Kratom, or Mitragyna speciosa as it is known botanically, is a traditional Southeast Asian medicine that has been utilized by indigenous populations for centuries to increase endurance, enhance mood, treat pain and mitigate opioid withdrawal symptoms. It is the latter use that has attracted our attention from a research standpoint during the global opioid crisis.
For over 25 years, one of us (McCurdy) has studied the design, synthesis and development of drugs to treat pain, anxiety and substance use disorders. While more research is urgently needed, for the past 15 years my team has investigated kratom and its chemical components to understand how they may be of use in treating the many conditions it has been anecdotally associated with. The first priority was to investigate the potential of kratom to reduce harm in opioid-dependent individuals and provide the medical community with solid scientific data to support or refute these claims.
Over the past seven years, one of us (Grundmann) has studied the use patterns and motivations for kratom consumption in the United States indicating that self-treatment is widespread for acute and chronic pain, anxiety and depressive disorders and mitigation of withdrawal symptoms from substance use disorders.
In 2020, according to the Centers for Disease Control and Prevention, 91,799 drug overdose deaths occurred in the United States. This was a staggering 31 percent higher rate than in 2019. Florida accounted for nearly 8,000 deaths during that time. There is no doubt that the pandemic contributed to this increase; however the currently utilized treatment options for substance use disorders or substance misuse are not sufficient to mitigate the current reality.
Although traditional use of kratom has been ongoing for centuries with no reports of serious harm, in the United States kratom products have been implicated in toxicology reports as a contributing factor to death in some cases. It is important to note that in the overwhelming majority of these cases, kratom was not ingested alone. Yet, several possible reasons could explain the differences seen in the United States, including the difference in how kratom products are shipped, stored or aged and how an individual approaches the intent of their use.
The U.S. Food and Drug Administration executed an import ban on kratom to the United States, but products are widely available in the U.S. marketplace. In fact, as of June 2019, approximately 1,950 metric tons of kratom were being exported to the U.S. per month. Therefore, a substantial population of Americans are using kratom as a self-treatment or recreational substance for the aforementioned, scientifically understudied indications.
In the U.S., there is currently not enough regulatory enforcement to ensure that dietary supplements or products like kratom are sold to consumers as standardized, high-quality, and pure plant material. Without improved regulatory oversight aimed at protecting consumers, individuals could purchase fake or low-quality (suspect) products in retail establishments that sell kratom. Even worse, unregulated kratom products could be adulterated with other dangerous substances.
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As is the case with other readily accessible over-the-counter and supplement products, kratom has pharmacological effects that can interfere with and affect other medications and pre-existing health conditions. It is in the consumers’ and public interest to ensure available kratom products are appropriately regulated. Allowing a lack of regulatory standards could further contribute to harm and undermine more research that is so important to the future regulatory decisions at the federal level.
The Florida Legislature currently has the opportunity to pass the Florida Kratom Consumer Protection Act (SB 1076) that would require products sold in the state to meet a higher bar of product purity, establish labeling requirements, and limit sales to consumers 21 years and older. It is a much-needed step to put some regulations in place and increase the safety of products that consumers have available to them.
With this legislation, the future of kratom research and education to the public and health care professionals will be strengthened. There is a substantial lack of understanding of kratom in the medical community. Nonetheless, consumers should consult with their physician or pharmacist if they wish to take kratom. By enhancing the regulatory environment and increasing awareness of kratom in the state, opportunities to elevate knowledge and research will certainly follow. The currently proposed Florida bill is an important step in standardization and regulation of kratom as we increase our scientific knowledge.
Christopher R. McCurdy is a professor in the University of Florida College of Pharmacy and director of the UF Translational Drug Development Core. Oliver Grundmann is a clinical professor in the department of medicinal chemistry in UF’s College of Pharmacy.