Kavita Babu and Edward Boyer are professors of emergency medicine and medical toxicologists at the University of Massachusetts Medical School.

Kratom was used for centuries by manual laborers for its analgesic and stimulant effects. Its active components (mitragynine and 7-hydroxymitragynine) target the same receptor as morphine, which accounts for its historic use as a remedy for opium addiction. But as early as the 1960s, the medical literature described addiction among people who compulsively ate kratom throughout their day.

Unfortunately it falls under loose regulations for dietary supplements. But making it a restricted drug would harm scientific development.

In recent years, kratom — as plant material, tea and extracts — has become increasingly available over the internet. On forums like Bluelight, chronic opioid users described how it decreased their craving for opioids, eased withdrawal symptoms and helped them abstain from heroin.

There is promise in the study of kratom and its alkaloids. Mitragynine appears to lessen pain without suppressing breathing. An effective pain medication that does not pose that possibly lethal side effect offers a valuable scientific advance.

Unfortunately, placing kratom (and its active components) in Schedule I status will dampen scientific development and potentially delay the creation of useful new medications.

Adverse effects are rarely reported and tend to occur when a product sold as kratom is adulterated. More recently, we have found samples in which we suspect additional mitragynine and 7-hydroxymitragynine were added to products sold as kratom to boost their effect — and possibly increase their addictive potential.

Since kratom is considered a dietary supplement, it falls under the loose regulatory parameters established by the Dietary Supplement Health and Education Act of 1994. This legislation provides remarkably little surveillance over the production of dietary supplements.

There are no standards for the kratom sold to consumers. The inability of consumers and physicians to accurately identify the contents of substances sold as kratom fundamentally muddies any discussion regarding the risk and benefits of this herb’s use. Any benefit or harm may be due to adulterants, rather than the original kratom plant itself.

While we support the Drug Enforcement Administration's decision not to pursue Schedule I status for kratom at this time, we would remind users to be wary that the kratom that they purchase may be something entirely different.



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