How a Kratom Ban Will Create Health Risks and Suffering—and Fuel Terrorism

    In recent weeks Washington has been stepping up its efforts to delegitimize kratomand a DEA source tells Filter that it’s only a matter of when, not if, the herbal supplement will be designated a Schedule I substance, putting it on par with heroin and various fentanyl analogues. But officials should reconsider. The move would subject millions of Americans to health risks and suffering. Less obviously, it would also be likely to finance Jihadist terror groups.

    The DEA took its first shot at scheduling kratom in 2016, but failed after a vocal backlash from the kratom community. The anti-kratom lobby has since stepped up its game. It includes the supplements industry, the American Society of Addiction Medicine, and one Florida legislator, Kristin Jacobs, who is so fixated on kratom that she has authored four failed bills to ban itand faced calls for her censure after she went off the rails during a media interview.

    The latest federal ramp-up started in February when the Food and Drug Administration formally classified kratom as an opioid. Out of 25 active compounds in kratom, the FDA found that 22 bind to the mu-opioid receptor. This makes kratom a partial opioid agonist, like buprenorphinewhich means the respiratory depression associated with full agonists like morphine is extremely rare.

    For pain patients, kratom can mean the difference between a comfortable, productive day and one spent in bed.

    Since then the FDA has relentlessly targeted kratom, in an obvious effort to lend scientific credence to emergency scheduling by the DEA. The FDA linked a salmonella outbreak over the summer to kratom, and issued a warning November 27 about heavy metals turning up in the compound. The Department of Health and Human Services also joined the fray in November, calling for a complete ban on kratom’s two most opioid-like components.  

     

    Much Ado About Nothing Much

    The effects of kratom are pretty tame. When I took it twice to see what all the fuss was about, it required nearly double the recommended dose of three grams to feel much of anything beyond a slight warmth and boost of energy. One study found that two-thirds of kratom users took the supplement to reduce use or abstain from heroin or prescription painkillers. It is not comparable to those drugs.

    For pain patients, however, kratom can mean the difference between a comfortable, productive day and one spent in bed.

    The FDA also released reports on 36 deaths from around the world that it claims were attributable to kratom. But in almost every case other substancesincluding benzodiazepines, alcohol and conventional opioidswere found in the victim’s system.

    Over the past few weeks public health experts, scientists and journalists have hustled to keep up with the rapidly escalating assault on kratom. All this for a plant that, even by the government’s highly dubious reckoning, kills fewer people annually than peanuts or acetaminophen.

    There are at least three major hazards inherent in the government’s approach.

    First, it risks pulling the safety net away from millions of Americans who managed to find a relatively inexpensive alternative to “big bad” opioids, using it for everything from back pain to fibromyalgia, as well as plain old enjoyment. Kratom has been a godsend for pain patients who have had their opioid doses cut, or have voluntarily abandoned traditional painkillers to avoid hurdles to access, potential risks and stigmatizing encounters (like being declared a “drug seeker” by the family pharmacist).

    Second, with up to five million Americans estimated to be regular kratom consumers, outlawing the powdered leaves of Mitragyna speciosa and creating an illicit market will have the effect of making kratom products more dangerous.

    And third, it will very likely give terror groups a significant new means to fund their activities.  

     

    Opportunities for Terror Groups in Southeast Asia

    Let’s take that last point, which you’d think might be the one to resonate the most with the Trump administration. Intelligence sources tell me that over the past decade, terrorist organizations have become heavily involved in drug trafficking (or collecting taxes from traffickers) as a means of funding jihadist activities.

    “As state sponsorship has declined and traditional terrorist funding streams have been shut down, the radical organizations have turned to drug trafficking and other crime for funding,” says Derek Maltz, an expert on money laundering who previously served as agent in charge of the Special Operations Division of the DEA. “You can’t corrupt government officials by using credit cards, you need a suitcase of cash. Terrorists need money to operate and drug trafficking is a tremendous source of revenue since it generates $400 billion a year around the globe.”

    During a recent high-level, off-the-record meeting with law enforcement—attended by a small group of senior narcotics officers and Homeland Security police—I was briefed on the links between sales of synthetic cannabinoids in the US and millions of dollars flowing to parts of the Middle East that include Yemen, an Al Qaeda stronghold.

    The remnants of ISIS in the Middle Eastand although such claims can be prone to exaggerationreportedly line their pockets with proceeds from sales of a counterfeit version of the stimulant captagon, part of a growing market estimated by the Global Initiative Against Transnational Organized Crime to be worth up to $1.39 billion in 2016.

    As in any illicit market, an international network and a capacity for violence will confer a competitive advantage.

