Kratom Fear Mongering
How Dangerous is this Legal Opioid?
CBS News recently aired a story on kratom, a mild opioid herbal supplement available online or in headshops around the country. The story, “Kratom products continue to draw criticism from health experts,” was a master class in sensationalism and fear mongering. If I didn’t know any better, I would think that kratom was a scourge on our society. A bigger threat to public health than fentanyl and anti-vaxxers combined. Fortunately, I do know better.
The report begins by announcing that “millions of Americans use an herbal supplement called ‘kratom’,” just before launching into a story of the unfortunate death of a young man named Ethan Pope, who apparently died of a kratom overdose. It then moves on to an interview with Mr. Pope’s parents — a common tactic in journalism that aims to put a face on the story, helping to personalize it.
The report continues with on off-screen narrator who states that “many places sell kratom, even gas stations” and that the FDA has found that kratom poses risks of “addiction, abuse, and dependence!” — as if those were three distinct types of risk rather than just three ways of saying the same thing. The narrator then says that Mr. Pope died of “cardiac arrest due to mitragynine intoxication.” But he pronounces it mi-TRA-je-nuh instead of the correct mi-tra-GHY-neen. Does anyone do any research at CBS News? Or know how to read? (Sound it out.)
Next up, an interview with the Pope family’s ambulance-chasing lawyers, who claim that kratom is “a deadly product that is insidiously addictive.” They go on to say that kratom products are “incredibly potent and potentially lethal.” The report concludes with the anchorman stating that “the FDA has found no evidence that kratom has any therapeutic benefits.”
I have no intention of downplaying Mr. Pope’s death and feel nothing but sympathy for his poor parents. I cannot image the pain they must feel having lost their son, especially in a way that was so completely unnecessary. But I am not interested in tragic stories. My interest is whether we should jump to the conclusion that kratom is dangerous.
For those who are not familiar with it, kratom is an herbal supplement from a tree that grows in Southeast Asia. It is a relative of the coffee plant that people in Thailand and Malaysia have used for centuries as a stimulant and pain reliever. The active ingredient in kratom is mitragynine, which activates mu-opioid receptors in the brain, just like morphine and other opioids. (You can read more about kratom and mitragynine here.)
As with any mu-opioid agonist, kratom can be habit forming and, in large enough quantities, can cause a potentially fatal suppression of breathing. So, it is possible to die from kratom overdose, as Mr. Pope apparently did. But that does not necessarily mean that kratom is dangerous. After all, the same it true of caffeine… or even water. (Consuming too much water in a short period of time can result in a potentially fatal condition called hyponatremia.)
So how dangerous is kratom? A study conducted by the CDC a few years ago, examined data from over 27,000 overdose deaths that occurred during July 2016–December 2017 and found kratom (or rather, mitragynine or its metabolites) were present in 152 of these cases (or 0.56%). However, all but seven of those people had other drugs in their system. That means that only 0.00025% of all overdoses in that period were due to kratom alone.
If “millions of Americans” use kratom with only about half a dozen annual overdoses, then kratom cannot be that deadly. For comparison, about 2 million people use cocaine in the U.S. (the smallest number that could be called “millions,” plural). The result is almost 25,000 annual overdose deaths.
A better comparison to kratom might be aspirin, which is responsible for about 30–40 U.S. overdose deaths annually. So, people die from taking too much aspirin; but no one would say that aspirin is a “deadly product” (… sold even in gas stations. Gasp!) So why claim that kratom is a deadly product based on a few anecdotal cases like that of Mr. Pope? Because news programs need to keep their viewers’ eyes glued to their TV sets. It is all about ratings, not journalism.
The lawyers representing the Mr. Pope’s parents claim that kratom is “incredibly potent.” Of course, potency is a relative term. So, let’s compare kratom to other opioids. If you want to get high on kratom, you would have to ingest about ten capsules containing 600 mg of kratom each. That’s 6 grams total, just to catch a buzz. That same amount of heroin would be lethal for an average sized human with no tolerance.
One recent study on mice found that mitragynine has an LD50 that is similar to heroin. (LD50 — or lethal dose 50 — is the amount of a material that, if given all at once, would cause the death of 50% of consumers.) That sounds bad, but there are two important caveats. 1) Mitragynine makes up only about 0.5–1.5% of the dry weight of kratom. That would make black tar heroin about 30 times more potent than kratom (assuming it’s not laced with fentanyl). 2) Part of what makes heroin so dangerous is that it is typically administered intravenously, whereas kratom is consumed orally. As a rule of thumb, the LD50 of a drug consumed orally is at least four times higher than the same drug consumed intravenously.
What about the claim that kratom has no therapeutic potential? If the FDA has found no evidence of any benefits from taking kratom, that could only be because they haven’t looked for any. First off, any substance that activates the mu-opioid receptors automatically alleviates pain. That is what mu-opioid receptors do.
But there is also empirical (as opposed to merely theoretical) evidence that kratom has therapeutic potential. A comprehensive systematic review of all studies on kratom found that it can be very effective in treating opioid withdrawal. In one survey, more than 80% of users who were taking kratom to wean themselves off of opiates reported alleviation from withdrawal symptoms. Another review study concluded that, along with alleviating opioid withdrawals, “There is also evidence from experimental animal models supporting analgesic, muscle relaxant, anti-inflammatory as well as strong anorectic [appetite suppressing] effects.”
Does anyone do any research at the FDA? Or are they too busy approving ineffective drugs?
Should kratom be regulated? Maybe. But whatever regulations we put on kratom should not be any more strict that other drugs — such as caffeine — that can be fatal but are usually harmless.
