Amid 'bad actors' and benefits, addiction experts urge Ohio to regulate kratom

COLUMBUS, Ohio (WCMH) – A plant known for its caffeine-like effects and potential to help with opioid addiction may soon fall under the purview of the state.

A bill to regulate kratom, a tree native to southeast Asia and sold in various forms online and in U.S. head shops, would end the legal gray area the substance occupies. Before the Senate Health Committee on Wednesday, parents of people with addiction, recovery workers and an addiction researcher pointed to the plant’s uses in managing chronic pain, mental health issues and opioid withdrawal – as well as “bad actors” who mix the drug with others – as a reason to regulate it.

Senate Bill 103, the “Kratom Consumer Protection Act,” would require those who wish to process, manufacture or sell kratom products to register those products with the director of agriculture. It sets a maximum kratom concentration and forbids the sale of products that contain any strength-altering substance that makes it “injurious to a potential consumer.” A version of the Kratom Consumer Protection Act passed the House last year but never made it out of Senate committee.

“The regulation of kratom products is necessary so that Ohioans can safely consume kratom from food processing and retail establishments for pain management and opioid withdrawal,” the bill’s sponsor, Sen. Louis Blessing (R-Colerain Township), testified at its first hearing in May.

What is kratom?

In plant form, kratom has been used for hundreds of years by laborers in Malaysia and Thailand to sustain energy during long work days. In other southeast Asian countries, it’s used in ceremonies and as an alternative to opiates.

Kratom contains dozens of compounds, but research has focused on two alkaloids responsible for many of its effects. Those alkaloids bind to opioid receptors – although kratom is not an opioid – and act as a stimulant, akin to caffeine, as well as a pain reliever. Some research suggests that the two alkaloids are more than 10 times as potent as morphine.

Although its roots have long been embedded in southeast Asian cultures, kratom is relatively new to the U.S. and other western countries. As an unregulated substance, it has proliferated in the gray legal markets of nutrition supplements, as an antioxidant energy-booster, and in smart shops, as a way to score a legal “high.”

Kratom can produce mild euphoric effects, testified Kirsten Smith, an addiction researcher at Johns Hopkins University who has studied the drug for eight years. But it is far more similar to a few cups of coffee than MDMA or other euphoria-causing drugs, she said.

Is kratom dangerous? FDA and addiction experts disagree

The Food and Drug Administration has long opposed kratom, citing since-clarified statistics about its potential to cause fatal overdoses. After the FDA’s advice in 2016, the Drug Enforcement Administration announced its intent to classify kratom as a Schedule I substance – the highest-regulated category reserved for substances with no known medical use and a high potential for abuse.

But two months later, after an influx of public comment sharply criticizing the decision, the DEA reversed course. In 2018, after a second consideration to schedule kratom, the Department of Health and Human Services determined that doing so would be “premature,” given the lack of evidence of a public safety risk.

“I can go over all of the data all day long, but what is absolutely clear is that among people who are using these products regularly, we are not seeing public health threat number one,” Smith said in her testimony. “And if we were, I would absolutely not be standing here today.”

Reports of kratom-caused fatal overdoses are dubious at best, Smith said, and research has found that in the vast majority of cases, kratom was present with other substances. 

A 2019 data review by the Centers for Disease Control and Prevention found that of more than 27,000 fatal deaths reviewed, kratom was found in about 150 people – or a half percent of deaths. Most of those people also tested positive for other drugs; fentanyl was found in more than half of cases, heroin was found in a third of cases and benzodiazepines were found in more than a fifth of the overdose deaths.

Utah state Sen. Curt Bramble, who sponsored what would become the country’s first Kratom Consumer Protection Act, testified that what is more dangerous is highly concentrated kratom products, often sold as powder or in capsules, that also contain substances to boost feelings of euphoria. Absent the force of regulation, Bramble said “bad actors” seeking a profit are able sell unlabeled, untested products under the name “kratom.”

“The fact is, the FDA isn’t doing their job, and when the FDA doesn’t do their job, it’s incumbent on states to step up,” Bramble said. 

Testifying alongside him was John Shinholser, who has been in recovery for over four decades and founded a peer-led recovery organization in Virginia. Self-described as a “no-BS, clean-and-sober guy who’ll give it to you straight,” he said he was skeptical of kratom when he first came across it about a decade ago – especially given its sale alongside other unregulated supplements and substances.

But Shinholser said he witnessed firsthand the lifesaving effects the drug had on those he helped in recovery. People told him they used kratom to manage anxiety, stress and post-traumatic stress disorder, a common ailment among the many veterans who visited his organization.

Research on kratom’s efficacy in managing mental health issues and chronic pain is limited mainly to self-reported data. A 2017 survey of nearly 2,800 kratom users by Johns Hopkins University found that 91% of users consumed kratom to help with chronic pain, 67% used it for anxiety and 65% used it to self-treat depression. Nearly 99% of those who used kratom for chronic pain would recommend it to others, and about 97% of those who used it for mood disorders reported the same. 

Smith, who was also one of the authors of the survey study, said in her experience researching kratom, many of those who started using the drug to help with recovery actually continued its use because of its productivity-enhancing effects. 

The National Institute on Drug Abuse has spent more than $20.5 million since 2018 funding research projects on kratom, including about $4 million in 2023. Much of that research focuses on kratom’s potential use as in treating opioid addiction.

“Our system for addicts and alcoholics has been the same for 50 years,” said Shinholser. “You got two choices: You either go to abstinence-based treatment, or you go to Jesus. And for 50 years, I didn’t see nothing else.”

Then along came kratom, he said, and in his experience, it’s helped bridge people to recovery who otherwise would not have sought help. Shinholser said its potential as a treatment for opioid addiction and other substance use disorders should continue to be researched.

“In the recovery world, my god, we need every tool we can get,” he said.