Miracle or menace? Experts and users weigh in on kratom

Source: WAFB
Source: WAFB
Source: WAFB
Source: WAFB

(WAFB) - Every day, Catherine Nieves drinks a cup of kratom tea. She compares it to a cup of coffee, giving her energy throughout the day and helping her focus on the tasks at hand. The tea leaves come from an herbal shop where she works in Florida. Ask Nieves to tell you about kratom and why she uses it, and she'll tell you it saved her life.

"My life completely turned around. It was incredible," said Nieves.

Like millions of people nationwide, Nieves says she fell victim to the opioid crisis. She says 8 years ago, she was homeless and using. After a friend died from an overdose, she says she was introduced to kratom as a way to stop abusing opioids. "Not only does it immediately halt the cravings for the opioids themselves, it also immediately halts the withdrawal symptoms," said Nieves.

Kratom is a plant native to southeast Asia. It can be taken in pill form, a powder, or as a tea. It's completely legal in most states and it boasts thousands of users who describe it as a medicinal herb that can treat a variety of ailments, from pain to anxiety. Many even believe it could be the answer to the growing opioid epidemic, helping people like Nieves walk away from their addiction.

Others, however, have grave concerns the growing popularity of kratom in the U.S.

"It's an unknown entity, and it really scares me," said Dr. Louis Cataldie, an addiction counselor.

Cataldie has treated thousands of patients for addiction for more than 30 years. In his experience, kratom has only hurt his patients' efforts to recover, often leading them back into harder drug use. He explains that in low doses, kratom can be a pain killer or an energizer. In higher doses, he says it mimics an opioid stimulating the same parts of the brain as heroin. Some users also report a euphoric experience if it's used in high doses.

"That receptor can ultimately cause addiction because if you stimulate a receptor, that receptor undergoes changes in your brain that makes your own body stop making the normal chemicals you need," said Cataldie.

Now the Food and Drug Administration (FDA) echoed those fears, calling kratom addictive and potentially deadly, especially when combined with other drugs. In a recent review, the FDA commissioner highlighted the risks associated with something that is currently completely unregulated and poorly studied.

"Patients addicted to opioids are using kratom without dependable instructions for use and more importantly, without consultation with a licensed healthcare provider about the product's dangers, potential side effects, or interactions with other drugs," stated Commissioner Dr. Scott Gottlieb.

Read his full statement here.

Cataldie agrees. He explains that overcoming addiction requires a person to "stop putting a toxic substance in your body" and to develop new coping skills.

"Addiction is a multifaceted illness. Just taking some over the counter drug that has no quality control, that may be contaminated with other substances is extremely dangerous," said Cataldie.

The FDA notes there are hundreds of kratom-related calls to U.S. poison control centers every year, increasing 10-fold from 2010 to 2015 as the substance has grown in popularity. The FDA also says it's aware of 36 deaths where a kratom product was involved.

However, advocates like the group American Kratom Association (AKA) dispute those findings, saying there's no case where kratom use alone led directly to death or an overdose. The AKA's website also states the drug is non-habit forming "unless taken in extremely high doses for extended periods of time."

The website also states:

If taken in excess, continuously over long periods of time, kratom consumers may experience dependence, similar to caffeine dependence. There can also be some discomfort if taken daily and use is abruptly discontinued.

Cataldie says that "discomfort" is a withdrawal.

"It's acts on the neural receptor when you start at a steady state for a while and you get off the drug you have a full-blown withdrawal. Definable, expected withdrawal syndrome is going to occur," said Cataldie.

Nieves, however, says she's no more addicted to her kratom tea than she was coffee. She also believes kratom has the potential to replace addictive opioid medication and she advocates for kratom on behalf of the AKA.

Since she stopped abusing opioids, Nieves says she turned her life around and is now engaged with children. During one of her pregnancies, her baby was delivered via C-section. She says doctors sent her home with a prescription for a narcotic. She says instead of depending on that prescription for pain relief alone, she turned again to kratom. As a result, she was able to use the prescription for a shorter time and smaller dose than directed without relapsing into her addiction. She says she disposed of most of the prescription safely.

While she disagrees kratom is dangerous, she does believe it could benefit from regulation and more study. That's something the FDA also recommended. "If proponents are right and kratom can be used to help treat opioid addiction, patients deserve to have clear, reliable evidence of these benefits," said Gottlieb.

Dr. Cataldie agrees it's possible the kratom plant could hold real benefits, but without proper regulation or guidance, he believes the products being sold in stores around the city are just too risky. "The Hippocratic Oath says first do no harm. Let's do everything we can to not do harm. Let's do our due diligence. Let's see what alkaloids are in that particular plant. Let's see if those are helpful and let's get rid of those that are not helpful or pathological," said Cataldie.

Now that the FDA has released its findings on kratom, the Drug Enforcement Agency (DEA) will begin its process of scheduling kratom and placing any restrictions on the drug if needed.

"DEA has received Health and Human Services's scientific and medical evaluation and scheduling recommendation for two constituents of kratom. DEA is moving forward with its independent analysis of this and other data, as required by law in order to place a substance under control," said a DEA representative in an email to WAFB.

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