Kratom, a legal, unregulated, opiate-like herbal supplement, is gaining popularity in recent years, especially among youth. While the plant is native to Asia, use has become more common in the United States to reduce opioid withdrawal symptoms (Veltri & Grundmann, 2019) and as a psychoactive recreational drug (McCance-Katz, 2019). Traditional screening panels do not test for the substance, rather, a special liquid chromatography or tandem mass spectrometry test is required (Eldridge, 2019). Because it is unregulated, Kratom can be purchased from smoke shops, gas stations, and online.
Kratom’s effect is unique, acting as either a stimulant or depressant, based on the dosage. In small amounts, Kratom can increase focus, physical energy, and talkativeness (Drug Enforcement Agency, 2022). In high doses, kratom creates sedative-like effects, similar to those of opiates (McCance-Katz, 2019). When consumed in very high quantities, kratom can cause hallucinations, delusions, and confusion (Drug Enforcement Agency, 2022). At any dose, the supplement can cause nausea, sweating, itching, frequent urination, and constipation (Drug Enforcement Agency, 2022).
The risk of addiction is high, as withdrawal symptoms are very commonly reported among regular users (Singh, et al, 2014). Physical symptoms include hot flashes, pain, difficulty sleeping, and decreased appetite (Singh, et al, 2014). Mental and emotional symptoms include restlessness, anger, sadness, and anxiety (Singh, et al, 2024).
The supplement is also common among polysubstance abusers, and death can result when Kratom is combined with other narcotics. While it is infrequently listed on death certificates as the sole cause, it is sometimes listed in tandem with other substances. According to the CDC, Kratom is most identified as causing death with fentanyl, heroin, and benzodiazepines (Olsen, et al, 2019).
Kratom also poses a significant risk to children. Because of a lack of research into the effects of the supplement, a few expectant mothers have turned to Kratom to curb opioid cravings during pregnancy. Exposed infants are reported to have experienced withdrawal symptoms such as jitteriness, sneezing, excessive suck, and irritability (Eldridge, et al, 2018). Though there have been few cases, it seems that children who are diagnosed with neonatal abstinence syndrome (NAS) because of kratom are able to withdraw through medication assisted treatment within a few days (Eldridge, et al, 2018).
Additionally, the number of teenagers smoking Kratom leaves or mixing the substance into drinks has increased (McCance-Katz, 2019). It is reported that youth are smoking Kratom leaves or mixing the substance into drinks. Further, research finds a correlation between the use of kratom and other substances among teens (Sharma, et al, 2022). Youth who smoke cigarettes or marijuana are about 2.5 times more likely to report kratom use than their nonsmoking counterparts (Sharma, et al, 2022). With Kratom usage on the rise in the United States, there is an increased concern among professionals that youth will continue to be more and more affected by both maternal and individual use.
There are reports of Kratom poisonings, too. Annual calls to poison control regarding Kratom concerns increased by 195 calls from 2016 to 2017 (Post, et al, 2019). Additionally, there is evidence that long-term use has a negative impact on the body, including damage to the thyroid, liver, and lungs (Alsaffar, et al, 2019).
Concern for Kratom usage in the United States is rising. However, it is not yet regulated. Congress is hesitant to place it on a schedule and most states do not want to ban it completely. Instead, many states are researching how they might go about allowing for safe use. In Ohio, HB 236, which seeks to regulate Kratom, has gained bipartisan support. The bill will require the Department of Agriculture to develop a program to regulate Kratom production and distribution (Chandler & Tucker, 2023). A license would be required to process Kratom, but not to possess, use, or sell it (Chandler & Tucker, 2023). The bill is presently in committee in the state senate, and it appears it may pass. Lawmakers believe that ensuring the safe production of the supplement will be much more beneficial to the community than banning it in its entirety (Chandler & Tucker, 2023).
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