Poisonings reported from taking kratom, a herbal drug sold over the counter, have soared as the substance has become an increasingly popular treatment for opioid withdrawal and addiction.
Phone calls about kratom exposures to poison control centers nationwide skyrocketed by more than 50-fold from 13 in 2011 to 682 in 2017, according to a new study released Thursday and published in Clinical Toxicology.
Over that period, 11 people died following kratom exposure, the study says, including two people who had exposure to only kratom as opposed to a combination of substances.
“There is a significant increase in the number of cases,” said Henry Spiller, director of the Central Ohio Poison Center, which led the study with the Center for Injury Research and Policy, the Research Institute at Nationwide Children’s Hospital and others.
He said the spike is probably the result of greater use, and perhaps larger doses, of a substance that has only recently turned more mainstream.
“There’s a general feeling, I think, that this is a natural substance, so it’s safe. But we need to get across there are risks with this. If use continues to grow, we’re going to see these problems because it is a real potent substance.”
What is kratom?
Kratom is a plant grown naturally in Southeast Asian countries including Thailand and Malaysia, where it’s been widely used for centuries. It’s sold as a powder, typically in capsules, that can be used in tea to ease opioid withdrawals as well as fatigue, pain, cough and diarrhea.
In the U.S., the herbal supplement is typically purchased at smoke shops, gas stations or online.
But kratom has garnered scrutiny by the Food and Drug Administration, which has said that, like opioids, it carries similar risks of abuse, addiction and in some cases, deaths.
Supporters of kratom, led by the American Kratom Association, have disputed the substance’s danger, citing past reports suggesting it has low toxicity and has a milder withdrawal than opiates. They compare the addiction characteristics of kratom to caffeine in coffee.
“Follow the science. Kratom itself is safe,” Charles Haddow, the group’s senior fellow of public policy, said last month.
Who is using kratom?
Between 3 million and 5 million people use kratom nationwide, according to the the association.
Adult men are the most common users. The new study found 89 percent of kratom-related poisonings were among people at least 20 years old, and 71 percent were among males.
The average age of kratom users was 31 years old in the study. But of the 1,807 kratom exposures from 2011 to 2017, 137 were among teens between 13 and 19 years old and 48 were among children 12 years old or younger.
The study found seven cases resulting from neonatal exposures, a finding that Spiller said was unexpected.
Thirty-two percent of kratom exposure cases among adults resulted in admission to a health care facility while 52 percent resulted in a serious medical outcome
What are the possible effects?
The study says that small doses of kratom produce mild stimulant effects, while opioid-like effects occur after moderate to high amounts and sedative effects are associated with very high doses.
Of 1,174 single substance kratom exposures reviewed in the study, the most common clinical effects were agitation and irritability, tachycardia, nausea, drowsiness and lethargy, vomiting, confusion and hypertension.
According to the report, serious clinical effects included seizures, respiratory depressing, increased bilirubin, bradycardia, rhabdomyolysis, renal failure, respiratory arrest and cardiac arrest.
How and where is the drug used?
Three-fourths of the kratrom exposure cases came after the drug was taken intentionally. But among children 12 or younger, 81 percent of exposure calls came after unintentional use.
Among adults, 60 percent of reported poisons came after the drug was intentionally abused. The percentage among adolescents was higher, 76 percent. About 1 out of 10 cases, both adults and adolescents, were attempted suicides.
In 83 percent of kratom exposures, the drug was taken via ingestion, followed by ingestion through other routes and nasal inhalation.
The majority of cases, 86 percent, occurred at a residence. States with the highest exposure rates are Idaho, Oregon, Minnesota, New Hampshire and Maine. The lowest exposure rates were found in Wisconsin and Delaware.
Why is kratom not regulated?
The Department of Health and Human Services in late 2017 recommended that kratom be listed as a Schedule 1 drug, which would ban the substance and put it in the same classification as heroin and LSD.
But such a move would have to come from the Drug Enforcement Administration, and no action has been taken. The proposal is currently in a public comment period.
Several states have considered ktratom regulations on the state level.
For now, the FDA has not approved Kratom for any medical use and the DEA
has listed kratom as a “Drug and Chemical of Concern.”
The American Kratom Association is fighting the move to ban the substance, arguing that the FDA has failed to show kratom is dangerously addictive and that it presents a risk to public safety.
The group has said a ban on katrom would potentially increase deaths because many users would turn to dangerous and addictive drugs.