Why Does the Food and Drug Administration Need to Ban Kratom?

Abstract

Kratom (Mitragyna speciosa) is an herb with no current indication for medical use with potentially addictive properties, yet it is being used in the management of pain, depression, and anxiety. The agent’s pharmacology lends itself for concern regarding recreational misuse (Drugs of Abuse, 2017). Kratom’s increasing popularity for use in the USA is reflected by National Poison Data System data that in 2011 there were 13 cases reported to poison control centers while in 2017 there were 682 calls in response to kratom exposure (Kratom exposure in the US linked to serious medical outcomes, 2019; Post et al. in Clin Toxicol. 57:847–54, 2019). Subjects most commonly use kratom for the self-treatment of pain, mood swings, and opioid-related withdrawal symptoms (Grundmann in Drug Alcohol Depend. 176:63–70, 2017). Known serious adverse events include hallucinations, delusions, reduced respiratory drive, and death (Kratom: unsafe and ineffective, 2019). Additional anecdotally reported side effects include hypothyroidism, seizure, hepatotoxicity, coma, and injury to the posterior white matter of the brain (Anwar et al. in MMWR Morb Mortal Wkly Rep. 65:748–9, 2016; Nelsen et al. in J Med Toxicol. 6:424–6, 2010; Sheleg and Collins in J Addict Med. 5:300–1, 2011; Castillo et al. in Proc (Baylor Univ Med Cent). 30:355–7, 2017). At this time, kratom remains without regulations on a federal level. The substance’s opioid-like pharmacology, ease of use, and lack of demonstrated safety or efficacy justify the need for continued extensive research (Brooks, 2019).