What if I told you there was an herb used by thousands to self treat chronic pain, post-traumatic stress disorder, anxiety, and to wean off dangerous opioid medications, and that a controversy over legality was currently playing out state by state in the USA? You’d think I was talking about marijuana, right? But you’d be wrong. It’s kratom.
Wait, what’s kratom?
Kratom (pronounced either “krah-tom” or “kray-tom”—take your pick) is the leaf of a Southeast Asian tree (Mitragyna speciosa) that grows in the rainforests of Indochina and Malaysia. It’s related to coffee, and human inhabitants of the area have used the leaves for their medicinal properties since time immemorial. Traditionally, the leaves were chewed in raw form and were used as an antidiarrhoeal, to stave off exhaustion, and as a painkiller and mood enhancer. In Thailand, it has also been commonly used to treat opioid dependence, premature ejaculation and diabetes. Reports suggest that up to 70% of the male population in some districts of southern Thailand are regular kratom users. To many Thais, kratom is their social equivalent to our coffee.
“There are three main strains—white vein, red vein and green vein kratom. They have varying proportions of mu (μ)-opioid receptor agonism, stimulation, and dissociative effect,” says a kratom importer I spoke with who wishes to remain anonymous. “Kratom from Borneo and Sumatra are noticeably different, but kratom doesn’t have the culture of coinnoisseurship that cannabis or wine do. In general, white vein is the most dissociating, red vein the most sedating and green vein the most stimulating—but those effects aren’t necessarily consistent, depending where the kratom was grown and how it was harvested.”
The leaf contains several alkaloids, but the pharmacological effects are not yet well studied. Kratom is a mu (μ)-opioid receptor agonist, which means it kills pain, although it differs significantly from opium-derived drugs in its effects. Importantly, kratom does not appear to suppress respiration like opioids do. If you take enough morphine or heroin, you will forget to breathe and you will die. But if you take too much kratom, you will be violently ill and projectile vomit. It’s very hard to hold down enough kratom to constitute an overdose. Kratom has been used since antiquity in its native range, and if it were seriously dangerous, it would carry that reputation there. It does not.
“For the average person, it is not difficult at all to stop using kratom. Coffee is harder and more painful to quit for many,” says kratom activist Paul Kemp. “There are rare people, usually former hard drug addicts who go at kratom like they went at opiates, who reportedly have fairly bad withdrawals—but still not as bad as with true opiates. Tobacco is much harder to quit than kratom.”
And yet, here we are in the U.S. with a pitched battle regarding the legality of kratom being fought on a state-by-state basis. The herb has been outlawed in Wisconsin, Indiana, Vermont, Arkansas, Tennessee, and the city of Sarasota in Florida. (Wisconsin is reconsidering the ban.) There is pending legislation in Iowa, Michigan, New York, New Jersey, New Hampshire, Kentucky, Alabama and Georgia. In many states where it’s outlawed, it’s been unfairly bundled together with dangerous synthetic research chemicals such as cathinone “bath salts.”
A healthy alternative?
Pain management and its side effects are a problem for many people. Some suffer liver damage from taking acetaminophen in large doses on a regular basis. NSAIDs like ibuprofen and aspirin cause gastric ulcers. Prescription opioids lead to dependency and possible heroin addiction. People also self-treat chronic pain with alcohol, with predictably bad long-term results.
Kratom has received a lot of undeserved bad press lately, as the media looks for the latest manufactured “health crisis” to drum up page views, but kratom is clearly an excellent candidate for harm-reduction efforts aimed at stemming the swelling tide of opioid overdose in America.
In 2014, more than 28,000 people died of opioid overdose in the U.S. Kratom alone has not been responsible for any of those deaths.
Opponents note that kratom has been illegal in Thailand since 1943, but don’t mention that it was outlawed specifically because it was so good at treating opium addiction that the Thai government was losing vast amounts of tax revenue from its legal opium trade during World War II. Recommendations by the Thai Office of Narcotics Control Board for kratom to be decriminalized in Thailand have been pending since 2010.
Due to issues of legality and concern for losing access to the herb, of the 20 or so people I interviewed for this article (face to face, via email, and in an Internet forum), only one was willing to publicly talk about his medical issues and his use of kratom—Paul Kemp, who founded the American Kratom Association (see accompanying interview).. Most of the people I spoke with depend on kratom for pain control.
J.P. is a mechanic. “I was taking opioid meds for my back pain, but I got laid off last year and lost my health insurance, so I quit going to the doctor,” he said. “I tapered off my remaining meds, but got in a situation where my back was really killing me, so I picked up some kratom capsules from a head shop and figured out how to dose myself with it. Kratom isn’t nearly as strong as prescription opioids, but since my tolerance had gone down I was able to tell a really big difference when I took it. Until I get insurance again I will continue to use kratom for pain management.”