    Meanwhile Southeast Asia, the region where almost all kratom is grown, is also one of the world’s fastest-growing centers of terror activity. According to one report: “The terrorism threat in Southeast Asia reached new heights in 2017…[and] the terrorism threat in the region transcends national boundaries in respect of recruitment and operations.”

    Thailand, for example, is one of the world’s two largest kratom producers, along with Indonesia. Its three southernmost provinces are well known trafficking corridors into Malaysia, which is struggling with a terror insurgency from ISIS-linked extremists.

    Indonesia has been waging a long and costly battle against elements of ISIS and the Al Qaeda-aligned group Jemaah Islamiyah, which was responsible for the 2002 Bali bombing and remains Southeast Asia’s biggest terror threat. Last year Interpol was sufficiently concerned to launch Project Trace, a three-year initiative to reinforce counter-terrorism capacity and expertise in the Association of Southeast Asian Nations (ASEAN) countries.

    If the US makes kratom a Schedule I substance, the handful of large, legal distributors that currently export kratom products will be replaced by any number of illicit-market operators. And as in any illicit market, an international network and a capacity for violence will confer a competitive advantage.

     

    Adulterated Kratom and Prohibition

    Moving back to the impact on US consumers, we should note that the more reputable existing legal distributors of kratom test their products for impurities and adulterants. Illicit-market operators have no incentive to do so.  

    In Southeast Asia, kratom is regularly mixed with codeine-laced cough syrup. Here in the US, some vendors already sell so-called “enhanced” Kratom—mixed with concentrated mitragynine or 7-hydroxymitragynine, the two partial opioid agonists that produce kratom’s analgesic effects.

    At least nine of the worldwide deaths cited by the FDA earlier this year involved kratom adulterated with O-desmethyltramadol—a metabolite of tramadol that has soared in popularity across the Middle East and North Africa. According to the United Nations, over 80 percent of illicit tramadol comes from India, located close to the world’s kratom-growing region.

    According to a prominent source in the US kratom community who asked not to be identified, there is already a booming illicit kratom market in the handful of statesincluding Alabama, Arkansas, Indiana, Tennessee, Vermont and Wisconsinthat have so far banned it. He mentioned that one significant source for illicit kratom is Craigslist.

    The “Iron Law of Prohibition” dictates that illicit-market vendors are incentivized to sell more concentrated products. They also sell products that contain more adulterants: See heroin and fentanyl. A country in which kratom use is illegal will inevitably be one in which kratom use is more dangerous.

     

    Pain Patients Under Threat

    Kratom has been used as a medicinal plant in Southeast Asia for centuries. It was relatively little-known in the US until the start of this decade, and was most often marketed here as a dietary supplement.

    But after the DEA began aggressively targeting pain management clinicstypically without arranging alternative medication management for tens of thousands of new “opioid refugees” kratom instead began turning up for sale at elevated prices in smoke shops across the US, marketed as a legal high.

    The Centers of Disease Control and Prevention issued dosage guidelines based on morphine milligram equivalents (guidelines that critics say are flawed) in 2016, and knowledge of the analgesic qualities of kratom quickly spread through the chronic pain community.  

    If there’s one thing we’ve learned, it’s that if the DEA does wind up banning its possession and use, kratom isn’t going anywhere.

    Many of the millions of Americans who use kratom for chronic pain management greatly prefer it to conventional opioids. These people include my partner, Carolyn, who was previously prescribed Vicodin her for Ehlers-Danlos Syndrome (EDS), a  disorder involving the body’s connective tissue. She finds that unlike hydrocodone, kratom attenuates her daily pain without making her lethargic.

    Carolyn purchases her products regularly from one of the nation’s most reputable vendors. If kratom is banned, she and millions of others may soon find that their safe, consistent supplement is hijacked by criminal enterprises, comes adulterated with substances that may range from unpleasant to deadly, and subjects them to legal risks.

    But if there’s one thing we’ve learned from 40 years of drug war, it’s that if the DEA does wind up banning its possession and use, kratom isn’t going anywhere.

    Some kratom users may choose to simply suffer in pain. Some may turn to other, riskier drugs to alleviate their pain. Many more will be forced onto places like Craigslist to find unvetted strangers to sell them an untested product at an elevated price.

    Instead of mitigating whatever low-level risks may be associated with kratom, it’s all but guaranteed that the government, if it stays on its current path, will do the opposite.

    • Christopher Moraff

      DISPATCHES is Christopher Moraff's weekly column for Filter, featuring analysis and beat reporting. Christopher has spent over a decade reporting on the intersection of policing, criminal justice and civil liberties. His immersion reporting from Kensington, Philadelphia, has earned him a reputation as an expert on injection drug culture and the fentanyl crisis. His work has appeared in publications including the Daily Beast, the Washington Post and Al Jazeera America. He is co-host of the podcast Narcotica, and curator of the stock photo site StashHouse.org.

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