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What’s kratom? Kansas lawmakers are weighing regulation of the herbal supplement

Kansas City Star 2/2/2023 Jenna Barackman, The Kansas City Star

Widely available for purchase primarily in smoke shops around the Kansas City area, kratom — an herbal supplement made from leaves grown in Southeast Asia — is federally unregulated. Users claim kratom relieves chronic pain, treats symptoms of mood disorders and mitigates the effects of opioid withdrawal.

Kansas lawmakers are considering the Kratom Consumer Protection Act, which, if passed, would define the supplement as a food product and end what Rep. John Eplee, an Atchison Republican and physician, called the “wild, wild west” of an unregulated industry he said begs to be regulated.

Mac Haddow, senior fellow on public policy at the American Kratom Association, said the legislation would protect consumers from dangerously adulterated, or kratom products that are contaminated with non-kratom substances, such as fentanyl, and mislabeled kratom products.

“We have to protect the Kansas citizens from those rogue, bad actor kratom manufacturers who are selling products that are simply dangerous,” Haddow said Wednesday at a legislative hearing in Topeka. “Today, that’s what we want to protect.”

The bill would prohibit the sale of any contaminated kratom, bar consumers under 18 from purchasing and would ensure that kratom products are accurately labeled.

The bill would also require kratom sellers to obtain dealers’ licenses and give the state’s secretary of agriculture access to a dealer’s location, products and equipment for inspection. If a dealer fails to comply with the proposed regulations, the secretary of agriculture could impose a fine of up to $1,000 for each violation and suspend the dealer’s license.

At low doses, kratom produces a stimulant effect. At higher doses, however, the controversial supplement can produce a euphoric effect similar to opioids, drawing concern from the Food and Drug Administration.

The FDA warned consumers in 2022 to avoid use, citing concerns that kratom users are at risk for dependence, addiction or abuse of the supplement.

Oliver Grundermann, a clinical professor at the University of Florida who conducted a 2017 survey of 8,000 Kratom users, said kratom does have addiction potential but that it is not well-researched enough to make any conclusions.

He added there have been some reports of users taking high amounts of kratom to create a similar effect to opioids, but that those users represent a minority.

The FDA currently approves no uses for kratom.

But stores like Vapor World Overland Park in Overland Park, Kansas, sell up to 40 to 50 kilos of kratom per week in a variety of different forms, including capsules, liquid extract shots and pure powder. Manager Lucas Brown said the store enjoys daily business from regular kratom users.

Many of the store’s regulars use kratom for increased focus, reduced anxiety and muscle pain. Brown himself uses white kratom in place of pre-workout.

“Kratom itself isn’t even that strong if you take a reasonable amount,” Brown said. “It’s very much like a sedative or like an Asprin. There’s worse things out there than a plant powder.”

MayoClinic, a prestigious medical research center based in Minnesota, expressed similar concerns to the FDA, calling kratom “unsafe and ineffective” in a 2022 post on its website. Researchers are increasingly concerned about kratom’s possible side effects, which could include seizures or overdose.

Haddow disputed claims made by the FDA and MayoClinic that kratom is unsafe, and said the FDA has a “long-standing bias against all dietary herbal substances.”

However, Haddow said he couldn’t say with certainty that it is impossible to overdose on kratom, but said he has not seen “a single documented overdose” from kratom alone.

A 2019 study from the Center for Disease Control and Prevention analyzing overdose deaths in 2016 and 2017 attributed kratom as the cause of death in 91 of 152 subjects who tested positive for kratom — including seven who tested positive for only kratom — but noted the presence of other substances could not be ruled out.

Grundermann said it is difficult to establish conclusively if kratom is the primary cause, contributed to or did not play a role in overdoses, adding that kratom-related overdoses were primarily due to polydrug intoxication.

Rep. Trevor Jacobs, a Fort Scott Republican, asked Haddow if he had any evidence to contradict the MayoClinic study since Haddow said it was “perfectly healthy.”

Haddow cited a 2018 letter by former U.S. Assistant Secretary of Health Brett Giroir who served under the Trump administration. Giroir rescinded his prior recommendation to schedule kratom as a Schedule I drug based on a lack of evidence and a “potentially substantial risk to public health.”

In his testimony, Eplee, the bill’s sponsor, said kratom is the lesser of two evils compared to opioids.

He said he previously recommended large doses of kratom to two of his patients who were able to “completely get off opioids and control their pain.” He added these patients experienced no dependency on the product or any other negative health outcomes.

Rep. Tom Kessler, a Wichita Republican, asked Eplee why regulation was needed for a product to which no deaths are directly attributed and have very few adverse effects when the industry wants “non-evasive” legislation to get rid of the “bad actors.”

Eplee said the legislation allows the Department of Agriculture oversight into the industry, especially if new discoveries are made about kratom in the future.

“I think it’s good to put as many appropriate regulations in place from the get-go than trying to do it later,” Eplee said.

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