The U.S. Drug Enforcement Agency (DEA) has added another drug to its controlled-substance list. This drug, which is growing acclaim for its various uses, is also still relatively unknown to most of the general public. Kratom, or Ketum, is a plant species Mitragyna speciosa which is most related to the coffee plant. Kratom has been promoted on many websites as a “safe and harm free” herbal supplement to treat aches and pain.
What does the DEA think?
Well, on September 30, 2016, the DEA will include kratom on its Schedule 1 Controlled Substance List. This classification will put kratom alongside other narcotics such as heroin. There was an interesting buzz in Sweden over a product called “Krypton Kratom” which many officials thought was pure kratom. In reality, it was kratom mixed together with a potent mu-receptor agonist O-desmethyltramadol (Tramadol) which contributed to the unintentional death of the nine cases presented. With that, they concluded the consumption of kratom was not as harmless as described on the internet.
The DEA's list of other kratom-associated deaths primarily described "polypharmacy" (mixing multiple drugs) as a factor in those fatalities, many of which involved benzodiazepines, sleep-inducing hypnotics such as zopiclone, and opioids such as fentanyl: Presented in a case report by Neerman et al.
So, what do experts think?
Walter C. Prozialeck, a professor of pharmacology at Midwestern University who wrote a comprehensive literature review on kratom for the Journal of the American Osteopathic Association, said he disagrees with the DEA’s characterization.
Experts expressed mixed opinions about the classification, with several stating kratom was improperly described as an opioid by the DEA. Kratom does act similar to morphine, being a u-opioid receptor agonist and treatment from kratom overdose is also managed with naloxone, despite mixed results for its utility in animal models.
However, the effects of kratom differ significantly from opiates with its full pharmacokinetic extent not being well-known in humans.