Sam Trathen stands at the counter in her small, dimly lit apartment kitchen. It's 11 a.m. and time for her first cup of kratom tea. The electric whir of her French press fills the room while she measures out the greenish brown powder onto a kitchen scale.
"I guess while that's heating up, I can weigh it out on a little scale. Usually about half a teaspoon is 2 grams,” Trathen said.
About 1.7 million Americans 12 and older used kratom in 2021, according to the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health.
Mac Haddow, with the American Kratom Association. estimates that number to be much higher — between 11 million and 15 million users.
"They break down roughly into a third that use it recreationally like you would a cup of coffee as a replacement for a cup of coffee, because they find that it has better effects for them,” Haddow said.
“Another third use it in order to mitigate feelings of anxiety and depression successfully. And then, of course, in that third category where people are struggling with acute and chronic pain issues and don't want to use more addictive substances like opioids."
What is kratom?
Kratom comes from the leaves of a tree in Southeast Asia and has long been used by farmers there for an extra caffeine boost in the morning, much like coffee.
But unlike in the United States, where kratom-associated deaths and addiction have headlined mainstream media, there’s little indication in countries like Thailand and Malaysia that the same thing is happening.
As the University of Florida notes on its kratom resource page: “Kratom products in the U.S. are not fresh leaf material and therefore, not the exact same product that is found in Southeast Asia traditional use. This difference, which has not been fully investigated, comes from the fact that products available outside of the traditional use are usually dried or aged in ways that could possibly change the chemical composition of the leaf material.”
In the United States, it is usually sold in powder form in stores, gas stations and online, but you can also find liquid extract products sold as energy shots.
Trathen uses it to deal with the pain of chronic kidney stones, bone spurs and arthritis. She said she can't function on opioids or medical cannabis.
“It helps me stay focused at work because I wasn't always in pain," Trathen said. "When you have like a chronic pain disorder, it helps to have something that just kind of takes the edge off.”
Kratom’s regulation problem
Kratom is illegal in seven states, but not Florida. Last year, a new law restricted kratom sales to those 21 and older. But otherwise it’s largely unregulated, a veritable “Wild West,” said University of Florida researcher Chris McCurdy.
A second kratom consumer protection bill, supported by groups such as the American Kratom Association, died in subcommittee in March during the Florida legislative session.
The bill would have prohibited the production, sale or distribution of kratom products combined with other substances, including synthetic alkaloids that “strengthen it to a dangerous degree” or that state statutes list as poisonous or harmful.
It would have also banned any product labels claiming kratom is intended to treat, cure or prevent any medical condition or disease.
Groups including the federal Food and Drug Administration have historically warned against the use of kratom, but advocates such as Haddow disagree.
“The FDA narrative about kratom initially is wrong. It's not a dangerous product; it is safe as long as it's regulated appropriately. So, that's what we're pushing for,” Haddow said.
“We hope that in the state of Florida next year that we'll be able to negotiate with the Department of Agriculture to give them a good regulatory pathway that would allow for consumer access to safe products, but not an overregulated environment that would block products from getting into the hands of consumers.”
Part of the problem when it comes to regulation, research and consumption, UF's McCurdy said, is that “not all kratom is equal.”
“Trying to classify it as a one, single substance is really not appropriate at this time. That's like calling all alcoholic beverages just alcohol, where you can have a light beer that's very low in alcohol content versus Everclear that could be 190 proof.”
“You could easily see how you could go from a minimal exposure with leaf material to incredibly, significantly higher exposure with some of these concentrated extract products.”
Research at UF and beyond
The University of Florida in Gainesville has been at the forefront of kratom research for several years. McCurdy has been studying the herb for more than 15 years.
UF has received numerous grants over the years to study kratom, including a five-year $3.4 million National Institute on Drug Abuse award that ended this year.
“Although we've learned a tremendous amount about individual alkaloids within the plant, those chemicals and how they interact with systems in our body, we've not learned a tremendous amount about the product overall as a whole leaf product or even as an extract product,” McCurdy said.
In February, the university’s College of Pharmacy hosted the third International Kratom Symposium, which featured over 20 presentations by scientists from fields including botany, chemistry, pharmacology and public health.
McCurdy said much of the research on people so far has been conducted with single doses of kratom — or increasing doses over a short period of time.
The FDA also recently conducted a single ascending dose trial in which none of the individuals experienced severe adverse effects outside of nausea.
"It was tolerated in the majority of individuals all the way up to 12 grams in a single dose,” McCurdy said.
He said the next steps will involve studies studying multiple dosages, drug interactions and efficacy trials to explore claims that kratom helps with pain, mood elevation and more.
McCurdy said there's still much to learn about kratom, and at times it has been unfairly criticized by the media, law enforcement and federal organizations.
Data on kratom-associated deaths, he said, are not always clear cut — and politics sometimes plays a role.
"Coroners are still elected positions in our country; they're political positions. You don't have to be a physician to be a coroner. ... They don't consider the whole bigger picture of what other things may have been going on or what may have been happening," McCurdy said.
A study published in 2019 looked at more than 27,000 overdose deaths that occurred between July 2016 and December 2017. Fewer than 1% tested positive for kratom, and of those, most also tested positive for another substance such as fentanyl, heroin, benzodiazepines, prescription opioids or cocaine.
A study published this year in the Journal of the American Medical Association (JAMA) reported that the majority of kratom users surveyed are “doing kratom in a very responsible way so that they're getting their benefit. They're not out there trying to get high or trying to abuse the substance,” McCurdy said.
"Certainly in some cases, there's been reports where kratom was the only thing in the individual system that led to a death,” McCurdy said. “Yet, you know, they may have not screened for very many other substances or even some substances may have been combined that isn't screened for at all because we're seeing so many new synthetic things, synthetic molecules show up in the illicit marketplace.”
The future of kratom
Currently, the FDA has a call out for a human abuse potential trial with the same doses that were used in that single ascending dosage trial to see if there's abuse potential with any of those doses.
Down the road, McCurdy said, there will be multiple ascending dose trials where researchers will start looking at multiple doses and escalating those doses in individuals until they reach an adverse event.
And then there will be “efficacy trials to understand, 'Is this actually working in a manner that everyone is claiming it works? Does it relieve pain? Does it elevate mood?' ”
McCurdy said the ultimate goal is to have an investigational new drug application approved by the FDA for purified mitragynine, the most abundant active alkaloid in the Mitragyna speciosa plant, in a “capsule formulated form” that would go into the NIDA Drug Supply Program so researchers can apply for grants to use that material for human clinical trials.
“We believe that process will probably be completed at the end of this calendar year early into 2025, where that material will be available for researchers with an FDA sort of ‘approval go-ahead green light’ to go into human trials,” McCurdy said.
While McCurdy said he’s absolutely an advocate for the positive benefits of kratom use, there’s much to be learned.
“We absolutely still need more research,” McCurdy said. “So, even though we've been able to move in monumental directions in the last five years, and we've learned a tremendous amount, that's led to more questions that we don't know answers to.”
Meanwhile, kratom users like Trathen look forward to more research they hope backs up their experiences with the herb.
“Having some scientific knowledge about how it works and what it does and how to not use it dangerously would be really helpful,” she said.
Until then, she said, she'll continue monitoring her kratom use with her doctor, who has her full support.
Copyright 2024 WUSF Public Media - WUSF 89.7
