Comment; Stimulant effect at low doses, opioid effect at high doses. Stimulants are generally the most addicting substances, take a bit more, opioid effect & respiratory depression–to say nothing of Salmonella & heavy metals! It SHOULD BE a schedule I drug with the DEA–used only for research purposes.

Bridget Kuehn, MSJJAMA. 2019;321(20):1966. doi:10.1001/jama.2019.6339

More than 90 deaths in the United States have been caused by kratom between July 2016 and December 2017, according to a CDC report.

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Kratom (Mitragyna speciosa), a plant native to Southeast Asia, has been growing in popularity as an herbal supplement. Consuming low doses of it may have stimulant-like effects, while higher doses may produce opioid-like effects, the report’s authors note. Because of its potential for abuse, the US Drug Enforcement Administration (DEA) has called it “a drug of concern.” The US Department of Health and Human Services has recommended that the DEA reclassify kratom as a schedule 1 substance, according to documents obtained by STAT news. And the US Food Administration has issued warnings about high levels of heavy metals and salmonella in kratom products. The agency has also issued warning letters to companies making unproven claims that kratom products may be used to treat opioid withdrawal and pain.

Now, the recent CDC report has found that 152 unintentional overdose deaths involved kratom between July 2016 and December 2017, accounting for 0.56% of the 27 338 US overdose deaths during that period. Multiple drugs were detected in nearly every kratom-related death. Fentanyl and its analogues were the most common substance detected in individuals with kratom-linked overdoses and were ruled the cause of death 65.1% of these overdoses, followed by heroin (32.9%), benzodiazepines (22.4%), prescription opioids (19.7%), and cocaine (18.4%). Coroners determined kratom was the cause of death in 91 of 152 cases.

About 80% of kratom-related deaths occurred among individuals with a history of substance misuse, and 90% had no evidence of current medically supervised pain care. The findings suggest the majority of these deaths were related to substance misuse involving multiple drugs and could help public health officials develop prevention strategies, the authors wrote.