Kratom is not an alternative to medical cannabis

Like the cannabis sativa plant, kratom has been used for centuries as a natural medicinal, recreational, and general wellness substance.

In fact, kratom shares some thera-peutic similarities with medical marijuana, purportedly as a treatment for headaches, insomnia, anxiety, depression, opioid use disorder, and opioid withdrawal.

It can also stir feelings of euphoria, a sensation that is common with marijuana use.

Kratom products, sold as capsules, powders, and liquid extracts, are popping up in such retail spaces as convenience stores and online storefronts. Many users mix powders in food and drinks, and brew tea with kratom leaves.

While, for some, kratom may appear to be an alternative to medical marijuana — and a less expensive option given that it is available off the shelf — it has spurred safety concerns at the federal and state levels.

USDA advisement

The U.S. Food and Drug Administration (FDA) has advised against using kratom for medical treatment or as a dietary supplement, citing its potential for abuse, which “has yet to be fully understood.”

The agency also has not approved kratom or any products containing its active ingredient, mitragynine.

Florida regulates kratom, restricting sales to persons 21 or older. The state also requires that kratom products be accurately labeled, free from harmful non-kratom substances, and compli- ant with purity standards.

Sarasota County banned the sale of kratom in 2014, classifying it as a designer drug, and Manatee County is reportedly considering a similar action. 

Dr. Deirdre James, who is board-certified in internal medicine and endocrinology, metabolism, and diabetes, says the accessibility of kratom gives consumers a false sense of security.

“People will falsely think that kratom is safe because it’s mostly over the counter or something that you can order online. However, it can cause severe liver damage, especially if you have something that is already predisposing you to liver damage. It can cause psychosis, especially in the developing brain,” explains Dr. James, who is also an associate professor of medicine at the University of Tennes- see Health Science Center in Memphis.

Other adverse effects of kratom use include nausea, vomiting, weight loss, constipation, stomach upset, and either drowsiness/dizziness or irritability/agitation, according to researchers at the Mayo Clinic.

Dr. James strongly recommends against using kratom and cannabis together, as they both act as sedatives.

FDA’s response

Bob Durkin, an attorney and registered pharmacist, previously served as acting director and deputy director of the FDA’s Office of Dietary Supplement Programs, where he helped shape policy and led compliance and enforcement initiatives. He offers the following advice to prospective kratom buyers.

“Look for kratom products that are packaged correctly, that have a complete label. There should be a supplement or nutrition facts panel on the back that provides all the components and constituents of what’s in that product,” he said.

“And most importantly, consumers should only buy a product that has directions or conditions of use about how to use the product. Be aware of the type of product they consume and know that some of the products are just plain leaf, some of the products are extracts.”

Mr. Durkin believes that kratom is often mistaken for 7-OH (7-hydroxymitragynine), a psychoactive compound that is synthesized from a component derived from the kratom plant.

Kratom may contain trace amounts of 7-OH, but the compound 7-OH can be processed separately into a highly potent synthetic drug, he explained.

The FDA has cracked down on companies that market isolated or concentrated 7-OH extracts.

The FDA reports that 7-OH “produces respiratory depression, physical dependence, and withdrawal symptoms characteristic of classical opioids, such as morphine, fentanyl, oxycodone, and hydrocodone.”

In August, Florida Attorney General James Uthmeier announced an emergency rule that made it illegal to sell, possess, or distribute any isolated or concentrated form of 7-OH in the state.

Dr. James notes that anyone considering using kratom should thoroughly research it and talk with their physician to get a medical professional’s perspective.

“I’m not necessarily sure from a provider standpoint that the benefits of it outweigh the risks, but I think information would be the strongest tool,” she comments.