“I was diagnosed with Lyme disease in 2014, and I suffer from deep fatigue, headaches, sore throat and body aches, both muscular and joint,” A.L., life coach and body worker told me. “I also have neurological symptoms: brain fog, depersonalization, tinnitus, and random sensations of buzzing or vibration. I bump into things a lot, I’m forgetful and disoriented, and I’m easily overwhelmed. Kratom helps relieve pain and gives me a subtle energy boost. It’s helpful to take during the day on days when I know I have things to do that can’t be put off, and it will get me through the day mostly functional. I got an ulcer from all the ibuprofen I used to take, so it’s been a very good alternative for that.”
Carpenter and web shop owner R.C. started using kratom to help him complete a five-year taper off of Subutex, a pharmaceutical used to treat opioid dependence. “Kratom helps relieve the ’blood boiling’ feeling I have when I feel withdrawals from that drug. It just barely takes the edge off, but any natural relief as gentle as kratom really helps. I would cold turkey it, but the withdrawals make it impossible for me to work.”
R.L., who has been an addict since the age of 16, finds that kratom takes away the craving for alcohol. “It works great for me—I’m able to function. I take it in the morning and at night coming back from work. I do go back and forth—sometimes I get fed up of kratom and go back to drinking after my kratom tolerance gets super high, but it’s a good thing to be able to switch to kratom rather than just drinking all the time. Alcohol will damage you, but if you take some kratom instead, your body feels good, your mind is more settled, and you’re more productive.”
As a chronic pain patient and someone with an allergy to most prescription opioids, I stumbled across kratom late last year and decided to try it out for myself. After purchasing a sampler pack from an online retailer, I was bemused to find each package adorned with a sticker reading “not for human consumption.” Kratom currently falls into a kind of regulatory Siberia. It’s legal in most states, but only if it’s not sold as a supplement—hence the confusing labels. You can buy kratom at most head shops, but the supply there will be both weak and overpriced. Additionally, since kratom is a botanical, potency and effect will vary with the place it was grown, the manner in which it was harvested and the individual metabolism of the person taking it. You can’t know accurately in advance how any particular batch will affect you personally, so if you’re interested in kratom as a painkiller or an anxiolytic (to relieve anxiety), the best strategy is to purchase a sampler pack like I did from a reputable online retailer and test several kinds. “You will find the best kratom from online suppliers who import it fresh from Indonesia,” says Paul Kemp.
But how do you find a good online retailer? because of the perverse laws surrounding kratom, if CATALYST made any retailer recommendations by name in this article, it might provide grounds for the FDA to shut them down or confiscate their shipments at the port of entry. The FDA’s rules right now don’t provide for a sensible regulation of kratom.
What you can do, however, is to seek out any of many kratom-related Facebook groups and internet forums and ask around, or simply Google “kratom online seller review” and do your own research. People who have found kratom to be effective for various medical conditions are generally enthusiastic about the herb, and willing to discuss their best sources at length.
As a botanical with a long history of medical use, kratom is exempt from the same testing that pharmaceuticals are. Since it’s an easily and cheaply grown herb, it’s a risk for a pharmaceutical corporation to invest the millions of dollars needed to develop a drug from it, patent it and bring it to market.
While the monetary rewards for kratom research are likely to be fairly low, the American population, so desperately in need of safer painkillers than opioids, could clearly benefit from it. Like marijuana, kratom has the potential to save lives when used sensibly in a medical capacity. It’s ironic that just as marijuana is beginning to experience widespread decriminalization and cultural acceptance, kratom is being unfairly vilified and criminalized, putting a definite end to any research at all in those localities where it’s been made illegal. This valuable herb, and the population of pain and anxiety sufferers it helps, both deserve better.
Paul Kemp, the founder and President of the American Kratom Association (AKA), talked with CATALYST about kratom, its use, and activism to keep it legal in the U.S.
Catalyst: How did you first encounter kratom?
Paul Kemp: A chiropractor I know introduced it to me. He was selling it out of his clinic and seeing a lot of new business coming in, due to the good results people were having for Lupus, anxiety, back problems and other chronic pain issues.
Once I found the right dose, I enjoyed how the herb energized me after a hard day’s work without interfering with my sleep (or making me high like marijuana does). I am also pre-diabetic. Kratom is traditionally used in Thai folk medicine for diabetes, and it has helped me tremendously. It may also be somewhat responsible for reducing the pain and inflammation I suffer from sciatica and lower back pain.
