When a patient showed up in a West Coast emergency room early this month suffering withdrawal from something he called "kratom," the psychiatrist on duty was forced to scramble for information. But when the doctor looked it up, she found that the opiate-like leaf from Southeast Asia is well known in the worlds of alternative medicine and the drug culture.
What the doctor, who asked not to be named, found in an Internet search were Web pages set up by dozens of companies selling kratom leaf and touting it as a way to combat fatigue, pain and depression — even as an antidote to heroin addiction.
But in addition to its possible medicinal uses, kratom is beginning to show up in U.S. emergency rooms, with doctors saying they are dealing with people sick from taking it — especially teens who try it to get high.
"Every month somebody is trying to get a new 'safe high'," said Frank LoVecchio, medical director of the Banner Good Samaritan Poison and Drug Information Center in Phoenix, Ariz. "(Kratom) is definitely not safe."
As with many herbal and chemical products on the market, science and law enforcement are playing catch-up. Little research has been done to determine the risks of taking kratom, so it remains legal and unregulated in the United States.
The leaf, which is indigenous to Southeast Asia, has been around for thousands of years, and proponents argue that it is safe and effective for many maladies, while having fewer side effects and being less addictive than pharmaceutical alternatives, such as oxycodone. In small doses, they say, kratom provides an energy boost — the plant is in the coffee family — and in larger doses it creates a mellow, sedating effect, acting on the opioid receptors.
"Kratom makes people feel pain free, strong, active and optimistic," according to the Website Kratom.com. It has multiple functions, said the site, which sells kratom leaves, powder and extracts from Thailand — "as a strong and reliable herbal painkiller, to relieve depression and as a social and professional enhancer to intensify communicational skills and induce higher motivation."
Just as its safety has not been well studied, the drug has no scientifically established medical uses — though it has many enthusiastic adherents who swear by it. Testimonials in support of its ability to relieve chronic pain, depression, diabetes and other maladies surface in droves whenever kratom makes the news, as witnessed in the comments following this blog published in the Phoenix New Times in August 2011.
But even promoters warn that daily use of kratom can lead to dependence and nasty side effects.
“Long-term daily high dose kratom consumption is also reported to induce nervousness, sleeplessness, loss of libido, constipation and the darkening of skin complexion,” Kratom.com says in its "dangerous effects" section.
Although there have been no fatalities from kratom, "The known risks and dangers of Kratom overdoses include hallucinations, delusions, listlessness, tremors, aggression, constipation and nausea," the site said.
The emergency room psychiatrist said the patient who recently came in reported using kratom several times a day, every day, "because he discovered that if he stopped it he started getting withdrawal." The doctor said the man's symptoms appeared "identical to heroin withdrawal."
Upon arrival, the patient was suffering "severe depression and anxiety and emerging opiate withdrawal symptoms," including chills, aching muscles and gooseflesh, the psychiatrist said. The patient was treated to ease withdrawal symptoms and then hospitalized, according to the doctor.
Like "bath salts" and "spice" — drugs that are now illegal but were legal and trendy until law enforcers and medical researchers gathered data on their dangers — kratom is under scrutiny, having been added to a Drug Enforcement Administration's list of "drugs and chemicals of concern."
If the DEA concludes that kratom poses a public health risk, the agency can request that the Department of Health and Human Services place it on a schedule of banned and controlled substances.
The discovery and review process is accelerating in the Internet age, said Barbara Carreno, public information officer for the DEA.
"Things used to get around by word of mouth and it took a long time," said Carreno. "Now anyone can find out about anything within a matter of minutes … so there’s a lot of experimenting with exotic things that no one had ever heard of."
Kratom is illegal in a number of countries in Europe and Asia — most notably Thailand, where much of it is produced. It is now the third most commonly used illegal drug in Thailand, according to the DEA. In that country’s drug culture, the leaf is sometimes combined with cough syrup and Coke, tranquilizers and marijuana to produce a narcotic drink called "4x100."
LoVecchio, of the Phoenix poison control center, said his encounters with kratom are skewed, by definition, because he sees only people who have suffered ill effects, not people who say they are benefiting from it. The ones he treats are typically teens too young to buy alcohol who instead turn to kratom to get high, he said.
"When we see people who take this, they sometimes get respiratory depression," said LoVecchio, similar to the effect of opiates like heroin. "What’s odd is that some of them get really, really agitated, a little combative, (with) nausea and vomiting. They usually get medication for nausea and Valium to ease the paranoia," before being sent home.
He said other users, such as recovered heroin addicts, report that the symptoms are less pronounced, probably because they have built up a tolerance to opiates.
"I would say ban it until a study proves to me that there is a benefit, for anything," LoVecchio said of kratom. "Or restrict it to certain areas, make sure you can control it, make sure people aren’t driving" while using.
For now, kratom is being vigorously marketed in the United States. Some sellers label it as "incense," claiming it is not sold for human consumption while also requiring that buyers be at least 18 years old. One variety being touted for its powerful punch is Maeng Da, which translates to “pimp grade kratom.”
As new vendors get into the market, some of established sellers are trying to encourage self-policing in the industry to avert a ban on kratom.
A Website for the Kratom Association, which claims more than 100 members, has launched a campaign to counter what it describes as harmful and irresponsible representation of the herb — censuring or reporting sellers and head shops that market it as a "legal high," target teenagers or sell kratom adulterated with illegal drugs or other harmful substances.
They are pressing for more research to establish medicinal effects even as they fight efforts to ban kratom.
In one instance, nearly 600 people signed a petition addressed to a Louisiana lawmaker who recently proposed a ban on kratom in his state. Ultimately, Sen. A.G. Crowe of Pearl River withdrew the proposal, but indicated he would call for rules preventing people under 18 from obtaining it.
"Kratom has been used for thousands of years for its medicinal properties. Kratom, when consumed, can treat depression, chronic pain, anxiety, opiate dependence, fatigue, stress and many other ailments," according letter petitioning Crowe. "Besides this it is used by many former addicts of alcohol and opiates. … Comparatively speaking, it is less addictive than coffee."
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