As new forms of natural medicine make their way into the American political sphere, a decades-old debate rages on about a compound that many believe could be an answer to the country’s current opioid crisis.
Kratom is a naturally occurring plant that has seen its use increase in the United States starting in the early 2000s, but more recently has come under scrutiny as the federal government takes a closer look at drug policies. And although some hurdles remain, recent posturing in the highest halls have kratom poised to forge a path that could become a blueprint for other natural medical alternatives.
Recent posturing in Congress has seen substances such as psilocybin, MDMA and DMT vaulted into conversations about natural medication, and those same mechanisms gave kratom a boost with the release of the House of Representatives appropriations bill for 2023.
Included in the text of the Health and Human Services portion of the bill was a special section dedicated to kratom. The legislation recognizes the role of government-funded research and calls for continued study to determine the “safety, tolerability, and clinical pharmacokinetics in humans.”
Beyond simply hinting at possible treatments, the bill specifically mentions “promising results” of how kratom can fit into American healthcare.
“The Committee is aware of the potential promising results of kratom for acute and chronic pain patients who seek safer alternatives to sometimes dangerously addictive and potentially deadly prescription opioids and of research investigating the use of kratom’s constituent compounds for opioid use disorder.”
The House committee made it clear: It’s time to take a look at how kratom can be a part of solving the opioid crisis in America.
“The Committee also urges NIDA to consider a human clinical trial on its therapeutic effects to treat opioid use disorder, especially in light of the increases in overdose deaths reported during the COVID–19 pandemic.”
Unfortunately for advocates of natural medicine, not all branches of the United States government agree.
In April of this year, the Food and Drug Administration put out a warning to consumers about kratom, and said it was concerned that kratom appears to “have properties that expose users to the risk of addiction, abuse, and dependence.” The warning includes no specific evidence, instead referencing that the “FDA is actively evaluating all available scientific information” before listing a trio of kratom seizures in the past ten years as part of “additional actions” the agency has taken to keep kratom from the market.
Two of the seizures mentioned occured in 2016, the same year the Drug Enforcement Agency attempted to schedule kratom as a Schedule I substance, meaning it has no accepted medical use. Like the FDA’s recent warning, the DEA’s announcement of the intended action was vague on scientific backing, instead referencing how poison centers received 660 calls between 2010 and 2015, which was a substantial increase from the two exposures that were identified between 2000 and 2005.
For reference, the National Institute on Drug Abuse reported 68,630 deaths involving an opioid in 2020.
That situation was also similar to the current climate in the fact that Congress did not agree with the decision of the federal agency in question. A coalition of lawmakers wrote the acting administrator, expressing “concern” with the proposed decision and urging the DEA to give more time for public comment and expert consideration.
“This hasty decision could have serious effects on consumer access and choice of an internationally recognized herbal supplement,” the letter said.
Unfortunately for the DEA, the experts sided with the concerns of Congress. An article published in the National Library of Medicine made it clear: Kratom is a well-established treatment option that was not being properly represented by the DEA’s proposed action.
“Although kratom appears to have pharmacological properties that support some level of scheduling, if it was an approved drug, placing it into Schedule I, thus banning it, risks creating public health problems that do not presently exist.”
What should happen, the article recommended, was proper regulation by the FDA to “ensure appropriate and safe use.” If the FDA failed to act, the article warned that surveys indicated kratom users would turn to illicit sources and expose consumers to potential risks associated with an unregulated market.
The report said: “There has been no documented threat to public health that would appear to warrant emergency scheduling of the products and placement in Schedule I of the CSA carries risks of creating serious public health problems.”
Ultimately, the DEA rescinded its plans for the proposed scheduling.
Now, nearly six years since that debate was settled, the FDA is still taking a hands-off approach toward regulating kratom. The warning issued in April of this year reminds consumers that there are currently no FDA-approved uses for kratom.
That position, and the FDA remaining out-of-step with congress on the issue, is causing some state governments to take matters into their own hands.
Last month, a regulatory board in Wisconsin caved to a bipartisan group of legislators and agreed to study kratom and make recommendations in the next six months, following a further review of available research. Earlier this summer lawmakers in Pennsylvania increased access to kratom, following in the footsteps of Oregon’s legislature, who passed legislation in March to better regulate kratom to ensure safe access for citizens.
Colorado was another state to take legislative action, passing the Regulation of Kratom Processors Act in June. That bill became law when it was signed by Governor Jared Polis, who was one of the legislators who spoke out against the DEA’s proposed action in 2016, and went on to urge the FDA to reconsider its stance.
For Polis, signing kratom legislation into law is just his latest step in allowing patients to have access to medical options that could potentially save lives.
“The beneficial potential, safety, and efficacy of kratom has been discussed, studied, clinically researched and found to be as safe as coffee,” stated the 2017 letter that Polis signed alongside 16 other members of Congress. “We have heard from many constituents who have used kratom to successfully end their dependence on dangerous opioids, and maintaining legal access to kratom is important for many Americans to maintain sobriety.”