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Kratom Identified as Natural Opioid by the FDA: Here’s What Consumers Should Know

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By Dr. Jennifer Sedillo, Faculty Member, Public Health, and Nirav Patel, Master of Public Health Student, American Military University

Kratom is a tropical tree (Mitragyna speciosa), which is only found in Southeast Asia. It has been traditionally used for centuries for medicinal purposes. Recently introduced in the United States as an herbal supplement, kratom has gained popularity as “a safe and legal psychoactive product that improves mood, relieves pain and may provide benefits in opiate addiction.”

[Related: How Infants Are Falling Victim to the Opioid Crisis]

Currently, kratom is legally sold in the U.S. However, the Food and Drug Administration (FDA) and other federal agencies have been investigating this herbal supplement to determine its future status.

Kratom Contains Compounds Similar to Opioids

The psychoactive substances found in kratom (mitragynine and 7-hydroxymitragynine) are thought to act on opioid receptors in the brain. But until recently, it was not known whether the active substances found in kratom were opioids.

A recent study using computational modeling from the FDA found that the most prevalent compounds in kratom, including mitragynine, have the most structural similarity to controlled opioid analgesics such as morphine derivatives. These compounds also bind to receptors that act as strong opioid agonists.

Kratom Has Led to Overdose Deaths

For over a decade, kratom has been used for the self-treatment of opioid withdrawal in the U.S. However, continued claims that it can ease opioid dependence are unsubstantiated and may lead to an addiction and withdrawal from kratom itself.

[Related: Surveillance Tactics to Find and Stop Opioid Dealers]

In fact, kratom overdose has led to at least 44 deaths in the U.S. Although this number pales in comparison to the 197,000 deaths from prescription opioid overdose from 1999-2016, both the addictive potential and potential harm of kratom warrants further investigation into its regulation as a controlled substance.

Furthermore, the risks of combining kratom with other prescription drugs may be similar to that of FDA-approved opioids. However, definitive studies have not been conducted.

Kratom Recalls Issued Due to Salmonella Contamination

So far in 2018, kratom products have been recalled 19 times by the FDA. These recalls did not occur due to the potential opioid effect of kratom, but for its contamination with a rare strain of Salmonella that poses food safety risks.

The FDA urges consumers who use kratom supplements to dispose of them and contact a healthcare provider if they experience symptoms such as “fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses

such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.”

DEA: Kratom Is a ‘Drug of Concern’

The Drug Enforcement Administration (DEA) currently lists kratom as a “drug of concern” and states that it is an addictive drug that “causes hallucinations, delusion and confusion.” It is neither illegal nor approved for medical use in the U.S. However, seven states, three cities and the District of Columbia currently prohibit the possession and use of kratom.

[Related: Illegal Synthetic Drugs Prompt Amendments to Federal Sentencing Guidelines]

If You Use Kratom, Report Adverse Reactions to the FDA

If you currently use kratom as an herbal supplement and experience an adverse reaction, report it through the FDA’s MedWatch program. This will provide the FDA with additional information for determining the safety of kratom use.

About the Authors: Dr. Jennifer Sedillo is an Associate Professor for the APUS Public Health Program. Her training is in cellular and molecular microbiology. She has been a co-author on many peer-reviewed articles. Her dissertation research was in molecular biology of malaria. Her current research interests are in public health community outreach and food safety. Follow the AMU & APU Public Health Facebook Page

Nirav Patel, EN VSP, is an active-duty officer in the United States Army pursuing a master of public health with American Military University. Nirav’s background is in environmental engineering, in which he possesses tremendous leadership skills. Nirav is currently a digital volunteer for AMU and a coach for Cricket Academy in Austin, Texas. To contact the authors, send an email to IPSauthors@apus.edu.com. For more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter.

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