“This is no longer a normal world”

Some people say a plant called kratom has helped them recover from opioid addiction. But to doctors and law enforcement, users are replacing one drug with another.

by Pat Worden

11/11/2018

Carrie Acree, The Dragon’s Mantle

It’s been clear for far too long that Akron is on the front lines of the opioid epidemic. And in the years that Akron has battled prescription painkillers, heroin, fentanyl and other drugs, many have explored self-treatment — with familiar substances like CBD and marijuana, and with a lesser-known cousin of the coffee plant known as kratom.

Some say kratom has been key to their recovery. Others, including some public health experts, say it may have similar effects to the substances it’s replacing.

Kratom has been used for centuries in Thailand, Malaysia, Myanmar, and neighboring countries for its mildly stimulative effects. Its use is also now illegal in those countries, as well as in Australia, Denmark, Sweden, South Korea, and the United Kingdom.

In the United States, the importation, distribution, and use of kratom is legal and largely unregulated — for now. The Drug Enforcement Agency and the Food and Drug Administration are working to change that.

Kratom is most commonly sold powdered, the leaves of the plant having been dried and pulverized. Kratom contains a number of chemical alkaloids, the most psychoactive of which is mitragynine. LIke opioids, mitragynine bonds with opioid receptors in the brain.

That’s why kratom proponents say the plant is a safer alternative to drugs like heroin, fentanyl and carfentanil. But it’s also why the DEA and FDA say that kratom is an opioid, and why they’re seeking to ban it as such.

Amaya, 19, of Akron, says that her addiction began with a pain pill prescription from a doctor following an accident. When her prescription ran out, she turned to street drugs—marijuana, cocaine, whatever she could get her hands on. When we spoke, she had been sober for three months and five days.

“I looked in the mirror and didn’t recognize myself anymore. I knew my two options were to end up in jail or end up dead,” she says.

Amaya says kratom has helped ease the physical symptoms of opiate withdrawal. A daily dose of kratom counteracts muscle aches and helps her sleep at night, she said.

But while kratom has helped her recovery, she says that other factors, like participating in a 12-step program, have been key.

“If your recovery is important to you, you’re going to do what you need to do. It’s a combination of things, and a lot of willpower,” Amaya says.

In Akron, kratom can be found in a variety of retail settings — vitamin and supplement stores, tobacconists, head shops and even gas stations. Some users, Amaya included, turn to organic herbalists for a product they perceive to be safer.

Kim Deneen, A Creative ApothaCare

Kimberly Deneen owns A Creative ApothaCare, a metaphysical and herbalism store, on Massillon Road in Ellet. She says she has stocked kratom since she first learned of its use by addicts in recovery.

“I’ve seen people progress, week after week, with kratom. I’ve seen them go from addiction, from not having a job, not having a place to live, to being productive members of society,” she says.

Deneen says she endeavors to keep kratom prices low and keep kratom available for her customers. Carrie Acree, who runs The Dragon’s Mantle on Kenmore Boulevard, says she also supplies certified organic kratom at below-market prices.

“We’re not trying to make a quick buck here,” Acree says. “A lot of our customers don’t have any other alternatives” for pain relief and addiction recovery support.

But Dr. Garry Thrasher, medical director for Akron’s ADM Crisis Center and Detox Unit, says “obviously there are some safety concerns” when people self-medicate with kratom and other unregulated substances.

Dr. Thrasher points to the lack of regulation and quality control in kratom. Users “don’t know what they’re getting,” since no one is testing or monitoring production of the product.

“I welcome more research, but I can’t advocate its use,” Thrasher says.

Thrasher expressed specific concerns about kratom’s use by opioid addicts.

Since kratom binds to opiate receptors, he says, “I’m afraid it might trigger opiate cravings.”

Acree says she sees more and more people turning to kratom for pain management. Her husband relies on it to relieve chronic back pain. She says he and others prefer kratom to prescription medication, and notes that a kratom ban will remove that choice. “If they don’t want pharmacy drugs, a lot of people will be left in pain.”

But a kratom ban may not be far off. In 2016, the DEA began working to reclassify kratom as a Schedule 1 drug, on par with heroin, cocaine and LSD. In August of that year, the DEA issued a statement of intent to use its emergency scheduling authority to remove kratom from the market, arguing that, like other Schedule 1 drugs, the plant “has a high potential for abuse,” and “no currently accepted medical use.”

The agency tabled the action in late 2016 after backlash from the public, including a bipartisan letter signed by 50 members of Congress.

Both the DEA and FDA continue to argue that kratom should be banned, but for now, neither regulatory agency has been able to do so.

A substance with similar regulatory uncertainty, especially in Ohio, is cannabidiol, or CBD oil. CBD can be distilled from either cannabis or its non-psychoactive cousin, hemp. In either form, CBD oil is marketed as an antioxidant, an anti-inflammatory, and even for the treatment of epilepsy and schizophrenia.

In most states, CBD oil is not considered medical marijuana and is regulated separately. But the Ohio Board of Pharmacy ruled in September that all CBD oil sales fall under the state’s new medical marijuana law, with distribution limited to licensed dispensaries.

With no dispensaries as yet in operation, most area retailers have stopped stocking CBD oil, though a few continue to carry it.

The ambiguous legal, regulatory, and medical standing of kratom is perhaps best summed up by Josh Bloom, Ph.D., Director of Chemical and Pharmaceutical Sciences for the American Council on Science and Health.

Bloom has authored several papers on kratom, arguing as recently as October 2016 against its classification as an unregulated dietary supplement. Bloom’s position is that kratom is a drug, and should be regulated as such.

In a January 2016 publication, Bloom calls out kratom’s main alkaloid, mitragynine, for what pharmacists call “off-target toxicity.” That means it impairs the brain by acting on multiple chemical receptors. He argues this is another example of kratom’s unpredictability and its limited effectiveness as a therapeutic treatment.

In recent months, however, as the opioid epidemic has reached crisis levels, Bloom has moderated his stance. While still no kratom advocate, he’s begun to see it as the lesser of two evils.

“Kratom hasn’t changed,” he says. “The situation has.”

Bloom stresses that scientific research on kratom remains rare. Classification as a Schedule 1 drug would effectively eliminate more research on the plant. Little is known about safe dosages, side effects, or how kratom reacts with other substances.

But amid a deadly explosion of fentanyl and carfentanil, with the accompanying spate of overdoses, Bloom says that, from a harm-reduction standpoint, kratom might be preferable to the alternatives.

“I wouldn’t encourage its use as a drug in a normal world,” Bloom says. “But this is no longer a normal world.”

Pat Worden is a lifelong Akron resident, currently living in Goodyear Heights. He’s a blogger, freelance writer, and former emergency medical technician.