By Pat Anson, PNN Editor
It’s no secret that illicit fentanyl has become a scourge on the black market. The potent synthetic opioid – about 100 times stronger than morphine -- is now involved in over half of U.S. overdoses. Fentanyl is being found in a wide variety of street drugs, including heroin, meth, cocaine and marijuana, and it is increasingly used in the manufacture of counterfeit painkillers and other fake medications.
“As traffickers have expanded into the sale of fentanyl-containing counterfeit pills, the scope of users who were exposed to fentanyl increased significantly; the prescription pain reliever misuser population is almost ten times that of the heroin user population,” a recent DEA report warns. “The presence of fentanyl-containing counterfeit pills in an area is increasingly associated with spikes in overdose deaths.”
Although there is no hard evidence that drug dealers are mixing fentanyl with kratom to boost its potency, some in the kratom community think it is inevitable that someone will try. There have already been cases of kratom products being adulterated with hydrocodone and other opioids.
“I don’t know that there’s been a case of fentanyl in kratom, but since that’s what they are finding in everything else and that is the most dangerous drug out there now, it stands to reason that someone who would spike kratom with hydrocodone would now spike it with fentanyl either wittingly or unwittingly,” said Jane Babin, PhD, a molecular biologist and consultant to the American Kratom Association (AKA), an advocacy group for kratom vendors and consumers.
Like other dietary supplements, kratom products are essentially unregulated and there are little or no quality controls.
In an effort to change that, this week the AKA officially launched a good manufacturing practice (GMP) program, which will require producers of kratom products to meet strict manufacturing standards verified by a third-party auditor if they want to be certified by the AKA.
"The AKA GMP Standards Program will help reassure the public and demonstrate to the FDA, DEA, lawmakers, and others that the kratom industry is acting responsibly," AKA president Dave Herman said in a statement.
"The AKA GMP Standards Program will also protect kratom consumers from unscrupulous vendors who produce kratom products using sloppy manufacturing procedures that allow for contamination, and equally important the standards program will exclude vendors who deliberately adulterate kratom products to boost their effect by adding dangerous and sometimes deadly substances like fentanyl or morphine."
In recent years, millions of Americans have discovered kratom, which has been used in southeast Asia for centuries as a natural stimulant and pain reliever. Kratom is widely available online and in smoke shops, but the quality of what’s being sold and where it comes from is often unknown – even by the people selling it.
“The stuff that’s sold as kratom in the United States cannot be reliably proven to be kratom,” Edward Boyer, MD, a Professor of Emergency Medicine at Harvard Medical School, recently told PNN. “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 products have been found to contain artificially high levels of 7-hydroxymitragynine, one of the naturally occurring alkaloids that make kratom act on opioid receptors in the brain. Manufacturers may also be lacing kratom with opioids and other drugs.
“One theory is that some unscrupulous vendors may be spiking kratom with something more potent to drive business. It may be even more prevalent than we know, which could account for some of the reports on Reddit and Blue Light (online message boards) that say kratom is addictive and it does lead to euphoria,” Babin said in an email.
A handful of states have already banned kratom and there is speculation that the DEA will soon try again to schedule it as a controlled substance, something the agency backed away from in 2016 after a public outcry. The FDA has recently mounted a public relations campaign against kratom, what the AKA calls a “shadow ban” that has led to kratom shortages.
Could the AKA’s effort to improve the quality of kratom products backfire by giving ammunition to federal regulators who want a nationwide ban?
“That kratom may be adulterated is not a reason to ban it. There are reports all the time of dietary supplements, even ones sold by reputable companies like GNC and Vitamin Shoppe, are adulterated with prescription drugs, banned substances and who knows what else,” says Babin.
“The other thing to consider is that if kratom is banned, demand may lead to a black market. It will likely be smuggled in and/or products not containing kratom will be sold as kratom and those may be spiked with other substances, including fentanyl.”