Kratom is sold in many states — but is the herb safe for pain relief? What experts say

A Washington man sat down in a recliner in his living room to watch television one evening and never woke up.

His wife, Sybil Coyne, found him the next morning and soon realized he wasn’t sleeping, or breathing.

A deputy sheriff and medics unsuccessfully tried reviving 39-year-old Patrick Coyne, a father of three children, before he was pronounced dead at his family’s home in Cowlitz County on June 28, 2020, a lawsuit says.

Next to his body was a bag containing a product derived from kratom, or Mitragyna speciosa — a natural plant with origins in southeast Asia — that he would buy at convenience stores. Patrick Coyne was increasingly using the kratom product daily to help manage his chronic back pain.

His cause of death was listed as the “toxic effects of mitragynine (kratom)” by the Cowlitz County Coroner, the lawsuit says.

Kratom is an unregulated product not approved for any use in the U.S., and is banned in five states, according to the Food and Drug Administration. While the agency warns against consuming it over potential safety concerns and addiction risks, the FDA supports further research to “better understand kratom’s safety profile.”

That has left many wondering if Kratom is safe to use at all — and if consumers can trust the unregulated market in which it is sold.

More on kratom and where it comes from

In this July 30, 2019, photo, officers gather illegally-grown kratom plants in Phang Nha province, Thailand. Thailand on Tuesday, Aug. 24, 2021, decriminalized the possession and sale of kratom, a plant native to Southeast Asia whose leaves are used as a mild stimulant and which has a following in the United States for its pain-relieving qualities.
In this July 30, 2019, photo, officers gather illegally-grown kratom plants in Phang Nha province, Thailand. Thailand on Tuesday, Aug. 24, 2021, decriminalized the possession and sale of kratom, a plant native to Southeast Asia whose leaves are used as a mild stimulant and which has a following in the United States for its pain-relieving qualities.

Kratom is native to Thailand, Malaysia, Indonesia and Papua New Guinea, the FDA says.

It’s sold in stores and online as a dietary or herbal supplement. In smaller doses, kratom can produce stimulant effects, according to the Centers for Disease Control and Prevention. If taken in higher doses, it can produce effects similar to opioids.

The plant consists of several different components called alkaloids, including mitragynine and 7-hydroxymitragynine, the “main known psychoactive components found in itsleaves, the World Health Organization reports.

Kratom can be consumed by chewing the leaves, ingesting the leaves in powdered form, drinking a kratom infused beverage and more, according to the WHO.

Kratom uses

People report using kratom for a variety of reasons, including pain relief, fatigue and to help curb drug withdrawal symptoms, according to the National Institute on Drug Abuse.

The American Kratom Association, a nonprofit consumer advocacy organization, estimates that millions of people in the U.S. consume kratom.

“Many individuals are using kratom as an alternative to opioids, and they’re using it to try to get off of prescription painkillers,” Christopher McCurdy, a professor of medicinal chemistry at the University of Florida and an internationally recognized kratom expert, told McClatchy News.

This is true for Michael Eatmon, a kratom consumer who served in the U.S. Navy as a member of Seal Team 8, according to a testimonial published by the American Kratom Association.

After repeated injuries during his time in service, he became addicted to pain medications until kratom helped curb his addiction and get his “life back.”

Kratom use in the U.S. dates back to the 1970s, according to the American Kratom Association. It started gaining more popularity around 2004 and 2005.

In southeast Asia, it’s been used for centuries, and is commonly accepted, similar to how drinking coffee is in the U.S., according to McCurdy.

Outdoor laborers consume it for stimulant effects to boost energy and help them tolerate working in a hot and humid environment, McCurdy said.

It’s also been used in southeast Asia for common sicknesses and religious and social gatherings, according to a 2017 study published in the journal Experimental and Clinical Psychopharmacology.

Is kratom legal?

Kratom is considered an adulterated product under federal law — meaning the FDA says there is not enough information to ensure the plant does not “present a significant or unreasonable risk of illness or injury” — and it’s not legal to import or distribute kratom in the U.S., Abolins explained.

Five states — Alabama, Arkansas, Indiana, Wisconsin and Rhode Island — have kratom bans, according to the American Kratom Association. Meanwhile, nine states have bans in certain state localities.

