The kratom tree grows in backyards throughout Indonesia, Malaysia and Thailand. In everyday life, people pluck a leaf from the Mitragyna speciosa tree and chew on it to energize themselves throughout the day. The kratom tree is in the coffee family and, like the caffeine in coffee, it’s the alkaloids that provide experiential effects. In the case of kratom, the primary alkaloid is mitragynine (there are at least 58 alkaloids all told).

In the U.S., kratom is said to improve mood, relieve pain and, crucially, may help people get over their opiate addiction. According to the U.S. Drug Enforcement Administration, at higher doses, kratom’s stimulant effects turn to sedative effects. Also in the U.S., kratom has been linked to dangerous adverse health events including death. The wrongful death lawsuits are flying against kratom companies.

Is kratom safe in the U.S.?

So how is it that kratom is used safely in everyday life in its traditional setting in Southeast Asia but side effects abound in the U.S.? A team of Malaysian researchers noted that “while several cases of toxicity and death have emerged in the West, such reports have been nonexistent in Southeast Asia where kratom has had a longer history of use.”

The researchers postulated kratom is purchased in local coffee shops in Asia, yet in the West consumers access the botanical mostly online. So maybe Americans don’t know how to make tea? Or more likely, the kratom Americans consume has higher concentrates of the experiential alkaloids?

Related:Kratom health risks at center of fight in final phase of criminal case

A methanolic extraction of kratom concentrates its alkaloid levels. One group of researchers found extractions contain eight times the kratom alkaloids compared to kratom tea.

Another group of researchers compared alkaloid levels of four commercial kratom products available to U.S. consumers to those from traditional kratom tea. “The content of mitragynine in commercial products, especially capsules available in the United States, is much higher than the total mitragynine consumed from brewed tea preparations, similar to those used traditionally by the natives of Southeast Asia,” the researchers noted.

How much higher? Between 17 and 97 times higher! That obviously makes the health risk higher.

Also, the adverse health effects reported in Western nations often pertain to kratom used with other controlled substances, while in Asia kratom users stick to the tea. Americans are such candy-flipping party people!

There’s a current lawsuit, which we covered at Natural Products Insider, over a criminal case involving illegally imported kratom. In this criminal case, it was disclosed the defendant’s girlfriend died from kratom — as well as a litany of other substances — oxycodone (aka, oxy), oxymorphone (aka, biscuits), lorazepam (a benzo like Xanax), midazolam (another benzo that’s used as anesthesia before surgery) and levetiracetam (brand name Keppra). Any of those substances is more serious than kratom. Stacked like that, death is not such a surprise. The only real surprise is that kratom is fingered as the cause of death.

Related:Slate of kratom wrongful death lawsuits expands with Jordan McKibban filing

Kratom was listed as contributing to or causing at least 4,100 deaths in 44 states and Washington, D.C., between 2020 and 2022, according to a Washington Post investigation. “The vast majority of those cases involved other drugs in addition to kratom,” the Post noted. “Still, the kratom-involved deaths account for a small fraction of the more than 300,000 U.S. overdose deaths recorded in those three years.”

Concern about kratom danger

In an opinion on its website, the Food and Drug Administration asserts kratom “is not lawfully marketed in the U.S. as a drug product, a dietary supplement, or a food additive in conventional food.” It says there is no approved kratom pharmaceutical, nor has any supplement company successfully filed a new dietary ingredient notification ([NDIN] though a half-dozen companies have tried, with FDA raising one or more concerns regarding all of them. FDA has also both refused international shipments of kratom into the U.S. and seized kratom products.

Related:FDA, supplement manufacturer debate NDI import alert request

But like CBD, which FDA said poses safety concerns, the agency was evidently powerless to stop the free market from selling it.

DEA tried but stopped to have kratom listed as a banned drug under the Controlled Substances Act (CSA), and instead has listed kratom as a Drug and Chemical of Concern.

Concerned states have stepped into the vacuum. Kratom is banned in six states: Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin. In Tennessee, synthetic kratom alkaloids are banned but not the kratom plant itself. Various cities, like San Diego and Denver, have also banned it.

Advocates for kratom safety

The American Kratom Association — no surprise here — advocates that kratom is actually safe, and that some 15 million Americans have availed themselves of the leaf.

The association says that one-third of these kratom users have low consumption rates, between 2-6 grams once or twice a day. These are the people whose use most aligned with those from Southeast Asia. Intake around 14 grams a day is for people who “use it for anxiety and depression.” Then there are people “using 16 to maybe 34 grams of kratom per day when they’re dealing with acute and chronic pain issues and trying to wean off of more dangerous drugs,” Christopher McCurdy, a medicinal chemist, behavioral pharmacologist and pharmacist, and professor at the University of Florida’s College of Pharmacy, told Natural Products Insider.

The Naturopathic Physicians Medical Board (NPMD) issued a kratom fact sheet for health care professionals. The group says a normal powder dose is 3-5 grams, while concentrated liquid extracts may require only 1-2 drops added to a drink. The NPMD concludes that when “consumed in higher doses (more than 5 g/dose and more than three times/day) on a frequent basis … The risk of dependence development appears to be higher if the extract is used for harm reduction to mitigate opioid and illicit drug withdrawal or for self-treatment of pain.”

The federal Kratom Consumer Protection Act was introduced in Congress in October, and its goal is to ensure that kratom and kratom-derived products remain safe and accessible to consumers.

Meanwhile, the National Institutes of Health (NIH) opined on the subject as recently as June 3, 2022. As part of its initiative to help end drug addiction, it is beginning to research the botanical.

I figured I’d follow suit. First stop: the Roots Kava Bar, located in Boulder, Colorado. The bar opened five years ago and in addition to selling kava, also serves up kratom tea.

Part II of this kratom safety and danger story will appear later this month on Natural Products Insider. Stay tuned!