October 3rd, 2016

Kratom And The DEA: An Eleventh Hour Reprieve

Kratom, a psychoactive substance derived from the leaves of a Southeast Asian tree, has been granted a last-minute reprieve. Its active agents, mitragyna alkaloids, have stimulating properties in low doses while higher doses activate opioid receptors and can relieve pain. Used for centuries as a medical agent, it can also be abused and lead to addiction. Because of the problematic use, it was made illegal in Thailand.  But because its use is so widespread there, enforcement has apparently been inconsistent.

In this country, the use of kratom, as an alternative to conventional opioid medications for pain, has been increasing. Generally legal in the USA (although banned in several states), it can be purchased online and in shops. As a result, a small industry has evolved leading to the formation of the American Kratom Association. Not surprisingly, some people have begun to use it recreationally, leading to addiction. When patients come to Kolmac with kratom addiction, we treat them the same way as we treat opioid addiction. This approach centers on psychosocial rehabilitation supported temporarily by medications such as buprenorphine and naltrexone with an ultimate goal of transitioning the patient into the recovery https://www.kolmac.com/about/our-approachsupport community.

Because of the problems associated with its use, including some reports of death, the Drug Enforcement Agency (DEA) decided on August 30th to invoke its emergency powers “in order to avoid an imminent hazard to public safety” and classify it as a Schedule 1 substance as of September 30th, thereby making it illegal. The decision triggered a protest in front of the White House as well as a letter from several US senators opposing the immediate ban, leading the DEA on September 30th to delay it.

The problem with placing a substance in Schedule 1 is that research on both its benefits and dangers becomes much more difficult. The classic example was when cannabis was “temporarily” placed in Schedule 1 in 1970 “until the completion of certain studies now underway to resolve the issue.” These studies were in fact never completed and we are still struggling – 46 years later — with the consequences of our resulting ignorance.

Recent research at Columbia University and Memorial Sloane Kettering suggests that kratom could have some advantages over the traditional opioid medications — the overprescribing of which has triggered our opioid epidemic.

The DEA has the difficult job of protecting us from dangerous substances but also can be overly rigid in its use of its powers, as exemplified in its August 2016 refusal to consider re-categorizing cannabis to enable badly needed research. In the current case of kratom, however, I believe that the DEA deserves to be commended for paying attention to the protests and taking, at least for the moment, a more measured course.


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