A leaf that might be able to wean people off opiates without serious withdrawal symptoms has entered the market. So why are officials who haven’t studied the science yet scrambling to ban it?

Brendan Kiley
The Stranger

Kratom is a leaf from Southeast Asia that produces opiatelike effects, though it is not itself an opiate. It has been chewed or brewed into a tea for generations, and in the past five years, it’s broken into the US market. When you find it at head shops in Seattle, it looks like loose-leaf tea or powder (sold either in a plastic bag or packed into capsules). The common wisdom is that snorting it and smoking it don’t work as well as oral ingestion, though some people have been known to inject the extract, too.

Kratom was first documented as an opiate substitute—a kind of herbal methadone—in Asia in the early 1800s. It’s often used by people who want an alternative to opiates, either because they’re trying to break an addiction or because they want some way to manage chronic pain without opiate-based drugs.

Every few months, a new intoxicant that isn’t technically covered by US drug-prohibition laws pops up on the market and policymakers, acting on very little information, freak out over it. Unfortunately for kratom, it has appeared in the immediate wake of the “bath salts” hysteria. (The hysteria was not entirely unjustified, as the active ingredient of “bath salts,” a chemical called MDPV, was held responsible for long-term psychiatric damage and several deaths.) Kratom is already in the early stages of the same cycle.

That cycle goes like this: Clever entrepreneurs find an intoxicant not covered under current law and begin selling it. People get excited about it and chatter online. Some user winds up in the emergency room—for reasons that may or may not be serious—and says its name to a doctor who’s never heard of it. The doctor calls the poison control center, and the public-health bureaucracy scrambles to figure out what this exotic new drug is. Someone talks to a reporter, and soon newspapers and TV stations are all over it, breathlessly warning parents about a “dangerous new high” threatening their children. Lawmakers see a chance to score some points by being tough on drugs and ban it. The drug fades away. A clever new entrepreneur finds a new drug, and the whack-a-mole cycle begins again.

Enter kratom, stage right.

In the fall of 2006, a 43-year-old computer programmer in Massachusetts (let’s call him Jeff) wound up in his local emergency room after having a five-minute seizure. Jeff had been taking kratom on a daily basis for three and a half years. That day, he had also taken a pharmaceutical stimulant called modafinil. Apparently, the combination didn’t agree with his neurological system. (Though doctors never figured out what, exactly, caused the seizure.)

In the fall of 2006, a 43-year-old computer programmer in Massachusetts (let’s call him Jeff) wound up in his local emergency room after having a five-minute seizure. Jeff had been taking kratom on a daily basis for three and a half years. That day, he had also taken a pharmaceutical stimulant called modafinil. Apparently, the combination didn’t agree with his neurological system. (Though doctors never figured out what, exactly, caused the seizure.)

The hospital staff had no idea what kratom was, but a resident working with the poison control center had heard of a physician named Dr. Edward Boyer who was interested in the plant. Boyer is a medical toxicologist at Children’s Hospital Boston, a teaching hospital for Harvard Medical School. He became interested in kratom after reading websites where, he says, some of the 40 million Americans who self-medicate for chronic pain were posting messages. They had been able to buy their pharmaceuticals online for years but, according to Boyer, “around 2006, the government shut down all these internet pharmacies, and all these people who were self-medicating for chronic pain had nothing. They were looking for a way to deal with opioid withdrawal.” They stumbled across kratom, and vendors began meeting the demand.

Boyer was just beginning to look into kratom when he got the call about Jeff and went to interview him.

Jeff is a “high-functioning” man, Boyer says, who’d made a lot of money as a computer programmer and was married to a Pulitzer Prize–winning writer. Jeff used to be addicted to hydromorphone, getting pills and cooking them so he could shoot up. (Jeff had reportedly studied chemistry in college and knew what he was doing.) One day, Jeff dropped his baby on the floor. “When he dropped the baby, his wife said, ‘Either the opiates go or I do,'” Boyer says. Jeff had tried to quit several times but couldn’t because of the pain of withdrawal. So he turned to kratom. At the time of his seizure, he’d been taking kratom for more than three years, spending more than $15,000 a year on the plant.

After the seizure, Jeff quit taking kratom. “He stopped the kratom cold turkey and only had a runny nose,” Boyer says—a surprising lack of withdrawal symptoms. “To go from injection drug use to nothing, with only a runny nose, is impressive.” Boyer coauthored a paper about Jeff, titled “Self-Treatment of Opioid Withdrawal Using Kratom (Mitragynia speciosa korth),” for the medical journal Addiction.

Finding an inexpensive, naturally occurring way to wean people off of heroin and prescription opiates without serious withdrawal symptoms would be a silver bullet for public health—and a gold mine for any entrepreneurs who discovered it.

Relative to opiates, kratom seems reasonably safe, at least in the short-term. (There have been a handful of deaths associated with kratom, but they all involved other drugs: one 20-year-old man whose toxicology results also showed he had morphine and “stovetop speed” made from nasal decongestants in his system; nine people in Sweden who died from taking a brand of kratom called Krypton that had been laced with pharmaceuticals.)

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