Kratom Helps Me Cope With Life, So What’s the Problem? 

A kilo is surprisingly heavy, I thought as I dropped the package onto my mattress with a thud. I never thought I would return to the life of digital scales and weighing grams, but here I am. Except it’s not illegal drugs (this time), it’s kratom.

A cousin of the coffee plant, kratom is a tree native to Southeast Asia. Its leaves are shredded into a bitter green powder and sold across the world. I order mine online, avoiding the low-grade product sold at gas stations and headshops.

Over the six months since I began using kratom, I haven’t been mentioning my use to many people, and certainly not in addiction-recovery circles. Decades of drug-war rhetoric baked irrational fears into the American psyche. If the drug isn’t alcohol or caffeine, it is insidious. Except anyone who has taken kratom realizes how bogus this is.

Kratom makes my days livable, manageable.

I take the herbal supplement two or three times daily, which ends up costing me about $1 per day. It would be cheaper (and faster-acting) if I only used the powdered form, which I sometimes do by making a sealed “taco” of Japanese potato starch disks called oblate papers. With a preference for speed and convenience, I usually take pre-filled capsules.

Its effects are mild, don’t impair me in any way, and have a natural ceiling—a consequence of kratom having both agonist and antagonist opioid-like properties. When I found a dose that worked for me, I stayed there, raising only incrementally to combat inevitable tolerance before going on “tolerance breaks.” Kratom makes my days livable, manageable.

The herb is not on our banned drugs list more by chance—including its former obscurity in the United States—than design. But there are periodic threats to this status. When there was talk of an international ban, which for now has not materialized, I felt the vice grip of the drug war once again.

I was addicted to heroin for years and, as a direct result, was in prison for years after that. Then came the random urinalyses and the perpetual fear. Once, the day after a doctor’s visit where my physician told me to drink more water because my blood pressure was low, my urinalysis sample came up “dilute” at the federal probation office, a punishable offense. I had long since quit opioids, but trace amounts of THC (whether from CBD or unwittingly consuming even the residue of edibles) could have sent me back to prison. I avoided all supplements, however natural, for fear of contamination.

My mental health suffered. If suicidality is a scale, I never get below a four out of 10. Some days are worse than others, with shocking amounts of my mental energy consumed by batting back thoughts of suicide. On the outside, this can look like laziness or paralysis. But merely existing in that moment, without taking a gun to my head, is the best I can do. The pandemic first triggered my jail-learned fear of infectious disease, thanks to being confined in overcrowded spaces with lice and tuberculosis for four years. Later, the pandemic restrictions caused another trigger for my PTSD as I felt trapped and confined.

The solution? Xanax. I was mostly living abroad during that time, where Big Pharma panic never took hold because opioid prescribing never took off. A psychiatrist prescribed me Xanax and encouraged me to try SSRIs, which I wouldn’t do (I have since softened). I had once binged benzos and feared that if I took one pill, I would end up with a needle in my arm the next day. But it didn’t happen. I used the medication when I needed it, never escalated my dose or frequency, and tapered off easily once my panic subsided. I learned then that addiction is not a fixed mental state, but rather a consequence of circumstance.

Back in the United States, my distant addiction history disqualified me for prescription benzodiazepines.

Back in the United States, my distant addiction history disqualified me for prescription benzodiazepines, despite my having used them without problems for an entire year. Left without pharmaceutical support, I began looking into alternatives for my anxiety, depression and chronic suicidal ideation.

Mostly, I fantasized about doing heroin. Being appointed to the Measure 110 Oversight and Accountability Council to oversee Oregon’s drug decriminalization has been one of the most challenging experiences of my professional career. However rewarding it may be, we find ourselves under constant, public pressure. I had never gotten so close to returning to heroin.

That’s when I found kratom. I’m a researcher, so naturally, I researched it exhaustively. Various subreddits provided ample material. With a sample size of thousands upon thousands of posts, I could glean clear patterns.

People use kratom for opioid replacement theory, opioid withdrawal management, chronic pain, anxiety, depression and other mental health woes. Others use it as a pre-workout supplement, for mild euphoria, or to make shift work more bearable. (Traditionally, it was used by Southeast Asian laborers working long hours in the sun.)

Few of these thousands of accounts of benefits are reflected in academic research. With few exceptions, kratom studies are retrospective, which introduces inherent negative bias. No one walks into the emergency department to tell you that kratom cut their pain in half; people walk in because something negative has occurred.

Of the few documented cases of kratom-involved death, virtually all had other substances present. It does not cause respiratory depression, unlike opioids. As buprenorphine induction for people using fentanyl becomes increasingly difficult, could kratom be used as withdrawal relief? I think so, but without legal standing I cannot do a randomized control trial and have it be ethical. It’s a catch-22.

Kratom does cause physical dependency, and that can be downplayed by its advocates. It has effects on the kappa opioid receptors, among other mechanisms. It has both mildly sedating and stimulant effects, a unique mix for a molecule. Now, when I go more than 14 hours without kratom, I have mild temperature dysregulation. I feel hot or cold, sweat. Anyone who has experienced opioid withdrawal is familiar with this symptom.

But critically, it stops there. My nose might run, my eyes water, but I feel fine. I’ll have trouble falling asleep, the most annoying symptom. But the very mild withdrawals can be averted by even rapid tapers, which I sometimes do for my tolerance breaks. When I stopped taking Xanax, I wrote out a schedule and stuck to it, and the same can be done with kratom.

Upon stopping, I do feel depressed and suicidal. But is that from withdrawal, or simply a return to baseline? Kratom is not a magic bullet. I still struggle with mental health most days. But at least I have something reliable to lean on that is unlikely to harm me.

For me, as for many others, kratom is the epitome of harm reduction when used as a replacement for far riskier alternatives.

Problems might arise only when use is stopped suddenly, as often happens with unregulated drugs whose supply is unreliable. There have certainly been issues with the kratom supply chain. Like all things billed “supplements” in the United States, it has almost no government regulations. It has been found adulterated with everything from bacteria to actual drugs. (I highly recommend Amanda Mull’s feature Everything is a Multivitamin about the deregulated chaos of the industry.)

These incidents have been used in calls to ban the substance but they’re evidence that more consumer protections are needed, not prohibitions. Kratom regulation bills, to enhance such protections, have passed in several states, Oregon included.

If kratom were banned tomorrow, or the supply failed completely, I would probably end up on Blues. Without something, however mild, to tickle my opioid receptors, I am a hulking mass of raw nerves, existential dread and anxiety. For me, as for many others, kratom is the epitome of harm reduction when used as a replacement for far riskier alternatives.

Why are a few non-prescribed drugs legal, and the rest banned? A mix of chance, racism, oppression and evidence-averse legislators. And yet for six months, I hesitated to share publicly that I use the substance. It doesn’t cause me intoxication and it helps, rather than hinders, me in getting through daily life. But in most recovery circles, it jeopardizes my status as a person in long-term recovery. It can also jeopardize my access to high-quality healthcare, as providers are wont to blame any symptom on this herb they do not understand. The internalized shame and stigma persist.

The days of demonizing drugs can and must be over. Kratom provides myriad benefits to people who use it, and could have substantial applications in addiction medicine and chronic pain treatment. But no form of drug use is cause for shame. I refuse to hide in the shadows any longer. 

 

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Photograph by drogen.bz via Wikimedia Commons/Creative Commons 3.0