Can you tell us a little about your kratom activism? How did you get involved in the cause of advancing kratom?
I was fascinated with the disconnect between the positive results many people were receiving and the aggressively negative and unfair treatment the herb was (and still is) receiving. I was familiar with the imperfect qualities of our monopolistic medical/pharmaceutical industry, having watched my mother slowly lose her health and her mind, as her doctor prescribed drug after drug for what would probably be diagnosed today as fibromyalgia. Each new drug they tried on her usually required another drug or two to control the side effects of the first one.
Is kratom use expanding in the US?
Yes, most definitely. It fills a need in the chronic pain community, where it does a better job of controlling pain, anxiety and depression than pharmaceuticals for many people, and it also helps many to wean off opioid drugs. For the most part, the TV-spread myth that kratom leads to heroin use has the story backwards: Pain patients, as well as some heroin users, have learned that kratom is an almost painless way to get through the traumatic withdrawal that stops most people from ending addiction.
Are there any statistics on kratom use in the US? How about in Southeast Asia or elsewhere in the world?
I am not aware of any official statistics of kratom use in the US, but the best estimate we’ve been able to come up with has been about 5 million consumers, with perhaps half of them using it mainly for medical purposes. It is expanding rapidly as one person who finds outstanding relief from the symptoms of Lyme disease, fibromyalgia or chronic fatigue syndrome tells everyone they know about kratom. I know a physician who has tried all the medical options for his ulcerative colitis, studied the research, and now quietly uses and recommends kratom for his patients.
In Thailand, an estimated 70% of the Muslim men in the southern provinces are said to use kratom to help with laboring in the hot jungles, with diabetes symptoms, or in traditional ceremonies, plus relaxing after work. There seems to be a similar situation in Malaysia, where kratom use is tolerated.
Can you tell me more about the environmental and economic impact of kratom cultivation in Southeast Asia?
Kratom grows wild throughout the region, and it’s also cultivated in plantations on cut-over lands. Older trees yield stronger kratom, so there is an incentive to preserve the jungle trees on virgin soils. It does a lot for the native economy, allowing poor peasants to earn some income. Kratom harvest is another reason to preserve old-growth rainforests, and is a better option for the locals than strip-mining or palm oil production. As the AKA grows in size and influence, we hope to be able to develop the growth of kratom as an economic resource for the people who cultivate it.
Is there any American research on kratom?
Dr. Christopher McCurdy at the University of Mississippi has done considerable research, hoping to use kratom as a safer treatment [for opioid dependency] than methadone.
How do you address the issue of addiction?
To manage the addictive potential of kratom, I have two mottoes: First “don’t chase the euphoria”—meaning don’t increase the dose just for the euphoric feeling; and “less is more”—use the least amount that provides relief for your body and your symptoms. Keep the same dose day after day, and take occasional breaks of several days to avoid building a tolerance. It also helps to change strains frequently so your body doesn’t get used to one alkaloid profile.
Do you think kratom needs anyregulation at all?
We advocate that kratom not be sold to those under 18. An ideal place for it to be sold might be in a health foods or apothecary shop, with knowledgable staff to explain its use. Consuming large doses to try to have a profoundly euphoric experience is not recommended. There is a ceiling effect, which prevents this from being done more than once or twice a week, and taking too much kratom also carries the potential for you to get violently sick, possibly for days. It’s better to use it for the sensible management of medical symptoms, or in small quantities and occasionally as a pleasant social lubricant, much as you’d have coffee with friends. It needs education in order to use it well, more than it needs regulation.
One fascinating thing about kratom is that the active alkaloids are also effective transdermally—that is, you can put it on your skin, and it works.
Sunburn treatment: Cold filtered kratom tea in a spray bottle is said to be an excellent ameliorative for the pain of sunburn. I haven’t been sunburned in years, but I’ll remember that if I get caught out this summer.
The tea is fairly easy to make: Add 1/4 cup of ground kratom herb to 2 cups of boiling water and steep for 15 minutes. Filter through cheesecloth, let cool, pour into a spray bottle and refrigerate.
Soap: I gave some fine-ground kratom leaves to a friend who is a professional soap-maker. She made several test batches, with the best results coming from a high-kratom, cold-process technique that yielded a dark brown bar flecked with exfoliating bits of kratom herb. She also added some eucalyptus essential oil, on the premise that it might enhance any painkilling or relaxing effects of the soap.
I distributed the soap among a few friends and told them to wash with it and report back with the results. In general, they loved the soap, and a majority asserted that it did, indeed, possess superior relaxation effects.
