Why Kratom Is At The Heart Of A Big Public Health Debate

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• The public health debate surrounding kratom and its compound 7-hydroxymitragynine (7OH) centers on its dual nature, acting as a mood booster/energy source in small doses but mimicking opioids in larger doses, with 7OH being significantly more potent and exclusively binding to opioid receptors.  Copied to clipboard!
• The availability and regulation of kratom products are complicated by the fact that the term 'kratom' covers a wide variety of products (teas, pills, extracts) whose strengths and contents, especially concerning 7OH concentration, are often poorly labeled, leading to risks similar to mislabeled alcohol.  Copied to clipboard!
• The FDA is recommending scheduling certain 7OH products alongside opioids, but this regulatory action faces historical precedent where the DEA backed down from controlling kratom's active ingredients after massive public protest nearly a decade ago.  Copied to clipboard!

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Introduction to Kratom and 7OH

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(00:01:26)

• Key Takeaway: Kratom is an umbrella term for products derived from a Southeast Asian tree, used traditionally for energy and pain, but products in the U.S. vary widely in strength.
• Summary: The podcast introduces kratom, noting its pronunciation variations, and explains it originates from tree leaves used for centuries in Southeast Asia for energy and pain relief. In the U.S., ‘kratom’ covers diverse products like teas, pills, and extracts, similar to how ‘cannabis’ covers various preparations. The FDA statement confirms that the classification of a specific product as a drug or supplement depends on its composition.

FDA Action on 7OH

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(00:03:11)

• Key Takeaway: FDA Commissioner Marty McCary explicitly stated that 7OH is an opioid, leading the FDA to recommend scheduling certain 7OH products alongside traditional opioids.
• Summary: FDA Commissioner Marty McCary declared that 7OH is an opioid, not just similar to one, during a July press conference. The FDA recommended scheduling specific 7OH products alongside opioids due to the compound’s potency, which is reported to be 13 times stronger than morphine according to the Journal of Medical Chemistry. This action highlights a significant regulatory concern regarding this specific compound.

Usage and Public Appeal

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(00:03:50)

• Key Takeaway: Kratom use estimates range from 2 to over 10 million users annually, often drawn to it as an alternative for weaning off opioids or managing chronic pain.
• Summary: Past estimates suggest between 2 million and 10 million people use kratom yearly, including those seeking to manage chronic pain or withdraw from prescription opioids. This appeal is significant given that 76% of U.S. drug overdose deaths in 2023 involved opioids, making alternatives attractive. However, researchers are divided on whether restricting access would harm those who benefit or if the products’ addictive properties necessitate regulation.

Chemical Differences and Potency

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(00:07:12)

• Key Takeaway: Kratom’s psychoactive effects stem from alkaloids like mitragynine and 7OH; while mitragynine binds to multiple receptors, 7OH binds more exclusively to opioid receptors, making it potentially more concerning.
• Summary: Kratom comes from a tree in the coffee family, and in small amounts, it can act as a stimulant, boosting mood and focus, comparable to coffee. In larger doses, it mimics opioids, relieving pain and causing euphoria. The plant contains alkaloids, including mitragynine and 7OH; 7OH is found in tiny quantities naturally but is concentrated in newer extracts, binding more exclusively to opioid receptors like fentanyl.

Addiction Data and Formulation Risks

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(00:09:27)

• Key Takeaway: Addiction to both kratom and 7OH is confirmed, with some studies showing over a quarter of natural leaf users met criteria for use disorder, and certain formulations bypass natural absorption barriers.
• Summary: Addiction to both kratom and 7OH is confirmed, with withdrawal symptoms resembling mild opioid withdrawal. One study found over 25% of natural leaf users met criteria for kratom use disorder. Furthermore, formulations like nasal sprays or sublingual tablets can circumvent natural processes that might otherwise limit 7OH absorption into the bloodstream and brain, increasing potential impact.

Regulatory History and Current Status

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(00:11:39)

• Key Takeaway: Unregulated kratom products have faced FDA recalls for contamination (salmonella, heavy metals), and the current push to schedule 7OH mirrors a 2016 DEA attempt that was halted by public protest.
• Summary: Because kratom and 7OH are not regulated like prescription drugs, the FDA has recalled products due to salmonella contamination and unsafe heavy metal levels like lead and nickel. A major concern is mislabeling, where products labeled only as ‘kratom’ might contain high concentrations of 7OH, akin to confusing beer with Everclear. The DEA’s current decision on scheduling 7OH follows a 2016 instance where they abandoned similar plans after widespread public opposition.