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Kratom: what it is and why lawmakers are regulating it

FILE - In this Sept. 27, 2017 photo, kratom capsules are displayed in Albany, N.Y. U.S. health authorities say kratom, a herbal supplement promoted as an alternative pain remedy, contains the same chemicals found in opioids, the addictive family of drugs at the center of a national drug abuse crisis. The Food and Drug Administration analysis, published Tuesday, Feb. 6, 2018, makes it more likely that kratom could be banned by the federal government. (AP Photo/Mary Esch, File)
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FILE - In this Sept. 27, 2017 photo, kratom capsules are displayed in Albany, N.Y. U.S. health authorities say kratom, a herbal supplement promoted as an alternative pain remedy, contains the same chemicals found in opioids, the addictive family of drugs at the center of a national drug abuse crisis. The Food and Drug Administration analysis, published Tuesday, Feb. 6, 2018, makes it more likely that kratom could be banned by the federal government. (AP Photo/Mary Esch, File)

Kratom is commonly sold as an herbal supplement in Kentucky, but it's drawing the attention of lawmakers and regulators who are taking note of its more potent variants.

You may have seen it popping up on signs at smoke shops around the state and wondered: Just what is Kratom?

It's an herbal extract that comes from the leaves of an evergreen tree that grows in Southeast Asia. At low doses, people report a stimulant effect. In higher amounts, users say it acts more like a sedative, reducing pain and anxiety.

I refuse, as a physician and in my health role, to give the false assurance that any of it is safe when none of it is regulated and no one has any idea what they're getting.
Dr. Steven Stack, Cabinet for Health and Family Services Secretary

Advocates, including the American Kratom Association, say naturally occurring Kratom is a "safe herbal supplement that behaves as a partial mu-opioid receptor agonist and is used for pain management, energy, even depression, and anxiety that are common among Americans."

Kratom has also been used to treat opiate addiction.

But Kentucky's leading health authority says the substance's claimed benefits come with with big asterisks.

"It has opioid-like effects and, in fact, under Kentucky law, it qualifies as an opioid," says Kentucky Cabinet for Health and Family Services Secretary Dr. Steven Stack.

Of Kratom's two main chemicals, Stack says the one that gets the most attention is called 7-OH. He describes it as "wicked potent, ultra-concentrated, addictive, creates withdrawal symptoms, and neonatal abstinence syndrome."

The Mayo Clinic describes Kratom as "unsafe and ineffective."

Uncertainty about just how much of the active substance in Kratom is present in any given dose, and the lack of FDA approval or regulation, has led at least seven states to outlaw it. Kentucky is now seeking to regulate Kratom, and bars the sale to anyone under 21.

Levels of the most active substance can be limited in the plant itself, but Stack notes it can be concentrated to produce magnified effects.

"Now, there's a tension here," he acknowledges. "Because you have a natural Kratom community (that) doesn't want these prohibitions because they say natural Kratom is not as dangerous. But I refuse, as a physician and in my health role, to give the false assurance that any of it is safe when none of it is regulated and no one has any idea what they're getting."

For now, the product remains on the shelves in Kentucky and lawmakers are waiting to see how the new regulations play out. But the recommendation from Kentucky public health officials is not to consume it.