High profile

An obscure herbal remedy has gained attention in the news recently. Advocates say it relieves pain, anxiety and depression. Some retailers market it as a natural alternative to weening addicts off of opioid medications—a possibility currently being explored by multiple scientific studies. But the Drug Enforcement Agency may soon place the herb’s active ingredients on the list of Schedule I drugs—a classification that would render sales illegal and put up serious barriers to future scientific research.

Mitragyna speciosa Korth, commonly known as kratom, is a plant indigenous to Southeast Asia. According to a 2015 article in the journal BioMed Research International, kratom has been used for centuries “to combat fatigue and improve work productivity … in Southeast Asia” and has “recently become popular as a novel psychoactive substance in Western countries.” It’s sold as capsules, liquids, gums, powders and dried leaves for tea. The effects are dose-dependent and mirror those of opioids—with small doses providing a stimulant, pain-relieving effect and larger doses delivering a sedative, euphoric effect.

Kratom is available at shops around the Truckee Meadows.

In late August, the DEA announced its intention to temporarily place kratom on the list of Schedule I drugs—alongside 10 others, including LSD, heroin, ecstasy and marijuana. The Schedule I designation is the most restrictive of the categories established by the 1970 Controlled Substances Act. It’s reserved for drugs that the government deems to “have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.” A “temporary” designation on this list can prove to be anything but, as has been the case with marijuana, which has been the subject of several rescheduling petitions since the 1970s but remains Schedule I today—deemed a greater threat to public safety than Schedule II drugs like methamphetamines and cocaine.

The DEA’s announcement was met with public outcry from consumers, retailers and the scientific community. And on Sept. 26, more than four dozen members of Congress—including Nevada’s Joe Heck—sent a letter urging the DEA to “delay finalizing the decision to define kratom as a Schedule I substance.” The letter went on to say that hasty scheduling of the substance without public input would threaten “the transparency of the scheduling process and its responsiveness” to citizens and the scientific community.

On Oct. 13, the Drug Enforcement agency responded by suspending immediate plans to schedule kratom and opening a public comment period—which closes on Dec. 1. As of the time of this writing, there were more than 6,000 public comments posted to the regulations.gov website, and a petition on whitehouse.gov to prevent kratom’s scheduling had nearly 150,000 signatures.

DEA action can often have unintended consequences. In 1985, when psychiatrists were having good luck with the new medication 3,4-Methylenedioxymethamphetamine in treating their patients, it was also occasionally used recreationally. The press learned about it, dubbed it ecstasy, and the DEA got interested. The drug was banned outright, resulting in illicit use skyrocketing and legitimate use ending.

As with most prospective government regulations, there are parties armed with conflicting “fact sheets” on both sides of this issue. While the kratom debate boils down to three main factors—its efficacy, risks and potential for abuse—even its definition depends on the source.

The American Kratom Association is one of several advocacy groups. A banner on its website tells visitors that kratom is “a natural botanical that’s improving health and wellness from coast to coast.” According the website, “Kratom is not a drug. Kratom is not an opiate. … Naturally occurring kratom is a safe herbal supplement that’s more akin to tea and coffee than any other substances.” The website’s fact page also states that, “when taken in appropriate amounts,” kratom is non-habit forming, can increase energy and provide pain relief, and that “many find relief from a variety of other mental and physical ailments.”

But the DEA has a kratom fact sheet of its own—one that paints a very different picture. The agency recognizes kratom as an opioid and lists it as a “drug and chemical of concern.” Its fact sheet claims that kratom use “can lead to addiction” and has been linked to “several cases … where individuals addicted to kratom exhibited psychotic symptoms, including hallucinations, delusion, and confusion.”

The American Kratom Association is correct in saying that kratom is not an opiate, because it’s not derived from opium. However, the DEA is correct in stating that its active ingredients—mitragynine and 7-hydroxymitragynine—are, in fact, opioids, substances that act on opioid receptors to produce morphine-like effects. However, determining to what degree kratom causes undesirable side effects like dependence or dangerous respiratory depression would require additional scientific research. (Studies examined for this article presented conflicting results.) And this seems to be where much of the outcry from the scientific community has come.

Researchers need a license to study schedule I drugs. Obtaining one can be difficult and time consuming. So the Schedule I designation is a bit of a Catch-22. It means a drug has “no currently accepted medical use in the United States” but also makes researching potential medical uses immensely more difficult.

Chris McCurdy is a kratom researcher at the University of Mississippi. In an article published in September, he told Scientific American, “I don’t oppose it [kratom] being regulated, I just oppose Schedule 1.”

For now, kratom remains available for purchase in Reno shops. And it’s not currently on the local DEA’s radar. In a phone interview, the DEA special agent in charge of the Reno office, Kasey Kanekoa, said agents are not aware of the amount of kratom currently available locally or when it began showing up in the city’s shops. He said investigations into kratom would not take place until and unless the substance is scheduled.

The Melting Pot World Emporium has carried kratom for two years. Owner Eric Baron said he first started seeing kratom at tradeshows about 12 years ago but didn’t start stocking it until a friend told him about successfully using it to combat anxiety and depression. Today, Baron said, his customers report using kratom to treat a variety of ailments, from anxiety to multiple sclerosis symptoms and various addictions. He said some regular users do build tolerances to kratom, but he doesn’t think the substance poses risks that justify a Schedule I designation. In Baron’s opinion, the DEA’s initial scheduling attempt was an effort to “sweep [kratom] under the rug and make it go away without doing their due diligence.”