Catie Dull / NPR
Americans know the dangers of drugs such as morphine and heroin. But what about a supplement that acts in the brain as an opioid and is available in many places for children, including vending machines?
Kratom, an abundant herb, legal in most states and potentially dangerous, is the subject of an ongoing debate about its risks and benefits.
Usually, the leaf, which comes from a tropical tree in Southeast Asia, is chewed, made or crushed in a bitter green powder. The chemicals in the herb interact with different types of receptors in the brain, some that respond to opioids and others to stimulants. It is often sold in the USA. UU. In processed form, such as pills, capsules or extracts, a small amount of kratom can cheer you up, while a large dose has a sedative effect.
Some people who have struggled with an opioid addiction and have switched to kratom swear that the substance saved their health, livelihood and relationships.
But the Federal Food and Drug Administration and the Drug Control Administration fear that kratom carries the risk of physical and psychological dependence and, in some people, addiction. The FDA warns consumers not to use kratom, and the DEA threatened to ban the sale and use of kratom in the US. UU. (Outside the investigation) in 2016; the defenders and legislators later rejected, and the stricter programming of kratom that would have caused that type of prohibition never happened. These days, the DEA lists it as a drug of concern.
"Kratom changed my life"
Lesley McClurg / KQED
Linda Kline, 33, of Reno, Nevada, sells kratom for a living. She says that her various stores across the west have given her a new purpose in life. And although she does not have an opioid dependence, she credits the kratom for changing her mental health.
"I went from feeling desperate and desperate to finding an alternative where I had total control over how I felt," she says.
I used to be paralyzed by anxiety and panic attacks. When his insurance company threatened to cut his Prozac prescription, he felt desperate. A friend suggested kratom, so she picked up a little in a smoke shop.
"It almost looks like you're just having a glass of wine," says Kline. "It's really relaxing. The walls don't melt."
The new habit costs about $ 6 per day, less than a glass of wine or an elegant cup of coffee. But Kline says he can't always find a high quality supply. The FDA has recalled dozens of salmonella-contaminated products sold online or in convenience stores. The agency has also found toxic heavy metals in kratom supplements.
That is one of the reasons why Kline started her own elegant boutiques, Bumble Bee Botanicals, dedicated exclusively to kratom products that, according to her, are all laboratory tested to ensure their purity. She has just opened her fifth location in less than two years. The stores offer 15 varieties of kratom at points of sale in California, Idaho and Nevada.
Although the Kline website has a disclaimer that its products have not been evaluated by the FDA and "are not intended to cure, treat or prevent any disease," some of its customers' Yelp online reviews state that Kratom has drastically relieved his chronic pain, insomnia, restless legs syndrome and more.
Lesley McClurg / KQED
Successful criticisms like that persecute Mateo Martínez.
"My brother believed in the marketing of kratom, which was a natural herbal supplement that could provide the same benefits of an opioid without the risks," says Mateo.
Mateo's younger brother, Marco, struggled with an opioid addiction in high school. Mateo describes Marco as a charismatic, creative teenager, passionate about video games, cartoons and anime. Mateo says Marco got hooked on the pain relievers after his dentist pulled his wisdom teeth.
"I was using them in a way that wasn't just to treat the pain," says Mateo.
The email receipts show that Marco used bitcoin to also buy Vicodin and fentanyl on the dark web.
Finally, Marco wanted to stop his opioid addiction and saw testimonials on YouTube and Reddit that promised that the kratom could be a way out. Soon Marco was taking kratom capsules several times a day.
During his first year at the University of California, Davis, the 19-year-old began to hyperventilate regularly. The incidents worsened, becoming episodes of seizures and ending in trips to the emergency room. During each hospitalization, the doctors were perplexed. No one thought of trying the kratom.
Marco died in his bedroom at UC Davis in February 2018, a Sunday night. The toxicology report listed "acute poisoning with mitraginine," a chemical component of kratom, as the cause of death.
"I think the kratom must come with a much more serious precaution that it is not harmless, "says Matthew." I am very heartbroken. "
In a recent 18-month period, the Federal Centers for Disease Control and Prevention reported an overdose of 90 kratom, although most also involved a combination of other substances.
Thin science, so far
"The data to support the benefits or harms of kratom are really very poor," says C. Michael White, head of the Department of Pharmacy Practice at the University of Connecticut. "Much of the information we have comes from unique case reports."
White says that animal studies suggest that kratom could be an effective analgesic, but human data collection has just begun. He says that scientists need to conduct many more investigations before the appropriate level of regulation is clear. White recently discussed in the American Journal of Health System Pharmacy that the safest place for kratom is behind the pharmacy counters, for adults only, but without a prescription.
McClain Haddow, spokesman for the American Kratom Association, agrees that the product should be sold only to people over 18.
"We want suppliers to register their product with the FDA and obtain a chemical analysis from a certified laboratory to ensure that the only ingredient is the natural alkaloid in the kratom plant," says Haddow. "Some manufacturers are adding products with fentanyl, heroin or morphine to give users a high."
Dr. Scott Steiger, deputy medical director of the opioid outpatient treatment program at Zuckerberg San Francisco General Hospital and Trauma Center, says he doesn't know how to advise patients who want to use kratom.
"I tell them that I don't know enough on the basis of science to tell them if it's a great idea or not," says Steiger, who is also an associate clinical professor of medicine at the University of California, San Francisco.
The DEA describes kratom as an addictive substance that causes hallucinations, illusion and confusion.
"I have seen that people who use kratom end up having difficulties to stop using it," says Steiger.
His patients report withdrawal symptoms such as nausea, sweating, aches and pains, loose stools, tearing and dysphoria. There is growing concern about the effects of kratom on the heart and liver.
Steiger emphasizes that doctors have evidence-based treatments such as buprenorphine and methadone to help people with an opioid addiction. It is not recommended to self-medicate with kratom until more research is available.
"We just don't know enough about this chemical and its long-term use to know if experimentation would lead to complications," says Steiger.