By Pat Anson, PNN Editor
Our story last week about drug addicts in Ohio allegedly shooting kratom to get a “heroin-like high” angered many people who use the herbal supplement to treat chronic pain and other medical conditions.
“Who the hell is injecting kratom? These people are out of their minds,” wrote one reader.
“No one and I mean no one has ever injected kratom. Kratom is a wonderous, natural plant with many positive effects,” said Erik.
“It’s pathetic that lies like this are being spread about a natural leaf that helps with pain,” wrote Jennifer Greenwood. “Nobody buys kratom from heroin dealers.”
But that’s exactly what the Ohio Substance Abuse Monitoring Network (OSAM) reported earlier this year in its statewide assessment of drug abuse trends. OSAM called a kratom “a psychoactive plant” and claimed drug users in northeast Ohio were buying kratom from heroin dealers and then injecting it.
“Participants reported that the most common route of administration for kratom is intravenous injection (aka “shooting”). Participants in the Akron-Canton region estimated that out of 10 kratom users, seven would shoot the drug and three would orally consume the drug (including drinking it as a tea),” OSAM said.
The OSAM report was cited by the Ohio Board of Pharmacy when it voted last week to classify kratom as a Schedule I controlled substance, alongside heroin, LSD and other dangerous drugs.
The board said kratom can cause hallucinations, psychosis, seizures, weight loss and insomnia, and cited six deaths in Ohio in which kratom was “the primary cause of death.”
The FDA and DEA have made similar claims about the health risks of kratom, but OSAM appears to be the first public agency to allege that kratom is taken intravenously. Repeated calls to OSAM for further information were not returned.
Kratom comes from the leaves of a tree that grows in southeast Asia, where it has been used for centuries as a pain reliever and stimulant. In recent years, millions of Americans have discovered kratom and started using it as a treatment for pain, addiction, anxiety and depression.
“I don’t think most kratom users are injecting it. Most users that I’ve ever talked to either mix it with a beverage, ‘toss and swish’, or take capsules,” says Jane Babin, PhD, a molecular biologist and consultant to the American Kratom Association, an organization of kratom vendors and consumers.
While skeptical that anyone would inject kratom, Babin says some addicts are desperate enough to try anything. She thinks the kratom sold by drug dealers in Ohio could be adulterated heroin.
“They describe kratom as a brown substance that resembles heroin. So I can’t help wondering if what they were using was heroin or at least something other than kratom,” Babin wrote in an email to PNN.
“I can’t imagine that they would be mixing powdered leaf kratom with liquid, heating it and injecting it. There’s too much insoluble plant matrix/cellulose. If they did, I would expect problems unless they could filter it… which isn’t likely. Injecting an ethanol extract directly would likely cause tissue damage, and I have to wonder how sterile any of it is.”
But there is a case in the medical literature of a 29-year old Rhode Island man doing just that. He started using kratom to treat his opioid addiction, but eventually developed a tolerance for it and needed more.
“He was initially drinking Kratom tea daily, then several times daily, until he found a way to inject it intravenously,” researchers reported last year in the Journal of Toxicology and Pharmacology.
“He began buying Kratom extract in alcohol. He let the alcohol evaporate in a spoon, and then dissolved the remaining resin in water to inject. Subsequently, he began cooking off the alcohol with heat. Finally, the patient said that he was impatient, and began injecting the extract directly. At the time of presentation, he was buying Kratom extract from multiple online vendors, and injecting 1 ml of extract six times daily.”
The man eventually checked himself into an emergency room and sought treatment for kratom addiction.
“This case is an important reminder of the chronic nature of opioid addiction, which has a high rate of relapse. As Kratom becomes more popular in patients seeking abstinence from opiates, including heroin, such intravenous use may also increase,” researchers warned.
One of the co-authors of that study believes there is another potential risk. Like other food and herbal supplements, kratom products are essentially unregulated and there are little or no quality controls.
“The stuff that’s sold as kratom in the United States cannot be reliably proven to be kratom,” says Edward Boyer, MD, a Professor of Emergency Medicine at Harvard Medical School.
“There is evidence to suggest that some of the kratom sold in the United States is adulterated to make it more potent, to make it more powerful.”
Boyer says some kratom supplements have been found to have artificially elevated levels of 7-hydroxymitragynine, one of the naturally occurring alkaloids that make kratom act on opioid receptors in the brain. He suspects opioid drugs are also being used to boost kratom’s potency.
“The fact that a lot of kratom is adulterated is not surprising,” says Jane Babin. “I suspect it is more prevalent in the stuff that’s being sold at smoke shops and gas stations. This is a red herring when it comes to kratom, in the same way that Salmonella contamination is. Both are ‘problems’ with simple solutions through regulation and oversight of kratom identity and purity.”
Instead of banning kratom, Babin says it should be regulated with a standards and certification program that would help keep adulterated products off the market.
Kratom is already banned in Alabama, Arkansas, Indiana, Vermont, Wisconsin and the District of Columbia. And there is speculation that the DEA may try again to classify kratom as a federal Schedule I controlled substance, which would make sales and possession of the plant illegal nationwide. The DEA withdrew a plan to ban kratom in 2016 after a public outcry.
Last week’s vote by the Ohio pharmacy board starts a months-long process of drafting new regulations for kratom, so a ban isn’t in effect yet. Public comments will be accepted until October 18.
“If Ohio does ban kratom (and I hope they don’t), I predict that the already epic opioid overdose problem in that state will get worse,” says Babin. “It would be a shame for Ohio to indirectly prove the value of kratom in combating the opioid crisis when, after it is banned, overdose deaths and suicides increase.”