know what people are using it for. It is targeting the highest risk group of people for behaviors that are never going to change. Why make it so readily available?”

Dr. Matt Davis, medical director of behavioral health at PRH, said treatment of people who use these types of unregulated drugs can be very tricky.

“You see new ones all the time,” said Davis. “There was the big thing with bath salts, or synthetic cannabis. The problem for us is many do not show up on routine (toxicology) screens, so it can be challenging to make an accurate diagnosis.”

Davis said, in some cases, the effects can mirror a mental illness with similar symptoms that could subside in a few days or months.

“A doctor could treat the person for psychosis and now they are exposed to a new set of drugs and their potential side effects, and it was not necessary,” said Davis.

Kolm said that because of its potential for addiction, and because of the bad outcomes that can happen, people should not use kratom and stores should not sell it.

“People are hurting themselves, and possibly others,” said Kolm. “When you are driving down the road, this person, out of control, might be coming the other way.”

Kolm said addiction has been in all cultures, going back through time. He said even though kratom is a naturally occurring substance, there is always the potential for abuse.

“We can’t see the forest for the trees here,” said Kolm. “It purports to address pain. How long will it be before unscrupulous pain clinics take this on? Before less than reputable addiction centers tout it? There will always be something like this around. We need to address it in a better way. There is real risk involved.”

The Center for Disease Control (CDC) found that kratom abuse leads to agitation, irritability, tachycardia, nausea, drowsiness and hypertension. Health risks found in kratom abusers include hepatotoxicity, psychosis, seizure, weight loss, insomnia, tachycardia, vomiting, poor concentration, hallucinations and death.