Soap-making is for the more ambitious; but in general, add enough ground kratom to a standard hot- or cold-process soap recipe to turn the mix avocado green and provide a satisfying amount of exfoliating “tooth” to the paste. The soap will oxidize to a dark chocolate brown as it sets up. Try either lemongrass or eucalyptus essential oil as a nice aromatherapeutic addition, and enjoy!
I think kratom is one of the nastier-tasting herbs out there, often leaving a lingering aftertaste for up to an hour post-ingestion. Some people find the taste similar to yerba mate tea. Kratom users have developed an array of ways of taking the dried, powdered herb:
Honey tea. Measure your kratom dose, dry, into a teacup, and add an equal amount of honey, blending to a paste. Add a small amount of boiling water and continue stirring. Sip it like tea; or wait till it cools and chug it. You can also mix it similarly with orange juice or hot chocolate.
Encapsulation. Do not buy kratom capsules pre-made. Because of the lack of standardization, these will often be low-quality and too expensive. Buy kratom powder and encapsulate them yourself. As each capsule contains a standard amount of kratom, it’s easier to estimate your effective dose. Use a capsule machine such as a Cap M Quik, available online or at local herb shops.
Dosage. Generally, it’s recommended to start with a half teaspoon of powdered kratom and see how you feel. A standard dose is between a teaspoon and a tablespoon, but start small. I have personally never needed more than a teaspoon at a time. Be aware of the hazards of habituation, and always take the smallest dose that’s effective for you.
If you get sick to your stomach, try a different strain. If no strains work for you, then don’t take any more kratom. It doesn’t work for everyone.
Sixteen percent of people who try kratom experience some nausea at any dose. A very small number of people also have a liver sensitivity to kratom. Why does this happen, when the majority of people respond well to the herb? We just don’t know. Make your doctor aware if you’d like to try kratom, to verify there aren’t any possible bad interactions with other drugs you are on, and to monitor your liver function if that may be a concern.
The knotty business of kratom importation
A kratom importer talks to CATALYST about bringing the jungle leaf into the US
Kratom is in a weird kind of limbo with the FDA and the DEA. It has not been banned outright, but the FDA will seize imports of kratom if they are marked as intended for use as a supplement. Shipments marked “not intended for human consumption” are still being allowed into the country, and the supply of kratom here hasn’t appreciably dwindled. Depending upon the volume of purchase directly from farmers in Indonesia, the markup can be more than 400%—but an importer may also be relying on bank transfers that supply no recourse if the seller doesn’t comply with their end of the bargain. An importer with nine years’ experience in the trade agreed to talk anonymously with us about the business.
How did you get into importing kratom?
I was consuming kratom myself, and I thought it made sense to start buying it wholesale. I used to import it directly from Indonesia, but now I mostly resell kratom that I buy from other importers.
How is kratom grown?
Kratom is mostly farmed. Even wildcrafted kratom locations turn into farms over time as they become actively managed. Farming kratom can be a very good income by local standards, and tree farming is generally sustainable and has a small ecological footprint.
What’s the local perception of kratom in Southeast Asia?
In Thailand, where it is native, it’s treated as a “light” drug on the same level as marijuana. People in cities that are part of the Thai drug culture are familiar with kratom, and they consider it the drug of hard workers, where marijuana is considered a drug for the lazy.
Kratom has no real native cultural use outside of Thailand. In Indonesia, people who are part of the drug culture have mostly never heard of kratom. There is some anecdotal mention on the Internet of kratom being tolerated or even encouraged by Thai Buddhists in a way that other substances aren’t, but I could not find any direct sources. I have not found much in the way of “kratom culture” like you have pot culture or alcohol culture.
How long has there been a market for kratom in the US?
For more than a decade now, but I’m not sure that use is increasing as quickly as the impression the media is giving. [Also], my impression is that far more people use kratom medically than recreationally.
The FDA or the DEA are not moving decisively to ban kratom, but they do seem to be harassing the importers. Is there a danger of kratom being banned?
I think the pharmaceutical companies would block kratom from becoming a Schedule I or II drug (either banned or tightly controlled) because there’s too much potential profit in bringing it to market in some form as a Schedule III or IV drug. A Japanese research group discovered [the active compound in kratom] 7-hydroxymitragynine and they’ve been granted a patent for other possible derivatives of mitragynine. Being a Schedule I or II drug would interfere with that.
How would you characterize the addictive potential of kratom?
Kratom is less addictive than pharmaceutical opiates because its complex pharmacology includes mechanisms known to reduce the addictive potential of pharmaceutical opiates. For a culture of harm reduction, this is a good thing. Kratom has a lot of potential for medical use.
Alice Toler is a CATALYST staff writer