“It’s a wild west marketplace,” McCurdy said. “You don’t know what you’re buying when you buy it.”

Is kratom safe?

The FDA says kratom can expose users to “risks of addiction, abuse and dependence.”

A deeper scientific understanding of the plant is needed, and that is the goal of researchers studying the plant, according to McCurdy. He said future clinical trials on the plant are also needed.

“Kratom falls into the same sort of space where cannabis falls into, where we have so much more human anecdotal evidence of use, and knowledge of use,” McCurdy said.

The science behind understanding how to use kratom “in a proper, safe and hopefully effective manner” is lacking, he explained.

Questions that need answering through further research include what constitutes an appropriate kratom dosage and determining when a dosage become potentially harmful or habit forming, McCurdy said. Other unknowns surrounding kratom include how it interacts with other substances and how a user’s genetics play a role.

While rare, there have been reports of psychiatric, heart, gastrointestinal and liver issues, according to the National Institute on Drug Abuse. Case reports suggest long-term use could also be linked to serious liver issues.

According to a CDC report published in 2019 examining 27,338 drug overdose deaths between July 2016 to December 2017, 152 people had kratom in their system when they died. For 91 of the individuals, kratom was listed as the cause of death. However, several also had other drugs, such as fentanyl, in their system.

A study published in November 2019 in the journal Preventive Medicine suggests “morphine-like opioids carry an overdose risk of a thousand or more times greater than kratom.”

In 2021, there were 80,411 reported opioid-involved overdose deaths, according to the NIDA. The agency says fatal overdoses linked to kratom use are rare.

Wrongful death lawsuits

According to the lawsuit filed over Patrick Coyne’s death, he wouldn’t have died if the kratom product he purchased — Kratom Divine’s Maeng Da tea — displayed proper warnings on its packaging regarding health risks. Society Botanicals LLC, which does business as Kratom Divine, is named as a defendant in the case.

A judge in Washington state ruled in a summary judgment that the product’s packaging was negligent due to inadequate warnings and instructions, according to the law firm Mctlaw. Attorney Talis Abolins, counsel for the firm and based in Washington state, is representing the case.

In July, a jury will decide whether such negligence caused Patrick Coyne’s death, Abolins told McClatchy News.

Wendi Rook, the CEO and sole owner of Society Botanicals LLC, told McClatchy News she will be appearing in court alongside her husband, who is also named as a defendant, to defend herself in the case. She said it’s unclear why her husband, as a company employee, was named in the lawsuit.

“We look forward to going to trial on July 5 and proving that Mr. Coyne’s kratom usage played no role in his untimely death,” Rook said in a statement.

“He suffered from multiple comorbidities, including severe obstructive sleep apnea…He also had untreated high blood pressure, an extremely large heart, and he was morbidly obese. To say that a product he used for a year or two without issues caused his death, rather than these extremely dangerous health conditions, flies in the face of logic and science,” Rook said.

Abolins confirmed to McClatchy News Patrick Coyne had health issues.

Patrick Coyne trusted Kratom Divine’s tea “as a safe alternative to the medical care that he actually needed…and it did relieve his pain, but it was a false hope,” Abolins said.

Rook told McClatchy News her company “has been selling it for 9 years with no adverse reactions reported, other than a couple of people vomiting.”

Other wrongful death lawsuits have been filed over kratom.

In Cobb County, Georgia, the parents of 23-year-old Ethan Pope filed a lawsuit in October after he was found dead after using a kratom product made by a different company, McClatchy News previously reported. The Georgia Bureau of Investigation reported he died from mitragynine intoxication, or “death by kratom,” according to a complaint.

Such cases are why some are urging caution about purchasing Kratom without more robust oversight or regulatory standards.

“While kratom is not the enemy — and it may lead to great breakthroughs with appropriate study by people who are familiar with what it takes to make something safe for the human body — don’t trust the industry,” Abolins said.

When it comes to those who advocate for kratom use and those concerned about it, McCurdy said, both are valid.

“While the harm and danger does exist, we need to understand how to control that and really make sure we don’t reach those types of situations,” he said. “And the only way we can do that is to get more science behind it and more understanding of where those two extremes need to be sort of regulated and moderated at.”

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